Breast cancer is a common disease. Over 180,000 new cases are reported each year. Research on breast cancer is moving rapidly and new treatments are constantly under evaluation.

There are many "reported" risk factors for developing breast cancer. Women with early onset of menses, late menopause and no children appear to be at increased risk. The use of oral contraceptives may increase the risk very slightly. The use of estrogen replacement therapy, after menopause, has been controversial, but at worse may only raise the risk of developing breast cancer slightly. Family history is important. Women with a close relative, such as mother, sister, or maternal/paternal grandmother are at increased risk. Inheritance of the BRCA1 is associated with a strong risk (70-90%) and the BRCA2 gene is associated with early breast cancer and male breast cancers. Diets high in fat content are also reported to be associated with breast cancer risk. Women who have more than two glasses of alcohol per day are also at risk. Radiation exposure increases the risk of breast cancer. Benign breast masses containing proliferative changes are also suggested to impart an increased risk of subsequent breast cancer.

Recently the use of tamoxifen has been suggested to reduce the risk of breast cancer among high-risk women.

Early detection may find breast cancer when it is still curable. Monthly self breast exams are an important part of a woman’s general health routine. Asymptotic women should begin screening mammography by the age of 50 and should continue every 1-2 years. Earlier mammograms have been recommended starting at age 40, although this remains controversial.

There are many different types of breast cancer. The most common type is adenocarcinoma. Lobular breast cancers account for 5-10% of cancers; these may affect both breasts together. Medullary cancers affect younger women. Mucinous cancers affect older women.

There are several important factors that help determine prognosis. Patients with larger tumors have a higher chance of tumor spread. Similarly involvement of lymph nodes under the armpit correlates with the risk of tumor spread. Women with hormone receptor positive (estrogen or progesterone) tumors may respond favorably to hormonal treatments. Other poor prognostic factors include high proliferative index (S-phase), undifferentiated tumors, and over-expression of Her-2/neu oncogene.

After obtaining a diagnosis of breast cancer, the next step is determining the extent of tumor spread. Stage I tumors are small (0-2 cm) and have not spread to the lymph nodes or distant sites. Stage II tumors are larger and may involve lymph nodes. Stage III tumors are large, involve lymph nodes (causing matting), and/or cause redness of the breast. Stage IV tumors have spread to distant sites such as the liver, bone, brain, lung or other vital organs.

The prognosis is determined largely by the tumor stage. Once breast cancer has spread (Stage IV) the cancer may be treatable, but is generally not considered to be curable. Therefore, efforts to detect and treat Stage I-III tumors are paramount.

Treatment of breast cancer is complex and constantly changing. Early stage tumors are treated with surgery with/without radiation. Chemotherapy and/or hormonal treatments (such as tamoxifen) may be used to decrease the risk of spread. Advanced tumors may be treated with chemotherapy, hormones, immunotherapy, radiation, surgery and other modalities.

Stem cell and bone marrow transplantation has been used to treat both high-risk early breast cancers and metastatic (spread) tumors.

Metastatic Disease Treatments with Transplantation

The use of high-dose therapy for women with breast cancer has been an active area of research over the past decade. This treatment continues to generate much controversy, but also appears to offer hope to women with advanced disease. To date only one study has directly compared standard dose treatment with transplant therapy, and this trial noted superiority to the transplant treatment. (Bezwoda WR et al: Journal of Clinical Oncology 1995; 13:2483). In this study 90 women with newly diagnosed breast cancer were treated with either standard dose chemotherapy or transplantation chemotherapy. The median survival for the women receiving transplantation therapy was double that of the women receiving standard dose therapy (90 weeks versus 45 weeks). At 3 years, approximately 20% of the responding transplantation patients remain alive. A recently completed United States Intergroup trial is comparing transplantation with standard chemotherapy. The results of this important trial are eagerly awaited.

The Adult Stem Cell- Bone Marrow Transplant Program of Hackensack University Medical Center has active transplant treatment protocols for this disease. For more information on this treatment or to schedule an appointment call (201) 996-5849.

One trial is seeking to determine if induction chemotherapy (chemotherapy given before the transplant) is necessary. One intriguing study has suggested that delaying transplant for approximately 3 months following standard chemotherapy may improve outcomes. We are questioning whether the induction chemotherapy induces a temporary chemotherpay resistance. This study is also using a novel purging technique to reduce potential tumor contamination in the stem cell product. It is hoped that a combination of positive and negative selection techniques will result in tumor free stem cells that can rescue the patients from the high-dose chemotherapy. For more information on this unique trial click here.

Women who have already received chemotherapy for metastatic disease may be eligible to participate in a trial of ex-vivo bone marrow expansion. This study uses bone marrow that has been "grown" in the laboratory in conjunction with the high-dose transplant chemotherapy. It is hoped that this marrow will have less chance of tumor contamination. For more information on ex-vivo expansion, check out the stem cell laboratory section.

Hackensack University Medical Center’s Blood and Marrow Stem Cell Program also has other transplant treatments for metastatic breast cancer including the high-dose cyclophosphamide, thiotepa, and carboplatin rescued by G-CSF mobilized peripheral stem cells.

Women who have relapsed following a prior autologous transplant may be eligible for an allogeneic transplant from an HLA-matched brother/sister donor. A unique trial using "submyeloablative" chemotherapy is designed to capitalize on a potential graft-versus-tumor effect.

In addition to the transplant studies, the physicians at the Northern New Jersey Cancer Center are experienced in the diagnosis and treatment of this disease. The Cancer Center also has non-transplant research studies for patients with metastatic disease including: (1) Weekly Taxol treatment, (2) rhuMAbHER2 monoclonal antibody for metastatic breast cancer patients who have failed 3 or more chemotherapy treatments, (3) Oral powdered shark cartilage, and (4) Phase III trial of Marimastat versus placebo in patients with metastatic breast cancer who have responding or stable disease after induction chemotherapy. For more information about these studies call (201) 996-5800.

High Risk (4-9 lymph node, 10 or more lymph node, and Inflammatory) Breast Cancer Treatments with Transplantation

Women who have multiple lymph node involvement or inflammatory breast cancer are at high risk of having their breast cancer spread. A recent "historical" comparison of women receiving standard chemotherapy with transplant chemotherapy has suggested a benefit to the transplant. (Peters WP et al: Journal of Clinical Oncology 1993: 11:1132). At 2.5 years, 38-52% of women who received standard dose therapy were doing well, compared to 72% among women who underwent transplantation. Two direct comparison trials for women with 10 or more lymph node involvement have recently been completed. The results of these trials are eagerly awaited.

The Adult Stem Cell- Bone Marrow Transplant Program of Hackensack University Medical Center has active transplant treatment protocols for this disease. For more information on this treatment or to schedule an appointment call (201) 996-5849.

One trial is comparing transplantation with aggressive sequential chemotherapy in women with 4-9 involved lymph nodes.

Women with inflammatory breast cancer, or 10 or more lymph nodes, may be eligible to participate in a trial of ex-vivo bone marrow expansion. This study uses bone marrow that has been "grown" in the laboratory in conjunction with the high-dose transplant chemotherapy. It is hoped that this marrow will have less chance of tumor contamination. For more information on ex-vivo expansion, check out the stem cell laboratory section.

Hackensack University Medical Center’s Blood and Marrow Stem Cell Program also has other transplant treatments for high-risk breast cancer including the high-dose cyclophosphamide and thiotepa rescued by G-CSF mobilized peripheral stem cells. For more information on this treatment call (201) 996-5849.

In addition to the transplant studies, the physicians at the Northern New Jersey Cancer Center are experienced in the diagnosis and treatment of this disease. The Cancer Center also has non-transplant research studies for patients with non-metastatic disease including: (1) Intensive adriamycin-cyclophosphamide plus tamoxifen versus conventional cyclophosphamide-methotrexate-flurouracil plus tamoxifen in node negative, estrogen receptor negative breast cancer, (2) Randomized phase III trial of sequential chemotherapy (adriamycin-taxol-cyclophosphamide) or concurrent chemotherapy (adriamycin-cyclophosphamide) followed by taxol in node positive Stage II/III breast cancer, (3) Octreotide plus tamoxifen with or without chemotherapy in node negative, estrogen receptor positive breast cancer, (4) Tamoxifen in node negative, occult invasive breast cancer treated with lumpectomy, (5) Randomized comparison of tamoxifen with or without fenretinade in post-menopausal women with involved lymph nodes and positive estrogen receptors, (6) Randomized trial comparing pre-operative AC chemotherapy versus pre-operative AC followed by pre-operative taxotere versus pre-operative AC followed by post-operative taxotere. For more information about these trials call (201) 996-5800.