& Breast Cancer
(unpublished; lack of such an article in the
Progress of breast cancer and gastric cancer in USA and Japan
of progress against cancer is assessed mainly by the reduction
of mortality. This reduction can emerge from a decrease in cancer
incidence, increase of proportion of early stages and/or better
treatment of clinically detectable cancer. We review and compare
time trends in incidence, screening (mammography, endoscopy),
early detection and case-mortality in the USA and Japan.
We discuss the reasons for the differences in the rates of minimally
invasive treatment (breast- and axilla node-preserving surgery
for breast cancer and endoscopic mucosal resection for gastric
cancer) and extent of conventional surgery for gastric cancer
between USA (D2 dissection rate of 10% only) [NEJM 2001;345;725-30]
and Japan (routine use of D2 dissection). Prophylactic surgery
with bilateral mastectomy on BRCA1/BRCA2 mutations carriers (J
Natl Cancer Inst 2001;93:1633-7] and most recently with total
gastrectomy on CDH1 gene (E-cadherin) mutations carriers [NEJM
2001;344:1904-9] has been established effective to reduce significantly
the risk of breast and gastric cancer, although several issues
need further prospective evaluation.
Postoperative (adjuvant) treatment has been established effective
to improve survival for breast cancer [J Natl Cancer Inst 2001;
93: 979-89], whereas for gastric cancer hopes provides a most
recent randomized trial [NEJM 2001;345;725-30] in contrast to
the negative up until now available results.
multimodality treatments of advanced-stages cancers are too expensive
with a rather small expected survival benefit. We discuss whether
the design of strategies for prevention (see also Genetics
- Molecular Targets) and early detection can be realistic,
more effective and less expensive than treatment to control breast
and gastric cancer.
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