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 Editor-in-chief: Gian Paolo Andreoletti, MD

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Comment

  • "The 21-gene assay in early-stage breast cancer" - David B. Geffen,  Department of Oncology, Soroka University Medical Center and the Faculty of Health Sciences, Ben Gurion University of the Negev. Beer Sheva, Israel
     
    "The prognosis of early stage estrogen receptor positive breast cancer is generally very good and the average benefit of adding adjuvant chemotherapy to adjuvant endocrine therapy is small but exists. The 21-gene recurrence score (RS) assay has been validated through the use of retrospective studies as prognostic of distant disease recurrence and predictive of the benefit of adding chemotherapy. We evaluated the impact of using the test in our practice, a university based group of oncologists who have a uniform treatment policy. For a high risk RS, chemotherapy was recommended, for a low risk, endocrine therapy alone and for intermediate risk, treatment based on traditional clinicopathologic factors with help from Adjuvant!on-line. In this retrospective analysis of 135 patients whom we tested with the 21-gene RS between 2006- 2009, in 25 % of patients we changed recommendation after obtaining results. Most changes were in the direction of not giving chemotherapy (70% of changes). A somewhat surprising finding was that 29 % of the 49 patients for whom we recommended chemotherapy after obtaining the RS, refused chemotherapy. The RS substantially reduced the number of patients receiving chemotherapy but we need to improve our patients' understanding of the implications of the test"  
    (Comment on:  Geffen DB et al.: "The impact of the 21-gene recurrence score assay on decision making about adjuvant chemotherapy in early-stage estrogen-receptor-positive breast cancer in an oncology practice with a unified treatment policy", Ann Oncol. 2011 Mar 1. [Epub ahead of print])

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Fragments of History

  • Charles H. Moore:, Royal Medical and Chirugical Society, London, 1867: “On the influence of inadequate operations on the theory of cancer", Med Chir Trans, 1867, 32: 245-80: “Taught without doubt by foregoing failures, our surgical ancestors adopted a method of operating which might well have been expected to prove effectual against a local recurrence of the disease. They transfixed the base of the mamma, and, raising it with ligatures, swept off the whole organ, together with all the skin that covered it. The proceeding had a barbarous appearance enough, but it was promising; and, if their knowledge of the disease had led the Surgeons of the time to adopt it before the skin was hopelessly infiltrated, they must have met with more success than they appear to have done. Postponing, however, all operation until the skin was brawny and covered with tubercles, and the deeper textures were involved without limit, they failed too often, with even such extensive cutting as they adopted, to comprehend the entire disease. It was a mistaken kindness which led to a change of this mode of operating. Under the influence of a clergyman, who expressed what must have been a prevailing horror at such Amazonian surgery, the practice was changed to an incision in the integument, which was reflected in flaps and brought together again after the removal of the cancerous tumour. There could have been no diminution of suffering by this prolongation of the operation, and what was gained by it in neatness was lost in life."

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