American Society for Clinical Oncology 40th Annual Meeting, New Orleans, LA, 5–8 June 2004: breast cancer highlights

Abstract

275 ASCO = American Society for Clinical Oncology; CTC = circulating tumor cell; MRI = magnetic resonance imaging; OS = overall survival; RT-PCR = reverse transcriptase-polymerase chain reaction; SNP = single nucleotide polymorphism; TTP = time to progression; UTR = untranslated region.Available online http://breast-cancer-research.com/content/6/6/275The American Society for Clinical Oncology (ASCO) held its 40th annual meeting in New Orleans, LA, USA on 5-8 June 2004. There were more than 20 oral presentations and greater than 150 poster presentations devoted to breast cancer research. Each of these presentations contributes to advances in the science of breast cancer prevention, diagnosis, prognosis and treatment. DiagnosisEmerging diagnostic tools in breast cancer include magnetic resonance imaging (MRI) and positron emission tomography evaluation. Data presented this year add to the growing understanding of how these modalities can be applied to patient management.The use of MRI in evaluation of the breast remains a controversial topic. In an abstract presented by Dr Schnall on behalf of the International Breast MRI Consortium, the value of MRI in multifocal disease was assessed [1]. This multicenter prospective trial enrolled 1004 women with suspicious mammograms and/or clinical findings. Prior to undergoing biopsy, these women received mammograms and underwent MRI of the breast. Biopsy of the index lesion was malignant in 428 women. Of these, 103 women had a second area of suspicion indicated by MRI compared with 36 women by mammogram alone. Biopsy confirmed multifocal disease in 56 of 78 MRI-detected abnormalities and in 17 of 20 mammogram-detected abnormalities. This study confirms the higher yield of MRI for detecting multifocal disease than the mammogram. It has yet to be shown that this higher yield will translate into clinical benefit for patients. Randomized trials to assess this benefit are warranted. Surgical treatmentOne of the biggest concerns expressed by breast cancer patients prior to surgical intervention is the effect of axillary evaluation on mobility, pain symptoms and risk of lymphedema. Studies presented this year address the optimal approach to axillary evaluation in terms of morbidity, and address whether certain subgroups of women do not require an axillary evaluation.Two randomized trials were presented that address the role of axillary evaluation in clinically node-negative breast cancer patients. The initial results of the ALMANAC study were presented by Dr Mansel [2]. This study compared sentinel lymph node biopsy with axillary dissection, with regards to primary outcomes of arm and axillary morbidity, the quality of life and costs in terms of resources. A total of 1031 patients were randomized to sentinel biopsy or to axillary dissection. If the sentinel biopsy was positive, patients went on to full axillary evaluation. Results of this trial confirmed the decreased morbidity of sentinel node biopsy in comparison with axillary dissection, with decreased risk of sensory loss and l...