A general perspective on breast disease and training system for breast cancer specialists in Europe

유방질환 및 유럽의 유방암 진료 시스템에 대한 고찰

  • Jo, Hoen-Il (Mirae & Heemang Obstetrics and Gynecology Clinic)
  • Received : 2010.06.29
  • Accepted : 2010.07.05
  • Published : 2010.07.15

Abstract

Breast is a female reproductve organ and breast disease is closely related to female reproductive function. In recent years, becoming the most frequent cancer in female, breast cancer has emerged as a major health concern for Korean women. Obtaining basic knowledge about breast disease is crucial for the specialists dealing with female reproductive organs. In this article a brief overview over the management of breast cancer as well as benign breast disease will be presented. In addition, the current stauts of training system for breast cancer in Europe will be discussed. Examinations of the current practices in Europe will be able to guide the effort in Korea to incorporate breast diseae into the field of gynecology.

유방은 여성의 생식기관의 하나로서 유방에 발생하는 질환은 여성 생식 기능과 밀접한 연관성을 갖는다. 최근에 한국 여성에서도 유방암은 발생률 1위의 암이 되었고 여성 건강을 위협하는 주요질환으로 대두되고 있다. 여성의 건강을 다루는 산부인과 의사로서 유방질환에 대한 기본 지식을 습득하는 것은 필수불가결한 요구라 할 수 있다. 이 글을 통해 양성 유방질환과 유방암의 진단 및 치료에 관한 간략한 개요를 제공하고자 한다. 또한 현재 유럽의 유방학 수련 체계에 대해서도 소개하고자 한다. 유럽의 유방질환 진료 현황에 대한 고찰은 향후 유방 진료를 활성화 하고자 하는 국내 산부인과의 노력에 많은 도움이 될 것이다.

Keywords

References

  1. International Federation of Gynecology and Obstetrics [Internet]. London: International Federation of Gynecology and Obstetrics; c2010 [updated 2010 May 2; cited 2010 Jun 10]. Availavle from: http://www.figo.org/news/professor-jose-aristodemo-pinotti-1934-2009.
  2. Vorherr H. Fibrocystic breast disease: pathophysiology, pathomorphology, clinical picture, and management. Am J Obstet Gynecol 1986; 154: 161-79. https://doi.org/10.1016/0002-9378(86)90421-7
  3. Love SM, Gelman RS, Silen W. Sounding board. Fibrocystic "disease" of the breast-a nondisease? N Engl J Med 1982; 307: 1010-4. https://doi.org/10.1056/NEJM198210143071611
  4. Guray M, Sahin AA. Benign breast diseases: classification, diagnosis, and management. Oncologist 2006; 11: 435-49. https://doi.org/10.1634/theoncologist.11-5-435
  5. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 1985; 312: 146-51. https://doi.org/10.1056/NEJM198501173120303
  6. Dupont WD, Parl FF, Hartmann WH, Brinton LA, Winfield AC, Worrell JA, et al. Breast cancer risk associated with proliferative breast disease and atypical hyperplasia. Cancer 1993; 71: 1258-65. https://doi.org/10.1002/1097-0142(19930215)71:4<1258::AID-CNCR2820710415>3.0.CO;2-I
  7. Tavassoli FA. Biphasic tumors. In: Tavassoli FA. editor. Pathology of the breast. 2nd ed. Stamford, CT: Appleton & Lange; 1999. p. 571-623.
  8. Carter BA, Page DL, Schuyler P, Parl FF, Simpson JF, Jensen RA, et al. No elevation in long-term breast carcinoma risk for women with fibroadenomas that contain atypical hyperplasia. Cancer 2001; 92: 30-6. https://doi.org/10.1002/1097-0142(20010701)92:1<30::AID-CNCR1288>3.0.CO;2-2
  9. El-Wakeel H, Umpleby HC. Systematic review of fibroadenoma as a risk factor for breast cancer. Breast 2003; 12: 302-7. https://doi.org/10.1016/S0960-9776(03)00123-1
  10. Shabtai M, Saavedra-Malinger P, Shabtai EL, Rosin D, Kuriansky J, Ravid-Megido M, et al. Fibroadenoma of the breast: analysis of associated pathological entities-a different risk marker in different age groups for concurrent breast cancer. Isr Med Assoc J 2001; 3: 813-7.
  11. Rahal RM, de Freitas-Junior R, Paulinelli RR. Risk factors for duct ectasia. Breast J 2005; 11: 262-5. https://doi.org/10.1111/j.1075-122X.2005.21684.x
  12. Cancer incidence in five continents. Volume VII. IARC Sci Publ 1997; (143): 1-1240.
  13. Ferlay J, Bray F, Pisani P, et al. GLOBOCAN 2002: cancer incidence, mortality and prevalence worldwide. IARC cancer base no. 5 (version 2.0). Lyon: The International Agency for Research on Cancer (IARC) Press; 2004.
  14. Coleman MP, Esteve J, Damiecki P, Arslan A, Renard H. Trends in cancer incidence and mortality. IARC Sci Publ 1993; (121): 1-806.
  15. Korean Breast Cancer Society [Internet]. Seoul: KBCS; c2009 [cited 2010 June 10]. Availavle from: http://www. kbcs.or.kr/.
  16. Arriagada R, Le MG, Dunant A, Tubiana M, Contesso G. Twenty-five years of follow-up in patients with operable breast carcinoma: correlation between clinicopathologic factors and the risk of death in each 5-year period. Cancer 2006; 106: 743-50. https://doi.org/10.1002/cncr.21659
  17. Fisher ER, Anderson S, Tan-Chiu E, Fisher B, Eaton L, Wolmark N. Fifteen-year prognostic discriminants for invasive breast carcinoma: National Surgical Adjuvant Breast and Bowel Project Protocol-06. Cancer 2001; 91: 1679-87. https://doi.org/10.1002/1097-0142(20010415)91:8+<1679::AID-CNCR1183>3.0.CO;2-8
  18. Weiss RB, Woolf SH, Demakos E, Holland JF, Berry DA, Falkson G, et al. Natural history of more than 20 years of node-positive primary breast carcinoma treated with cyclophosphamide, methotrexate, and fluorouracil-based adjuvant chemotherapy: a study by the Cancer and Leukemia Group B. J Clin Oncol 2003; 21: 1825-35. https://doi.org/10.1200/JCO.2003.09.006
  19. Reed W, Hannisdal E, Boehler PJ, Gundersen S, Host H, Marthin J. The prognostic value of p53 and c-erb B-2 immunostaining is overrated for patients with lymph node negative breast carcinoma: a multivariate analysis of prognostic factors in 613 patients with a follow-up of 14-30 years. Cancer 2000; 88: 804-13. https://doi.org/10.1002/(SICI)1097-0142(20000215)88:4<804::AID-CNCR11>3.0.CO;2-Y
  20. Schoppmann SF, Bayer G, Aumayr K, Taucher S, Geleff S, Rudas M, et al. Prognostic value of lymphangiogenesis and lymphovascular invasion in invasive breast cancer. Ann Surg 2004; 240: 306-12. https://doi.org/10.1097/01.sla.0000133355.48672.22
  21. Frkovic-Grazio S, Bracko M. Long term prognostic value of Nottingham histological grade and its components in early (pT1N0M0) breast carcinoma. J Clin Pathol 2002; 55: 88-92. https://doi.org/10.1136/jcp.55.2.88
  22. Northridge ME, Rhoads GG, Wartenberg D, Koffman D. The importance of histologic type on breast cancer survival. J Clin Epidemiol 1997; 50: 283-90. https://doi.org/10.1016/S0895-4356(96)00366-6
  23. Vorgias G, Koukouras D, Paleogianni V, Tzoracoeleftherakis E. Prognostic significance of factors affecting disease free interval and overall survival for Stage II breast cancer in Greece. A multivariate cohort study. Eur J Obstet Gynecol Reprod Biol 2001; 95: 100-4. https://doi.org/10.1016/S0301-2115(00)00361-4
  24. Ferrero-Pous M, Hacene K, Bouchet C, Le Doussal V, Tubiana-Hulin M, Spyratos F. Relationship between c-erbB-2 and other tumor characteristics in breast cancer prognosis. Clin Cancer Res 2000; 6: 4745-54.
  25. Menard S, Balsari A, Casalini P, Tagliabue E, Campiglio M, Bufalino R, et al. HER-2-positive breast carcinomas as a particular subset with peculiar clinical behaviors. Clin Cancer Res 2002; 8: 520-5.
  26. Fisher B, Costantino JP, Wickerham DL, Cecchini RS, Cronin WM, Robidoux A, et al. Tamoxifen for the prevention of breast cancer: current status of the National Surgical Adjuvant Breast and Bowel Project P-1 study. J Natl Cancer Inst 2005; 97: 1652-62. https://doi.org/10.1093/jnci/dji372
  27. Fisher B, Costantino JP, Wickerham DL, Redmond CK, Kavanah M, Cronin WM, et al. Tamoxifen for prevention of breast cancer: report of the National Surgical Adjuvant Breast and Bowel Project P-1 Study. J Natl Cancer Inst 1998; 90: 1371-88. https://doi.org/10.1093/jnci/90.18.1371
  28. Vogel VG, Costantino JP, Wickerham DL, Cronin WM, Cecchini RS, Atkins JN, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006; 295: 2727-41. https://doi.org/10.1001/jama.295.23.joc60074
  29. Julien JP, Bijker N, Fentiman IS, Peterse JL, Delledonne V, Rouanet P, et al. Radiotherapy in breast-conserving treatment for ductal carcinoma in situ: first results of the EORTC randomised phase III trial 10853. EORTC Breast Cancer Cooperative Group and EORTC Radiotherapy Group. Lancet 2000; 355: 528-33. https://doi.org/10.1016/S0140-6736(99)06341-2
  30. Vargas C, Kestin L, Go N, Krauss D, Chen P, Goldstein N, et al. Factors associated with local recurrence and cause-specific survival in patients with ductal carcinoma in situ of the breast treated with breast-conserving therapy or mastectomy. Int J Radiat Oncol Biol Phys 2005; 63: 1514-21. https://doi.org/10.1016/j.ijrobp.2005.04.045
  31. Morrow M, Strom EA, Bassett LW, Dershaw DD, Fowble B, Giuliano A, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin 2002; 52: 277-300. https://doi.org/10.3322/canjclin.52.5.277
  32. Solin LJ, Recht A, Fourquet A, Kurtz J, Kuske R, McNeese M, et al. Ten-year results of breast-conserving surgery and definitive irradiation for intraductal carcinoma (ductal carcinoma in situ) of the breast. Cancer 1991; 68: 2337-44. https://doi.org/10.1002/1097-0142(19911201)68:11<2337::AID-CNCR2820681102>3.0.CO;2-R
  33. Fisher B, Anderson S, Bryant J, Margolese RG, Deutsch M, Fisher ER, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233-41. https://doi.org/10.1056/NEJMoa022152
  34. Arriagada R, Le MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 1996; 14: 1558-64. https://doi.org/10.1200/JCO.1996.14.5.1558
  35. Effects of radiotherapy and surgery in early breast cancer. An overview of the randomized trials. Early Breast Cancer Trialists' Collaborative Group. N Engl J Med 1995; 333: 1444-55. https://doi.org/10.1056/NEJM199511303332202
  36. Bear HD, Anderson S, Smith RE, Geyer CE Jr, Mamounas EP, Fisher B, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer:National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 2006; 24: 2019-27. https://doi.org/10.1200/JCO.2005.04.1665
  37. Overgaard M, Jensen MB, Overgaard J, Hansen PS, Rose C, Andersson M, et al. Postoperative radiotherapy in high-risk postmenopausal breast-cancer patients given adjuvant tamoxifen: Danish Breast Cancer Cooperative Group DBCG 82c randomised trial. Lancet 1999; 353: 1641-8. https://doi.org/10.1016/S0140-6736(98)09201-0
  38. Ragaz J, Olivotto IA, Spinelli JJ, Phillips N, Jackson SM, Wilson KS, et al. Locoregional radiation therapy in patients with high-risk breast cancer receiving adjuvant chemotherapy: 20-year results of the British Columbia randomized trial. J Natl Cancer Inst 2005; 97: 116-26. https://doi.org/10.1093/jnci/djh297
  39. Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman DR, Goldstein LJ, et al. Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 2006; 295: 1658-67. https://doi.org/10.1001/jama.295.14.1658
  40. Berry DA, Cirrincione C, Henderson IC, Citron ML, Budman DR, Goldstein LJ, Martino S, Perez EA, Muss HB, Norton L, Hudis C, Winer EP. Estrogen-receptor status and outcomes of modern chemotherapy for patients with node-positive breast cancer. JAMA 2006; 295: 1658-67. https://doi.org/10.1001/jama.295.14.1658
  41. Buzdar A, Douma J, Davidson N, Elledge R, Morgan M, Smith R, et al. Phase III, multicenter, double-blind, randomized study of letrozole, an aromatase inhibitor, for advanced breast cancer versus megestrol acetate. J Clin Oncol 2001; 19: 3357-66. https://doi.org/10.1200/JCO.2001.19.14.3357
  42. Buzdar AU, Jonat W, Howell A, Jones SE, Blomqvist CP, Vogel CL, et al. Anastrozole versus megestrol acetate in the treatment of postmenopausal women with advanced breast carcinoma: results of a survival update based on a combined analysis of data from two mature phase III trials. Arimidex Study Group. Cancer 1998; 83: 1142-52. https://doi.org/10.1002/(SICI)1097-0142(19980915)83:6<1142::AID-CNCR13>3.0.CO;2-5
  43. Muss HB, Case LD, Richards F 2nd, White DR, Cooper MR, Cruz JM, et al. Interrupted versus continuous chemotherapy in patients with metastatic breast cancer. The Piedmont Oncology Association. N Engl J Med 1991; 325: 1342-8. https://doi.org/10.1056/NEJM199111073251904
  44. Falkson G, Gelman RS, Pandya KJ, Osborne CK, Tormey D, Cummings FJ, et al. Eastern Cooperative Oncology Group randomized trials of observation versus maintenance therapy for patients with metastatic breast cancer in complete remission following induction treatment. J Clin Oncol 1998; 16: 1669-76. https://doi.org/10.1200/JCO.1998.16.5.1669
  45. Veronesi U, Paganelli G, Viale G, Luini A, Zurrida S, Galimberti V, et al. A randomized comparison of sentinel-node biopsy with routine axillary dissection in breast cancer. N Engl J Med 2003; 349: 546-53. https://doi.org/10.1056/NEJMoa012782
  46. Mansel RE, Fallowfield L, Kissin M, Goyal A, Newcombe RG, Dixon JM, et al. Randomized multicenter trial of sentinel node biopsy versus standard axillary treatment in operable breast cancer: the ALMANAC Trial. J Natl Cancer Inst 2006; 98: 599-609. https://doi.org/10.1093/jnci/djj158
  47. Howell A, Cuzick J, Baum M, Buzdar A, Dowsett M, Forbes JF, et al. Results of the ATAC (Arimidex, Tamoxifen, Alone or in Combination) trial after completion of 5 years' adjuvant treatment for breast cancer. Lancet 2005; 365: 60-2. https://doi.org/10.1016/S0140-6736(04)17666-6
  48. Coates AS, Keshaviah A, Thurlimann B, Mouridsen H, Mauriac L, Forbes JF, et al. Five years of letrozole compared with tamoxifen as initial adjuvant therapy for postmenopausal women with endocrine-responsive early breast cancer: update of study BIG 1-98. J Clin Oncol 2007; 25: 486-92. https://doi.org/10.1200/JCO.2006.08.8617
  49. Baum M, Budzar AU, Cuzick J, Forbes J, Houghton JH, Klijn JG, et al. Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early breast cancer: first results of the ATAC randomised trial. Lancet 2002; 359: 2131-9. https://doi.org/10.1016/S0140-6736(02)09088-8
  50. Piccart MJ, Di Leo A, Beauduin M, Vindevoghel A, Michel J, Focan C, et al. Phase III trial comparing two dose levels of epirubicin combined with cyclophosphamide with cyclophosphamide, methotrexate, and fluorouracil in node-positive breast cancer. J Clin Oncol 2001; 19: 3103-10. https://doi.org/10.1200/JCO.2001.19.12.3103
  51. Levine MN, Pritchard KI, Bramwell VH, Shepherd LE, Tu D, Paul N. Randomized trial comparing cyclophosphamide, epirubicin, and fluorouracil with cyclophosphamide, methotrexate, and fluorouracil in premenopausal women with node-positive breast cancer: update of National Cancer Institute of Canada Clinical Trials Group Trial MA5. J Clin Oncol 2005; 23: 5166-70. https://doi.org/10.1200/JCO.2005.09.423
  52. Bang SM, Heo DS, Lee KH, Byun JH, Chang HM, Noh DY, et al. Adjuvant doxorubicin and cyclophosphamide versus cyclophosphamide, methotrexate, and 5- fluorouracil chemotherapy in premenopausal women with axillary lymph node positive breast carcinoma. Cancer 2000; 89: 2521-6. https://doi.org/10.1002/1097-0142(20001215)89:12<2521::AID-CNCR2>3.0.CO;2-F
  53. Mamounas EP, Bryant J, Lembersky B, Fehrenbacher L, Sedlacek SM, Fisher B, et al. Paclitaxel after doxorubicin plus cyclophosphamide as adjuvant chemotherapy for node-positive breast cancer: results from NSABP B-28. J Clin Oncol 2005; 23: 3686-96. https://doi.org/10.1200/JCO.2005.10.517
  54. Henderson IC, Berry DA, Demetri GD, Cirrincione CT, Goldstein LJ, Martino S, et al. Improved outcomes from adding sequential Paclitaxel but not from escalating Doxorubicin dose in an adjuvant chemotherapy regimen for patients with node-positive primary breast cancer. J Clin Oncol 2003; 21: 976-83. https://doi.org/10.1200/JCO.2003.02.063
  55. Eniu A, Palmieri FM, Perez EA. Weekly administration of docetaxel and paclitaxel in metastatic or advanced breast cancer. Oncologist 2005; 10: 665-85. https://doi.org/10.1634/theoncologist.10-9-665
  56. Conlin AK, Seidman AD. Taxanes in breast cancer: an update. Curr Oncol Rep 2007; 9: 22-30. https://doi.org/10.1007/BF02951422
  57. Romond EH, Perez EA, Bryant J, Suman VJ, Geyer CE Jr, Davidson NE, et al. Trastuzumab plus adjuvant chemotherapy for operable HER2-positive breast cancer. N Engl J Med 2005; 353: 1673-84. https://doi.org/10.1056/NEJMoa052122
  58. Hamajima N, Hirose K, Tajima K, Rohan T, Calle EE, Heath CW Jr, et al. Alcohol, tobacco and breast cancer-collaborative reanalysis of individual data from 53 epidemiological studies, including 58,515 women with breast cancer and 95,067 women without the disease. Br J Cancer 2002; 87: 1234-45. https://doi.org/10.1038/sj.bjc.6600596
  59. Deapen D, Liu L, Perkins C, Bernstein L, Ross RK. Rapidly rising breast cancer incidence rates among Asian-American women. Int J Cancer 2002; 99: 747-50. https://doi.org/10.1002/ijc.10415
  60. Minami Y, Tsubono Y, Nishino Y, Ohuchi N, Shibuya D, Hisamichi S. The increase of female breast cancer incidence in Japan: emergence of birth cohort effect. Int J Cancer 2004; 108: 901-6. https://doi.org/10.1002/ijc.11661
  61. Richard MA, Baum M. Dowsett M, et al. Provision of breast services in the UK; the advantage of specialist breast units. Report of a Working Party of the British Breast Group. The Breast Supplement 1994.
  62. Blichert-Toft M, Smola MG, Cataliotti L, O'Higgins N. Principles and guidelines for surgeons-management of symptomatic breast cancer. European Society of Surgical Oncology. Eur J Surg Oncol 1997; 23: 101-9. https://doi.org/10.1016/S0748-7983(97)80001-7
  63. Blamey RW. The British Association of Surgical Oncology Guidelines for surgeons in the management of symptomatic breast disease in the UK (1998 revision). BASO Breast Specialty Group. Eur J Surg Oncol 1998; 24: 464-76. https://doi.org/10.1016/S0748-7983(98)93104-3
  64. Guidance for Purchasers: Improving Outcomes in Breast Cancer-The Manual. Leeds: NHS Executive Publication, 1996.
  65. The requirements of a specialist breast unit. Eur J Cancer 2000; 36: 2288-93. https://doi.org/10.1016/S0959-8049(00)00180-5
  66. SenoNetwork [Internet]. Milan: SenoNetwork; 2010 [cited 2010 June 25]. Availavle from: http://www.senonetwork.org/.
  67. Merck B, Cansado P, Fernandez-Frias A, Rodriguez- Lescure A, Costa D, Lacueva FJ, et al. Application of the EUSOMA criteria in breast units in countries of the European Union. Cir Esp 2005; 77: 65-9. https://doi.org/10.1016/S0009-739X(05)70809-5
  68. European Board and College of Obsetricians and Gynaecologists (EBCOG) and European Society of Gynaecological Oncology (ESGO). Subspecialist training programme in Gynecological Oncology [Internet]. Brussels: Postgraduate training and assessment working Party of EBCOG in cooperation with ESGO; c2009 [cited 2010 June 25]. Availavle from: http://www.esgo.org/Education/Documents/1-ESGO-EBCOG_Subspecialty_Training_Programme_ inGO.pdf.
  69. Beckmann MW, Gitsch G, Emons G, Berg D, Kaufmann M. Qualification and education in gynecological oncology. Zentralbl Gynakol 2006; 128: 1-4. https://doi.org/10.1055/s-2006-921359
  70. Cibula D, Kesic V. Surgical education and training in gynecologic oncology I: European perspective. Gynecol Oncol 2009; 114(2 Suppl): S52-5. https://doi.org/10.1016/j.ygyno.2009.02.021
  71. Cataliotti L, De Wolf C, Holland R, Marotti L, Perry N, Redmond K, et al. Guidelines on the standards for the training of specialised health professionals dealing with breast cancer. Eur J Cancer 2007; 43: 660-75. https://doi.org/10.1016/j.ejca.2006.12.008