Table Of Content

APPROACHES TO BREAST CANCER PREVENTION Developments in Oncology Volume 62 APPROACHES TO BREAST CANCER PREVENTION edited by BASil A. STOll Honorary Consulting Physician to Oncology Department St Thomas' Hospital, and to Joint Breast Clinic, Royal Free Hospital, London, UK SPRINGER SCIENCE+BUSINESS MEDIA, B.v. Library of Congress Cataloging-in-Publication Data Approaches to breast cancer prevention / edited by Basil A Stoll. p. cm. - (Developments in oncology: 62) Includes index. ISBN 978-94-010-5664-9 ISBN 978-94-011-3742-3 (eBook) DOI 10.1007/978-94-011-3742-3 1. Breast-Cancer-Prevention. I. Stoll, Basil A (Basil Arnold) 11. Series. [DNLM: 1. Breast Neoplasms-prevention & control. 2. Risk Factors. Wl DE998N v. 62/ WP 870 A652] RA645.C3A76 1991 616.99' 44905~c20 DNLMIDLC for Library of Congress 90-5374 ISBN 978-94-010-5664-9 Printed on acid-free paper All Rights Reserved © 1991 Springer Science+Business Media Dordrecht Originally published by Kluwer Academic Publishers in 1991 Softcover reprint of the hardcover 1st edition 1991 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, includin~ photocopying, recording or by any mformation storage and retrieval system, WIthout written permission from the copyright owner. Contents Preface vii List of Contributors ix Part One: Biological Basis of Risk Factors Chapter 1 Defining Breast Cancer Prevention 3 Basil A. Stoll Chapter 2 Is Female Breast Cancer Increasing? 15 D. Maxwell Parkin and Janine Nectoux Chapter 3 Hormones and Proliferative Activity in Breast Tissue 35 Irma H. Russo, Gloria Calaf and Jose Russo Chapter 4 Growth Factor Expression in Breast Tissue 53 Peter J. Ba"ett-Lee Chapter 5 Avoiding Hormone-Related Risk Factors 61 James Owen Drife Chapter 6 Oral Contraceptives and Breast Disease 73 Kathryn F. McGonigle and George R. Huggins Chapter 7 Hormone Replacement Therapy and Breast Cancer Risk 97 Timothy J.A. Key Chapter 8 Diet, Alcohol, Body Size and the Prevention of Breast Cancer 113 Tim E. Byers and David F. Williamson Part Two: Interventional Approaches Chapter 9 Role of Prophylactic Mastectomy 135 Mary Jane Houlihan and Robert M Goldwyn Chapter 10 Protection by Progestagens or Antioestrogens 149 Basil A. Stoll Chapter 11 Chemoprevention of Breast Cancer 169 Marcia Will and Joseph A. Fontana Chapter 12 Methodologic Aspects of Prevention Trials 181 Jack Cuzick Chapter 13 Monitoring High Risk Women: Psychological Aspects 191 Henry T. Lynch, Patrice Watson, Theresa A. Conway and Jane F. Lynch vi Contents Chapter 14 High Risk Groups and Cost Strategies 207 Victor G. Vogel and Richard R Love Chapter 15 Motivating the Public in Cancer Prevention 221 Carl M. Mansfield Chapter 16 Approaches and Prospects 229 Basil A. Stoll Index 237 Preface This book is a logical companion volume to Women at High Risk to Breast Cancer (Kluwer, 1989) edited by me previously. It distinguishes two aspects of current approaches to clinical breast cancer prevention. The first is the need to advise individual women on how they might reduce their personal risk, while the second is the design of measures aimed at reducing the total incidence of breast cancer in the community. While the former is a problem faced daily by clinicians, the latter is a goal which will involve large scale, carefully planned interventional studies. Because knowledge of the risk factors for breast cancer is incomplete and clinical trial reports are scarce, there is as yet, no scientifically-based model for personal breast cancer prevention. Nevertheless, widespread publicity associated with breast screening programmes has created a large group of highly anxious women who have been informed that they are at higher than average risk to the disease. They are con- cerned by the personal threat posed by a family history of the disease and by the al- leged dangers of obesity, diet, alcohol, or the use of hormonal agents such as oral contraceptives or hormone replacement therapy. Hopes among these women have been stimulated recently by preliminary reports in the news media of clinical trials in progress involving new agents aimed at prevent- ing breast cancer in women. Few clinicians are informed on approaches to prevention and this book aims to review the evidence and to provide a guide to those which are either available or under investigation. Although some of these approaches have been the subjects of published papers, this is the first monograph offering an up-to- date, balanced assessment of the various methods, their rationale and indications. In the management of the individual woman, the book distinguishes clearly between possible avoidance measures, interventional measures and attempts at earlier diagnosis of breast cancer. It also distinguishes those personal measures selected ac- cording to a woman's degree of risk, from measures which offer a potential for clinical trial in the population at large. In the absence of measures which can promise to reverse the malignant process, our current goal is to achieve dormancy in the growth of an existing subclinical focus of breast cancer. We aim to stop cell replication or in- duce differentiation so that a susceptible individual may die of some other disease before breast cancer manifests clinically. In aiming to reduce the incidence of breast cancer in the community, the major questions raised in this monograph are: what are the best strategies to be used, where future research is most urgently needed and whether the population at large viii Preface can be induced to modify their exposure to the risk factors which have been postul- ated. Although a few small clinical trials are under way, it will be many years before mature results can be reported. It is therefore, timely to collate the state-of-the-art in a readable book so that we can identify the gaps in our knowledge and direct future research along the most productive lines. I wish to publicly congratulate all the contributors for rising magnificently to the challenge posed by this novel work. Each chapter presents a coherent account of one specific aspect, but the incompleteness of our knowledge sometimes leads to dif- fering assessments of risk factors or interventional methods. This has necessitated slight overlap between some chapters. BASIL A. STOLL London, 1991 List of Contributors Peter J. Barrett-Lee MB, BS, BSc, MRCP Joseph A. Fontana, MD, PhD Registrar Associate Professor of Medicine and Oncology Academic Department of Radiotherapy University of Maryland Cancer Center Royal Marsden Hospital Baltimore, Maryland Sutton, Surrey USA UK Robert M. Goldwyn, MD Tim E. Byers, MD, MPH Clinical Professor of Surgery Chief Harvard Medical School Epidemiology Branch Chief, Division of Plastic Surgery Division of Nutrition Beth Israel Hospital Center for Chronic Disease Prevention and Boston, Massachusetts Health Promotion USA Atlanta, Georgia Mary Jane Houlihan, MD USA Instructor Gloria Calaf, PhD Harvard Medical School Scientist Director Department of Pathology Beth Israel Breast Care Center Michigan Cancer Foundation Beth Israel Hospital Detroit, Michigan Boston, Massachusetts USA USA Theresa A. Conway, BSN George R. Huggins, MD Department of Preventive MedicinelPublic Chairman Health Department of Obstetrics and Gynaecology Creighton University School of Medicine Francis Scott Key Medical Center Omaha, Nebraska Baltimore, Maryland USA USA Jack Cuzick, PhD Timothy J.A. Key, DPhil Head Research Fellow Department of Mathematics, Statistics and Imperial Cancer Research Fund Epidemiology Cancer Epidemiology Unit Imperial Cancer Research Fund Radcliffe Infirmary London Oxford UK UK James Owen Drife, BSc, MD, FRCSEd, Richard R. Love, MD, MS FRCOG Associate Professor of Human Oncology Professor of Obstetrics and Gynaecology Medicine and Family Medicine & Practice University of Leeds University of Wisconsin Clinical Cancer Center Leeds Madison, Wisconsin UK USA x List of Contributors Henry T. Lynch, MD Jose Russo, MD Professor and Chairman Chairman, Department of Pathology; Director, Department of Preventive Medicine and Public Pathology Laboratory Services and Member Health Michigan Cancer Foundation Creighton University School of Medicine Detroit, Michigan Omaha, Nebraska USA USA Basil A. Stoll, FRCR, FFR Jane F. Lynch, BSN Honorary Consulting Physician Department of Preventive Medicine and Public Oncology Department Health St Thomas' Hospital and to Creighton University School of Medicine Joint Breast Clinic Omaha, Nebraska Royal Free Hospital USA London UK Kathryn F. McGonigle, MD Department of Obstetrics and Gynecology Victor G. Vogel, MD, MHS Francis Scott Key Medical Center Assistant Professor of Medicine and Baltimore, Maryland Epidemiology USA MD Anderson Cancer Center Department of Medical Oncology Carl M. Mansfield, MD, FACR, FACN Assistant Professor of Epidemiology Professor and Chairman University of Texas School of Public Health Department of Radiation Oncology and Houston, Texas Nuclear Medicine USA Bodine Center for Cancer Treatment Philadelphia, Pennsylvania Patrice Watson, PhD USA Department of Preventive MedicinefPublic Health Janine Nectoux Creighton University School of Medicine Descriptive Epidemiology Programme Omaha, Nebraska International Agency for Research on Cancer USA Lyon France Marcia Will, MD Clinical Associate D. Maxwell Parkin, MD University of Maryland Cancer Center Chief of Unit Baltimore, Maryland Descriptive Epidemiology Programme USA International Agency for Research on Cancer Lyon David F. Williamson, MS, PhD France Epidemiologist Division of Nutrition Irma H. Russo, MD Center for Chronic Disease Prevention and Chief, Experimental Pathology Laboratory Health Promotion Co-Director Pathology Laboratory Services Atlanta, Georgia and Associate Member USA Department of Pathology Michigan Cancer Foundation Detroit, Michigan USA