The widespread application of adjuvant therapy has shown clear benefits in the treatment of operable breast cancer. It is essential for the clinicians to select appropriate adjuvant regimens for this heterogeneous group of patients. Recent data from clinical trials evaluating the utility of adjuvant therapy were reviewed.

The third generation of aromatase inhibitors (AI) play an important role in the adjuvant treatment of hormonal positive postmenopausal breast cancer. Compared with tamoxifen, either upfront or sequential using of Al can both significantly improve the outcome of breast cancer patients. However, there is a continuous debate of sequence or upfront usage of Al in clinical applications. With the publication result of BIG 1-98 clinical trial and interpretation of the data, we can further recognize and optimize the usage of Al in breast cancer treatment.

The National Surgical Adjuvant Breast and Bowel Project (NSABP) is a cooperative group to conduct clinical trials in breast and colorectal cancer research. In this article, we review NSABP breast cancer clinical trials.

Purpose: To analyze the clinical and pathological factors in post-operative breast cancer patients with bone metastasis, and, identify risk factors predicting the skeletal metastasis. Methods: We evaluated data from 3 796 patients who were surgically treated from January 1981 to December 2000. Those patients were divided into groups according to different first events. Then we assessed data of 116 cases of bone metastasis as first event, and comparing with visceral metastasis and lymph node or soft tissue metastasis cases. Results: In our group there were 116 cases with bone metastasis as first event, about 3. 1%; bone metastasis correlated with young age, large tumor, clinical palpable axillary nodes, pathological positive nodes, stage II/HI disease and non-specific invasvie breast carcinoma. Multivariate logistic regression found that large tumor, clinical palpable axillary nodes related with bone metastasis in pre-operative data. In post-operative data, large tumor, pathological positive nodes and non-specific invasive breast carcinoma correlated with bone metastasis. Hormone receptor status and HER2 expression did not predict the bone metastasis. All cases received standard local and adjuvant systemic treatment. Among patients who had as their first event a local recurrence or a recurrence in soft tissue or lymph node or local and systemic metastasis, there were more specific invasive carcinomas than those in bone metastasis group. Occurrence of bone metastasis and visceral metastasis had similar time distribution, however, local recurrence and/or node, soft tissue metastasis occurred earlier than skeletal metastasis. Conclusions: Pre-operative bone scintigraphy was indicated in those with young age, T2/T3 tumor, and clinical palpable nodes. Breast cancer patients at high risk for bone metastasis were T2/T3 tumor, non-specific invasive breast carcinoma and with 4 or more involved axillary lymph nodes. It might be important to study the effect of bisphosphonates in the adjuvant settings.

Purpose: To evaluate the efficacy and toxicity of Navelbine( NVB) and Epirubicin ( Epi -ADM) as the neoadjuvant chemotherapy in the treatment of locally advanced breast cancer. Methods: From September 2001 to February, 2003, 76 cases, LABC patients ( II b ~ HI b ) were treated with NE chemotherapy before operation. Neoadjuvant chemotherapy regimens containing vinorelbine( N), 25 mg/m (days 1 and 8) and epirubicin( E), 60 mg/m (days 1) were administered every 3 weeks for three cycles before local treatment. The response in the primary tumor and the regional lymph nodes and the chemotherapy toxicity were observed for each patient. Results: The response in the primary tumor: clinical objective response was 84. 2% (19.7% (15/76) CR and 64. 5% (49/76) PR) , 14. 5% (11/76) SD and 1.3% (1/76) PD. Pathological complete response was found in 11 cases( 14. 5%). 9 cases (28. 1%) who have positive FNA result in the regional lymph node before chemotherapy showed negative result in the surgery specimen. The most common toxicities are leukocytopenia, nausea/vomiting and alopecia. Leucopenia grade 3-4 was reported in 54. 2% of the patients but there were no chemotherapy related toxic deaths. Conclusions: The combination of Vinorelbine and Epirubicin is a very active and well-tolerated regimen as neoadjuvant chemotherapy for the LABC.

Purpose: Hypoxia is common in breast cancer and may influence gene expression to promote malignancy. Estrogen receptor (ER) -? status is an important predictor for both prognosis and clinical response to endocrine therapy. The aim of our current study is to demonstrate the relationship between hypoxia and ER-? in breast cancer tissue. Methods: We have examined ER-a expression by immunohistochemistry in parallel with indicators of hypoxia in 51 ER-a ligand binding assay positive breast tumors for in vivo evidence of this phenomenon. Results: Overall, 49 tumors were ER-a positive by immunohistochemistry. Regional loss of ER-a expression was consistently present in peri-necrotic as compared to distant regions in both in situ (n =29, P

Objective To study the phenotype profiles of bone marrow micrometastatic tumor cells in patients with breast cancer. Methods Immunocytochemical staining was used to study the biologic markers of disseminated tumor cells, and U-PA activity of the plasma in the bone marrow was assayed in breast cancer patients.Results Judged by positive immunocytochemical staining of EMA and CK19, bone marrow micrometastasis was found in 30 out of 72 (41 67%) breast cancer patients. The primary tumor size (? 2=6 417, P=0 040) and p53 protein expression (? 2 =5 930, P=0 025) were significantly correlated with the incidence of micrometastasis. Disseminated tumor cells expressed low protein cyclinD1, p53,Ki-67, EGFR, and high protein p21. Tumor size and axillary lymph node status were found to be significantly correlated with the u-PA activity level. Conclusion Disseminated tumor cells in the bone marrow was in a status of low-cycling and low-proliferation.

Purpose:To estimate prevalence of BRCA1 and BRCA2 mutations among Chinese patients with breast cancer in eastern China. Methods:Frozen tumor tissues were obtained from 79 female patients, and three exons (2, 11, 22) of BRCA1 and three exons (9, 14, 22) of BRCA2 were examined with 23 pairs of primer, using polymerase chain reaction (PCR) single strand conformational polymorphism (SSCP) sequencing method. Results:It was found that in cDNA of BRCA1, there is a single nucleotide variation of T→C at position of 2430. By the RFLP method, we confirmed that the variation in the general population is a single nucleotide polymorphism. The distribution of T allele and C allele is different between cases and controls, but the difference is not significant. Conclusions:It implied that the mutations of BRCA1 and BRCA2 in breast cancer patients in eastern China is very rare.

Objective To evaluate the effect of an Internet support program on uncertainty in illness in breast cancer patients after operation. Method One hundred and nineteen breast cancer patients after surgery who were discharged from Shanghai Cancer Hospital were assigned into the control group (63 cases) and the intervention group (56 cases). A 12-week Internet support program was offered to the patients in the intervention group, while the patients in the control group received the routine follow-up. Measurement of uncertainty in illness was taken at the sixth week and the twelfth week after the baseline survey. Results The total score of the uncertainty in illness as well as the factor scores of ambiguity and lack of information showed downward trend in both the intervention group and the control group, and the three indexes in the intervention group declined more rapidly than those in the control group. The scores of the three indexes in the intervention group were significantly lower than those in the control group at the twelfth week. Conclusion The Internet support program which offers abundant information, multi-disciplinary cooperation and real-time interaction intervention is an effective approach in reducing uncertainty in illness for breast cancer survivors.

Objective To evaluate the accuracy of ultrasonography and magnetic resonance imaging detection on preoperatively predicting axillary lymph node in breast cancer patients.Methods From August 2010 to February 2011,the clinical data of 293 breast cancer patients underwent preoperative breast ultrasound exam and MRI detection in Ruijin Hospital were analyzed retrospectively.Results In 293 breast cancer patients,3 suffered from bilateral breast cancer.The sensitivity,specificity,negative predictive value and positive predictive value of ultrasound were 60.0％,90.6％,78.0％ and 80.2％,respectively.The sensitivity,specificity,negative predictive value and positive predictive value of MRI test were 50.5％,90.8％,74.0％ and 77.9％,respectively.There was no significant difference between ultrasound and MRI test in these four indices (P ＞ 0.05).No significant difference on accuracy and predictive value was seen in subgroup analysis according to tumor size,tumor grade,hormone receptor and HER2 status between the two examinations.The sensitivity and specificity of ultrasound associated with MRI test were 70.6％ and 97.2％.Conclusions The accuracy and predictive value between preoperative ultrasound exam and MRI is comparable.Ultrasound associated with MRI examination can achieve high specificity,which may spare a portion of patients free from sentinel lymph nodes biopsy.