Breast cancer is the most common cancer in women excluding skin cancer. Breast cancer is the second leading cause of cancer deaths in women following lung cancer. The study and reporting of St. Bernards results with breast cancer is very important.

In Figure 1 is the incidence rate for all stage breast cancers seen at St. Bernards from 1995 to the year 2000. Breast cancer is unique in that a large percentage of women are diagnosed with non-invasive Stage 0 breast cancer. This percentage has grown nationally primarily due to increased use of mammograms. Figure II compares the incidence of Stage 0 breast cancers at St. Bernards and the national incidence, which are comparable. Another uniqueness with breast cancer is the influence of female hormones, especially estrogen. A recently published study has proven that hormone supplementation produces increased rates of breast cancer. Following the release of this study, hormone supplementation for postmenopausal symptoms has largely been discontinued. Over the past couple of years nationally we have seen a decrease in the incidence of breast cancer and this may be related to less estrogen supplementation.

Aromatase inhibitors gained widespread usage following release of the ATAC trial that demonstrated increased survival in postmenopausal women with estrogen receptor positive tumors in comparison to the use of Tamoxifen, the standard for several years. These drugs reduce postmenopausal estrogen levels to near zero, again an indication that breast cancer is related to estrogen levels.

Estrogen manipulation continues to be important in the management of breast cancer a part of the multimodality treatments used to fight breast cancer. We continue to use surgery, radiation and chemotherapy.

Figures III and IV compare St.Bernards 1995–2000 statistics and national statistics from 1998 for overall survival in Stage 0, I and II breast cancers.

John Allgood, M.D.
Radiation Oncology

References: NCDB