Breast cancer (non-metastatic)
Identifieur interne : 004759 ( Pmc/Corpus ); précédent : 004758; suivant : 004760Breast cancer (non-metastatic)
Auteurs : Justin Stebbing ; Geoff Delaney ; Alastair ThompsonSource :
- BMJ Clinical Evidence [ 1752-8526 ] ; 2011.
Abstract
Breast cancer affects at least 1 in 10 women in the UK, but most present with primary operable disease, which has an 80% 5-year survival rate overall.
We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions after breast-conserving surgery for ductal carcinoma in situ? What are the effects of treatments for primary operable breast cancer? What are the effects of interventions in locally advanced breast cancer (stage 3B)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
We found 83 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding chemotherapy (cyclophosphamide/methotrexate/fluorouracil and/or anthracycline and/or taxane-based regimens), or hormonal treatment to radiotherapy; adjuvant treatments (aromatase inhibitors, adjuvant anthracycline regimens, tamoxifen); axillary clearance; axillary dissection plus sentinel node dissection; axillary radiotherapy; axillary sampling; combined chemotherapy plus tamoxifen; chemotherapy plus monoclonal antibody (trastuzumab); extensive surgery; high-dose chemotherapy; hormonal treatment; less extensive mastectomy; less than whole-breast radiotherapy plus breast-conserving surgery; multimodal treatment; ovarian ablation; primary chemotherapy; prolonged adjuvant combination chemotherapy; radiotherapy (after breast-conserving surgery, after mastectomy, plus tamoxifen after breast-conserving surgery, to the internal mammary chain, and to the ipsilateral supraclavicular fossa, and total nodal radiotherapy); sentinel node biopsy; and standard chemotherapy regimens.
Url:
PubMed: 21718560
PubMed Central: 3217212
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PMC:3217212Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Breast cancer (non-metastatic)</title><author><name sortKey="Stebbing, Justin" sort="Stebbing, Justin" uniqKey="Stebbing J" first="Justin" last="Stebbing">Justin Stebbing</name></author><author><name sortKey="Delaney, Geoff" sort="Delaney, Geoff" uniqKey="Delaney G" first="Geoff" last="Delaney">Geoff Delaney</name></author><author><name sortKey="Thompson, Alastair" sort="Thompson, Alastair" uniqKey="Thompson A" first="Alastair" last="Thompson">Alastair Thompson</name></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21718560</idno><idno type="pmc">3217212</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3217212</idno><idno type="RBID">PMC:3217212</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">004759</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">004759</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Breast cancer (non-metastatic)</title><author><name sortKey="Stebbing, Justin" sort="Stebbing, Justin" uniqKey="Stebbing J" first="Justin" last="Stebbing">Justin Stebbing</name></author><author><name sortKey="Delaney, Geoff" sort="Delaney, Geoff" uniqKey="Delaney G" first="Geoff" last="Delaney">Geoff Delaney</name></author><author><name sortKey="Thompson, Alastair" sort="Thompson, Alastair" uniqKey="Thompson A" first="Alastair" last="Thompson">Alastair Thompson</name></author></analytic><series><title level="j">BMJ Clinical Evidence</title><idno type="eISSN">1752-8526</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Introduction</title><p>Breast cancer affects at least 1 in 10 women in the UK, but most present with primary operable disease, which has an 80% 5-year survival rate overall.</p></sec><sec><title>Methods and outcomes</title><p>We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions after breast-conserving surgery for ductal carcinoma in situ? What are the effects of treatments for primary operable breast cancer? What are the effects of interventions in locally advanced breast cancer (stage 3B)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).</p></sec><sec><title>Results</title><p>We found 83 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.</p></sec><sec><title>Conclusions</title><p>In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding chemotherapy (cyclophosphamide/methotrexate/fluorouracil and/or anthracycline and/or taxane-based regimens), or hormonal treatment to radiotherapy; adjuvant treatments (aromatase inhibitors, adjuvant anthracycline regimens, tamoxifen); axillary clearance; axillary dissection plus sentinel node dissection; axillary radiotherapy; axillary sampling; combined chemotherapy plus tamoxifen; chemotherapy plus monoclonal antibody (trastuzumab); extensive surgery; high-dose chemotherapy; hormonal treatment; less extensive mastectomy; less than whole-breast radiotherapy plus breast-conserving surgery; multimodal treatment; ovarian ablation; primary chemotherapy; prolonged adjuvant combination chemotherapy; radiotherapy (after breast-conserving surgery, after mastectomy, plus tamoxifen after breast-conserving surgery, to the internal mammary chain, and to the ipsilateral supraclavicular fossa, and total nodal radiotherapy); sentinel node biopsy; and standard chemotherapy regimens.</p></sec></div></front></TEI><pmc article-type="review-article"><pmc-comment>The publisher of this article does not allow downloading of the full text in XML form.</pmc-comment>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMJ Clin Evid</journal-id><journal-id journal-id-type="iso-abbrev">BMJ Clin Evid</journal-id><journal-id journal-id-type="publisher-id">Clin Evid</journal-id><journal-title-group><journal-title>BMJ Clinical Evidence</journal-title></journal-title-group><issn pub-type="epub">1752-8526</issn><publisher><publisher-name>BMJ Publishing Group</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21718560</article-id><article-id pub-id-type="pmc">3217212</article-id><article-id pub-id-type="publisher-id">0102</article-id><article-categories><subj-group subj-group-type="heading"><subject>Women's Health</subject></subj-group><subj-group subj-group-type="secondary-section"><subject>Oncology</subject><subject>Care of the Elderly</subject></subj-group></article-categories><title-group><article-title>Breast cancer (non-metastatic)</article-title><alt-title alt-title-type="abridged">Primary breast cancer</alt-title></title-group><contrib-group><contrib contrib-type="author" equal-contrib="yes" deceased="no"><name><surname>Stebbing</surname><given-names>Justin</given-names></name><degrees>MA FRCP FRCPath PhD</degrees><role>Professor of Cancer Medicine and Medical Oncology</role><aff><institution>Imperial College Healthcare NHS Trust, Charing Cross Hospital</institution><addr-line>London</addr-line><country>UK</country></aff></contrib><contrib contrib-type="author" equal-contrib="yes" deceased="no"><name><surname>Delaney</surname><given-names>Geoff</given-names></name><role>Director of Cancer Services</role><aff><institution>Cancer Therapy Centre, Liverpool Hospital</institution><addr-line>Sydney</addr-line><country>Australia</country></aff></contrib><contrib contrib-type="author" equal-contrib="yes" deceased="no"><name><surname>Thompson</surname><given-names>Alastair</given-names><prefix>Professor</prefix></name><role>Professor of Surgical Oncology</role><aff><institution>Department of Surgery and Molecular Oncology, Ninewells Hospital and Medical School, University of Dundee</institution><addr-line>Dundee</addr-line><country>UK</country></aff></contrib></contrib-group><author-notes><fn><p>JS declares that he has no competing interests. GD has contributed to clinical trials involving drug supplied by AstraZeneca; it is likely that he will contribute to the ensuing publications. AT has been reimbursed by AstraZeneca, Novartis, Pfizer, and Roche for attending symposia, including a speaker fee. AT has contributed to trials involving these companies' products, and to the ensuing publication, which forms some of the evidence referenced in this review.</p><p><italic>We would like to acknowledge previous contributors to this review, J Michael Dixon and Alan Rodger.</italic></p></fn></author-notes><pub-date pub-type="epub"><day>08</day><month>2</month><year>2011</year></pub-date><pub-date pub-type="collection"><year>2011</year></pub-date><volume>2011</volume><elocation-id>0102</elocation-id><permissions><copyright-statement>© BMJ Publishing Group Ltd, All Rights Reserved</copyright-statement><copyright-year>2011</copyright-year></permissions><self-uri xlink:type="simple" xlink:href="http://www.clinicalevidence.bmj.com/ceweb/pmc/2011/02/102/">This article is available from http://www.clinicalevidence.bmj.com/ceweb/pmc/2011/02/102/</self-uri><abstract><sec><title>Introduction</title><p>Breast cancer affects at least 1 in 10 women in the UK, but most present with primary operable disease, which has an 80% 5-year survival rate overall.</p></sec><sec><title>Methods and outcomes</title><p>We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions after breast-conserving surgery for ductal carcinoma in situ? What are the effects of treatments for primary operable breast cancer? What are the effects of interventions in locally advanced breast cancer (stage 3B)? We searched: Medline, Embase, The Cochrane Library, and other important databases up to April 2009 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).</p></sec><sec><title>Results</title><p>We found 83 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.</p></sec><sec><title>Conclusions</title><p>In this systematic review we present information relating to the effectiveness and safety of the following interventions: adding chemotherapy (cyclophosphamide/methotrexate/fluorouracil and/or anthracycline and/or taxane-based regimens), or hormonal treatment to radiotherapy; adjuvant treatments (aromatase inhibitors, adjuvant anthracycline regimens, tamoxifen); axillary clearance; axillary dissection plus sentinel node dissection; axillary radiotherapy; axillary sampling; combined chemotherapy plus tamoxifen; chemotherapy plus monoclonal antibody (trastuzumab); extensive surgery; high-dose chemotherapy; hormonal treatment; less extensive mastectomy; less than whole-breast radiotherapy plus breast-conserving surgery; multimodal treatment; ovarian ablation; primary chemotherapy; prolonged adjuvant combination chemotherapy; radiotherapy (after breast-conserving surgery, after mastectomy, plus tamoxifen after breast-conserving surgery, to the internal mammary chain, and to the ipsilateral supraclavicular fossa, and total nodal radiotherapy); sentinel node biopsy; and standard chemotherapy regimens.</p></sec></abstract><abstract abstract-type="key-points"><title>Key Points</title><p>Breast cancer affects at least 1 in 10 women in the UK, but most present with primary operable disease, which has an 80% 5-year survival rate overall.</p><p>In women with ductal carcinoma in situ (DCIS), <xref ref-type="sub-article" rid="BMJ_0102_I5">radiotherapy</xref> reduces local recurrence and invasive carcinoma after breast-conserving surgery. The role of <xref ref-type="sub-article" rid="BMJ_0102_I6">tamoxifen</xref> added to radiotherapy for DCIS remains unclear because of conflicting results. </p><p>In women with primary operable breast cancer, survival may be increased by full surgical excision, tamoxifen, chemotherapy, radiotherapy, <xref ref-type="sub-article" rid="BMJ_0102_I4">ovarian ablation</xref>, or <xref ref-type="sub-article" rid="BMJ_0102_I21">trastuzumab</xref> (in women who over-express <italic>HER2/neu</italic> oncogene).
<list list-type="bullet"><list-item><p>Incomplete excision may increase the risk of local recurrence, but <xref ref-type="sub-article" rid="BMJ_0102_I19">less-extensive mastectomy</xref> that excises all local disease is as effective as radical mastectomy at prolonging survival, with better cosmetic results.</p></list-item><list-item><p><xref ref-type="sub-article" rid="BMJ_0102_I17">Axillary clearance</xref> (removal of all axillary lymph nodes) achieves local disease control, but has not been shown to increase survival, and can cause arm lymphoedema.</p></list-item><list-item><p><xref ref-type="sub-article" rid="BMJ_0102_I20">Sentinel lymph node biopsy</xref> or 4-node sampling may adequately stage the axilla with less morbidity compared with axillary clearance.</p></list-item><list-item><p><xref ref-type="sub-article" rid="BMJ_0102_I12">Adjuvant tamoxifen</xref> reduces the risk of recurrence and death in women with oestrogen-positive tumours.</p></list-item><list-item><p><xref ref-type="sub-article" rid="BMJ_0102_I16">Primary chemotherapy</xref> may facilitate successful breast-conserving surgery instead of mastectomy. <xref ref-type="sub-article" rid="BMJ_0102_I1">Adjuvant combination chemotherapy</xref> improves survival compared with no chemotherapy, with greatest benefit likely with<xref ref-type="sub-article" rid="BMJ_0102_I1219153607402"> anthracycline-based regimens</xref> at standard doses for 4 to 6 months.</p></list-item><list-item><p>Radiotherapy decreases recurrence and mortality after <xref ref-type="sub-article" rid="BMJ_0102_I7">breast-conserving surgery</xref>. Post-<xref ref-type="sub-article" rid="BMJ_0102_I8">mastectomy</xref> radiotherapy for women who are node-positive or at high risk of recurrence decreases recurrence and mortality.</p></list-item><list-item><p><xref ref-type="sub-article" rid="BMJ_0102_I18">Adjuvant aromatase inhibitors</xref> improve disease-free survival compared with tamoxifen, but their effect on overall survival is unclear. <xref ref-type="sub-article" rid="BMJ_0102_I1179236786074">Adjuvant taxane-based regimens</xref> may improve disease-free survival over standard anthracycline-based therapy. </p></list-item></list></p><p>In women with locally advanced breast cancer, <xref ref-type="sub-article" rid="BMJ_0102_I13">radiotherapy</xref> may be as effective as surgery or tamoxifen at increasing survival and local disease control.
<list list-type="bullet"><list-item><p>Adding <xref ref-type="sub-article" rid="BMJ_0102_I14">tamoxifen or ovarian ablation</xref> to radiotherapy increases survival compared with radiotherapy alone, but adding chemotherapy may not reduce recurrence or mortality compared with radiotherapy alone.</p></list-item><list-item><p>We don't know if chemotherapy alone improves survival in women with locally advanced breast cancer as we found few trials.</p></list-item></list></p></abstract><counts><table-count count="NaN"></table-count><ref-count count="155"></ref-count></counts></article-meta><notes notes-type="disclaimer"><sec><title>Disclaimer</title><p>The information contained in this publication is intended for medical professionals. Categories presented in Clinical Evidence indicate a judgement about the strength of the evidence available to our contributors prior to publication and the relevant importance of benefit and harms. We rely on our contributors to confirm the accuracy of the information presented and to adhere to describe accepted practices. Readers should be aware that professionals in the field may have different opinions. Because of this and regular advances in medical research we strongly recommend that readers' independently verify specified treatments and drugs including manufacturers' guidance. Also, the categories do not indicate whether a particular treatment is generally appropriate or whether it is suitable for a particular individual. Ultimately it is the readers' responsibility to make their own professional judgements, so to appropriately advise and treat their patients.
To the fullest extent permitted by law, BMJ Publishing Group Limited and its editors are not responsible for any losses, injury or damage caused to any person or property (including under contract, by negligence, products liability or otherwise) whether they be direct or indirect, special, incidental or consequential, resulting from the application of the information in this publication.</p></sec></notes></front></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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