Breast Cancer
On this page:
- Biology and Genetics
- Risk Factors
- Prevention
- Early Detection, Diagnosis, and Prognosis
- Treatment
- Cancer Control, Survivorship, and Outcomes Research
Despite significant advances in detection, diagnosis, treatment, and prevention, breast cancer continues to have a devastating impact on American women. By the end of 2003, an estimated 211,300 women are expected to be diagnosed with breast cancer and nearly 39,800 will die of the disease. An estimated 2 million women in the United States have either survived breast cancer or are living with breast cancer today.
SEER data indicate that breast cancer is responsible for the highest number of new, invasive cancer cases among women each year and, after lung cancer, the second leading cause of cancer deaths in women. The increase in breast cancer incidence that began in the early 1980s continues today, although this increase has slowed dramatically since 1987. Despite this improvement, recent years have shown an increased incidence in women over the age of 50. Overall, breast cancer mortality rates also have shown an encouraging downward trend, dropping 1.4 percent per year from 1989 to 1995 and 3.2 percent per year thereafter. This trend suggests that improved breast cancer management, from early detection to treatment, is having a beneficial effect. The largest decrease in mortality occurred in young, white and African-American women. Currently, white women exhibit greater incidence than African American women, but lower mortality rates.
NCI's Breast Cancer Progress Review Group released a report in 1998 that evaluated the current state of breast cancer research, identified research gaps and resource needs, and developed recommendations for future research priorities to move the field ahead. In 2003, an internal working group at NCI will begin a review of the progress of the national breast cancer research program over the last 5 years by looking at disease trends, new FDA-approved interventions; clinical trials, both new and ongoing; advances in scientific knowledge, and NCI supported research activities.
Biology and Genetics
Molecular Profiling. DNA array technology is being used to establish molecular profiles of gene expression in a series of breast cancer specimens and normal, at-risk, breast. The analysis results in an easily visualized clustering of specimens that have similar patterns of gene expression and provides a relative measure of the similarity of the expression patterns between any two specimens. Identification of clusters of genes that are expressed in different cell types or are associated with cell proliferation have demonstrated that this technology will allow exploration of potentially important interactions between different cell types in tumors.
Mouse Models. NCI sponsors a number of projects such as the MMHCC, to develop, analyze, and apply mouse cancer models. Significant improvements in the technology of modeling human breast cancer in mice have resulted in models that more accurately mimic the human situation in which genetic alterations occur in a subset of somatic cells. Mouse models have facilitated the investigation of distinct pathways involved in breast cancer, important for cancer prevention and therapeutic studies and for target validation in cancer drug discovery.
Estrogen Receptors. Estrogens influence the growth, differentiation, and function of the human reproductive system and stimulate the proliferation and metastatic activity of nearly 40 percent of breast tumors. Estrogen receptor (ER) expression seems to correlate with prognosis and may provide targets for therapy. Treatments such as tamoxifen and raloxifene, which block ERs, do not seem to affect ER negative tumors, found in 20 to 30 percent of all breast tumors and more prevalently in women under age 50, in black women at all ages, and in women at risk due to alterations in the BRCA1 gene. Animal models of ER-negative breast cancer may lead to strategies for preventing ER-negative disease. Other studies are examining possible correlations between tumor cell characteristics, age, race, reproductive status, and lifestyle issues and ER status.
Cyclin E. Cyclin E, a key cell cycle regulator involved in the control of the initiation of both DNA replication and centrosome duplication, is often overexpressed in a variety of malignant tumors, including breast, gastric, and ovarian and appears to correlate with a more aggressive breast cancer phenotype and a poorer patient outcome. Recent studies in cell lines show that cyclin E overexpression leads to chromosomal instability and polyploidy, and along with patient analyses, suggest that cyclin E expression may be a powerful prognostic indicator for survival for patients with breast cancer.
Gene Mutations. Fifteen to 20 percent of familial breast cancers can be accounted for by germ-line mutations in the breast cancer susceptibility genes BRCA1 and BRCA2. Estimates of the lifetime risk of breast cancer among women with BRCA1 or BRCA2 vary from 56 percent to as high as 80 percent to 85 percent (as opposed to a 12 percent lifetime risk for most women). These women have an increased risk of ovarian cancer as well. Studies in Ashkenazi Jewish women diagnosed with breast cancer, 7 percent of whom carry mutations in BRCA1 and BRCA2, have found that early birth in women with BRCA mutations does not confer protection against later breast cancer. Investigators in NCI's Cancer Genetics Network (CGN) are examining whether hormonal factors and genes involved in hormone metabolism, carcinogen metabolism, and DNA repair modify risk for cancer in women who with BRCA1 and 2 mutations.
Rare germ-line mutations in p53 and CHK2 (Li-Fraumeni syndrome), PTEN (Cowden syndrome) and the serine threonine kinase STK11/LKB1 (Peutz-Jegher syndrome) account for another small fraction of the familial cases. Genes for the remaining familial clusters are unknown and may be caused by low-penetrance susceptibility genes. Causes for sporadic cancers are not clear, but many genes that contribute to growth and apoptosis have been found to be deregulated in sporadic breast cancer.
The Cancer Genome Anatomy Project coordinates data and reagents that will support advances in molecular detection and diagnosis with the goal of providing a complete picture of all major molecular changes that occur during cancer development. CGAP currently has information on nearly 20,000 cDNA sequences for normal and malignant breast, which include 400 genes unique to breast.
Specimen Resources. NCI Cooperative Breast Cancer Tissue Resource provides researchers with access to approximately 9,000 cases of formalin fixed, paraffin embedded breast cancer tissue samples with associated pathology and clinical data, particularly well suited to validation studies of diagnostic and prognostic markers.
Risk Factors
Genetic Factors. The Breast and Ovarian Cancer Family Registries include information and laboratory specimens from over 6,000 families at risk and support investigations in genetic epidemiology, including the identification and characterization of genes, gene-gene interactions, and gene-environment interactions. The CGN, a group of collaborative clinical centers of excellence in cancer genetics, participate in the development and testing of interventions to better prevent, detect, and treat breast cancer among individuals at high risk.
Diet. It has been hypothesized that estrogen-like compounds in soy foods influence the risk of breast cancer. A population-based case-control study among women in China found that soy food consumption appears to lower the risk of breast cancer. High soy and dietary folate intake during adolescence were associated with reduced risk of breast cancer later in life. This effect appeared to be strengthened by increased dietary intake of methionine, vitamin B12, and vitamin B6. There is conflicting data on the association between dietary fat and breast cancer risk. Studies are ongoing, although a recent analysis showed no overall association.
Obesity. Before menopause, obese women are at a decreased risk for breast cancer. Post menopause, the same obese women have an increased risk for breast cancer, which is ameliorated by hormone therapy. The roles of caloric intake and energy balance are under investigation. Limited studies in African American women have shown reduced obesity-associated risks for breast cancer. The Four Corners Breast and Endometrial Cancer Study is investigating obesity and weight change effects on breast and endometrial cancer among minority women, while the Black Women's Health Study is focusing on risk factors for breast cancer that include obesity.
Breast Changes. Case-control studies have shown that increased mammographic breast density, atypical hyperplasia, and nonproliferative benign disease increase the risk for breast cancer. Women who have breast fed one or more children have a slightly reduced risk of breast cancer compared with parous women who have not breast fed.
Other Lifestyle Factors. The Health, Eating, Activity, and Lifestyle (HEAL) study, begun in 1996, is designed to explore the associations among physical activity, eating habits, weight patterns, diet, hormones, prognostic factors, and the differences in these associations among various racial and ethnic groups in relation to risk for breast cancer.
Diethylstilbestrol (DES). Women given DES during pregnancy showed a modest, but statistically significant increase in breast cancer risk which was not exacerbated by family history, use of oral contraceptives, or hormone therapy. A study of DES-exposed daughters showed a slight, not statistically significant, increase in risk for invasive breast cancer, and also for ER positive tumors in women over 40, but not in younger women.
Hormones. Estrogen, essential for the normal growth and development of the breast and reproductive tissues, childbearing, and regulation of the menstrual cycle may play a role in carcinogenesis. Lifetime exposure to estrogen has been linked to an increased risk for breast cancer. Progestins, acting with estrogen, bring about mammary gland proliferation. The role of progestins in breast cancer etiology has been examined in the context of oral contraceptives and postmenopausal hormone use. Prolactin, a polypeptide hormone, essential for the development of mammary glands and for lactation, enhances the rates at which mammary tumors develop in animals.
A population based case-control study of breast cancer in Asian women living in the U.S. found that endogenous hormone levels varied with differences in degree of westernization and that aspects of hormone metabolism may play a role in population differences in breast cancer incidence. Other studies of endogenous sex hormones have shown strong correlations between increased levels and increased risk for breast cancer in postmenopausal women.
Postmenopausal Hormone Use. Recent studies on postmenopausal hormone use and breast cancer have suggested that length of use and the type of postmenopausal hormone therapy, estrogen alone versus an estrogen/progestin combination, may be important factors. A recent reanalysis of data from more than 50 studies on breast cancer showed an increased risk of breast cancer in women who used postmenopausal hormone therapy (estrogen only) for longer than 5 years. Risk increases with the length of hormone use but decreases after a woman stops taking hormones.
After estrogen alone was linked with an increased risk for endometrial cancer, many women began using estrogen/progestin combination therapy. In July 2002, NIH stopped early the Women's Health Initiative multicenter clinical trial of estrogen plus progestin in 16,608 healthy menopausal women who had not had a hysterectomy. Mid-trial results showed adverse health effects, including a 26 percent increase in breast cancer risk (or 8 additional breast cancers per 100,000 women); and a higher risk for developing heart attacks, strokes, and blood clots in the legs and lungs. Although the estrogen plus progestin therapy yielded benefits, including fewer cases of hip fractures and colon cancer, on balance the harm was greater than the benefit. Increased breast cancer risk has not been found in the ongoing study of estrogen-only (in women who already had a hysterectomy before joining the study)
Oral Contraceptives. The Women's Contraceptive and Reproductive Experiences (Women's CARE) study, a population-based, case-control study involving over 9,000 women ages 35-64 found that oral contraceptive use was not associated with a significant increase in risk of breast cancer. A 2002 study concluded that women with BRCA1 mutations who had used oral contraceptives for 5 or more years had a 33 percent increased risk of breast cancer. Those women in the study who used oral contraceptives before the age of 30, who had been diagnosed with breast cancer before age 40, or who used early types of oral contraceptives (before 1975) had a higher risk of breast cancer. Carriers of BRCA2 mutations did not show the increased risk with oral contraceptive use. Other studies have suggested that long-term use of oral contraceptives before first pregnancy increases risk.
Environmental Factors. NCI research programs are investigating the links between breast cancer and exposures to pesticides, air pollution, drinking water contaminants, electromagnetic and ionizing radiation, and lifestyle and other factors. A major thrust of current research work is focused on biomarker approaches (genetic, molecular, cellular, and tissue or organ specific) as one way to assess internal dose. Research is being conducted to measure the estrogenicity of environmental chemical exposures. Markers of exposure are being developed and validated. Current research includes identification of geographic areas with increased breast cancer incidence, morbidity, and mortality and potential contributions of local environmental factors. Of particular concern has been the relationship to risk of organochlorine products, which are established endocrine disrupters. Investigators in the Division of Cancer Epidemiology and Genetics (DCEG) have undertaken several studies in populations uniquely exposed, including a study in India, where DDT is still used, and in occupational groups such as farmers, dry cleaners, and formaldehyde workers.
The Long Island Breast Cancer Study Project (LIBCSP) is an NCI and NIEHS multistudy effort to investigate whether environmental factors are responsible for breast cancer in specific counties in New York and Connecticut. Scientists have found no evidence supporting an association between organochlorines, including the pesticide DDT, its metabolite DDE and industrial compounds known as PCBs; and heightened risk of breast cancer. Exposure to air-polluting polycyclic aromatic hydrocarbons in the environment appears to elevate women's risk of breast cancer, but women with a higher ratio of 2-hydroxyestrone had decreased risk of breast cancer by a modest 50 percent. Further analyses and a follow-up study are in progress. A case-control study is investigating the possible association between electromagnetic fields and increased risk for breast cancer. Findings from this study are expected in mid- to late 2003. In 2001, NCI completed development of a prototype health-related geographic information system (GIS-H) for Long Island that provides researchers with a new advanced tool to investigate relationships between breast cancer and the environment on Long Island.
Recently, a joint NCI, NIEHS, and CDC task force developed several strategies to address the high breast cancer rates in Marin County, California, including recalculating and comparing breast cancer rates for Marin County and all of California, enhancing existing GIS in California, completing epidemiologic studies on breast cancer in Marin County, and partnering with the CDC to explore opportunities and technologies for measuring environmental exposures.
Radiation. Current research in the Radiation Epidemiology Branch focuses on the specific effects of diagnostic, therapeutic, and occupational exposure to ionizing radiation, a known risk factor for breast cancer, in established cohorts such as X ray technologists, ataxia telangiectasia carriers, and A bomb survivors. Multidisciplinary investigations are focusing on genetic susceptibility to radiation carcinogenesis and the interactions of radiation dose, hormonal factors, and genetic factors. Scientists have found that women with scoliosis (abnormal curvature of the spine) who were exposed to multiple diagnostic X rays during childhood and adolescence have a 70 percent higher risk of breast cancer than women in general. Nonionizing radiation (electromagnetic field) exposure has been hypothesized to affect breast cancer risk through changes in melatonin levels that affect estrogen secretion. Current research is measuring electromagnetic field exposure in several cohorts, including teachers in California, nurses, X-ray technologists, who have the potential for cumulative exposures up to as much as 0.2 Gy, and radiation technologists.
Prevention
Chemoprevention. Many breast cancer prevention studies are testing the effectiveness of selective estrogen receptor modulators (SERMs), such as tamoxifen and raloxifene.
One of the largest breast cancer prevention studies ever undertaken, the Study of Tamoxifen and Raloxifene (STAR), has enrolled 15,000 of a planned 19,000 participants through more than 500 centers across the United States, Puerto Rico, and Canada. The study will determine whether the drug raloxifene, which is used for osteoporosis prevention and treatment and previously shown to reduce breast cancer incidence, is as effective as tamoxifen in reducing the risk of breast cancer. The long term safety of both drugs will be studied. Thirty percent more minority women have joined the study than in the preceding Breast Cancer Prevention Trial of tamoxifen. The Capital Area SERM Study is evaluating the safety of raloxifene in premenopausal women who are at increased risk for breast cancer.
Women at high risk for breast cancer, especially premenopausal women, who took the drug tamoxifen were less likely to be diagnosed with benign breast conditions, such as atypical hyperplasia, than women at equal risk who took a placebo. The results of the 2001study are part of the follow-up for the Breast Cancer Prevention Trial.
Prophylactic Surgery. Studies published in 1999, found that prophylactic mastectomy was associated with a reduction in incidence of breast cancer of at least 90 percent among women with a family history of the disease. Similarly, other recent studies have found that prophylactic mastectomy, salpingo oophorectomy (removal of the ovaries and fallopian tubes) or oophorectomy (removal of the ovaries) reduced the number of cases of breast cancer in women with alterations in BRCA1 or 2. A study of breast cancer among Swedish women who had breast reduction surgery found that removal of greater amounts of tissue reduced breast cancer risk dramatically.
Early Detection, Diagnosis, and Prognosis
Imaging Technologies. NCI is funding research on a variety of technologies for breast imaging, including digital mammography, elastography, magnetic resonance imaging (MRI), magnetic resonance spectroscopy, ultrasound techniques, positron emission tomography (PET), single photon emission computed tomography (SPECT), and thermography. Projects studying PET and SPECT involve the development of imaging agents designed to look at molecular, biological, or metabolic characteristics, such as radiolabeled estrogen-like compounds to indicate the overexpression or location of estrogen receptors.
Optical-imaging techniques provide information about the presence and amount of various chemicals in tissue. Optical technologies using the near-infrared region of the spectrum, combined with MRI, may allow sensitive and specific detection of breast abnormalities. Thermography (digital infrared imaging) can detect the increase in regional breast temperature resulting from increased chemical and blood vessel activity in both precancerous tissue and the area surrounding a developing breast cancer.
Mammography. NCI is funding research to reduce the already low radiation dosage of mammography; enhance mammogram image quality; develop statistical techniques for computer-assisted interpretation of images; enable long-distance, electronic image transmission technology (telemammography/teleradiology) for clinical consultations; and improve image-guided techniques to assist with breast biopsies. Computer-enhanced images in digital mammography can detect suspicious areas that human review might miss. In 2001, NCI and the American College of Radiology Imaging Network launched the Digital Mammographic Imaging Screening Trial (DMIST) to compare digital mammography to standard film mammography.
MRI. Several large studies are examining the application of MRI in the detection of breast cancer to reduce the number of false-positive X-ray mammograms that lead to biopsy. MRI in combination with near-infrared optical imaging is being evaluated for heightened sensitivity and specificity in breast abnormality detection.
Other Imaging Initiatives. Ongoing studies of the NCI-supported American College of Radiology Imaging Network, include a study of breast MRI to assess response to chemotherapy prior to surgery and a study partially supported by the Avon cosmetics company to study ultrasound for screening. The Small Animal Imaging Resource Program supports studies to develop and apply a wide variety of functional, quantitative imaging modalities through partnerships with industry.
Gene Expression Profiles. Studies in the Director's Challenge program have distinguished five subsets of breast cancers, previously unidentified by morphology. Two of the subsets, HER2/neu overexpressing and basal cell tumors, correspond to poor prognosis.
Population-Based Breast Screening. The Breast Cancer Surveillance Consortium works to reduce breast cancer mortality by enhancing current understanding of breast cancer-screening practices and fostering collaborative research in the hope of improving the practice of community-based mammography screening.
The International Breast Cancer Screening Network (IBSN), a consortium of 25 countries that have active population-based screening mammography programs, is dedicated to collaborative research aimed at identifying and fostering efficient and effective approaches to breast cancer control worldwide through population-based screening mammography.
NCI, in partnership with the Centers for Medicare and Medicaid Services, the National Asian Women's Health Organization, the CIS, and Asian community organization, recently released educational brochures in English, Chinese, Vietnamese, and Tagalog, to encourage Asian-American/Pacific Islander women in their 40s and older to get mammograms every 1 to 2 years using Medicare benefits for screening.
Sentinel Node Biopsy. The status of lymph node involvement is likely to gain increased clinical significance in the future as improved imaging techniques detect growing numbers of women who have small tumors. NCI is sponsoring two large trials comparing long-term survival for patients assessed using the less invasive technique of sentinel node biopsy with those having complete axillary lymph node dissection, which has a number of associated serious, long term side effects. The studies will also compare the postsurgical side effects between the two groups.
Treatment
Proteomics. A new clinical proteomics program investigates new methods to diagnose cancer earlier and monitor the protein status of a patient before, during, and after treatment for cancer by generating a protein "fingerprint" Potential benefits include developing individualized therapies using targeted treatments; preclinical assessment of the toxic and beneficial effects of treatments; earlier diagnosis; and improving the understanding of tumors at the protein level to develop more effective treatments.
Adjuvant TherapyTamoxifen. In the October 2002, investigators with the National Surgical Adjuvant Breast and Bowel Project (NSABP) reported that women with very small breast tumors who received both radiation therapy and the drug tamoxifen after surgery had fewer recurrences of cancer in the same breast than women who received either radiation therapy or tamoxifen, but not both. This supports treating most women with early breast cancers with radiation therapy following conservative surgery. Additionally, women with ER-positive tumors benefit from tamoxifen treatment, suggesting that tumor size as well as tumor type, hormone sensitivity, and the woman's general health need to be considered when making treatment decisions.
Fulvestrant. The drug tamoxifen is effective against breast cancer by binding to estrogen receptors, but not in all tumors and for a limited time in others. High levels of the proteins, HER-2 and AIB1 in combination, seem to make tumors in some women more resistant to tamoxifen. Fulvestrant, effective against tamoxifen-resistant tumors, attaches to the ER but, unlike tamoxifen, destroys the receptor, thereby blocking all estrogen activity. The FDA recently approved fulvestrant for treatment of tamoxifen-resistant, ER positive breast cancers. Fulvestrant was recently shown to be as effective as anastrozole, an aromatase inhibitor, in treating postmenopausal women with advanced, previously treated breast cancers. It is not yet known whether fulvestrant is effective in premenopausal women.
Aromatase Inhibitors. A new class of drugs, aromatase inhibitors (AIs), have been shown to be effective in treating advanced, ER and progesterone receptor positive breast cancer, and also show promise as adjuvant therapy for early breast cancer. The FDA has approved anastrozole (Arimidex©) for adjuvant treatment of breast cancer based on the results of the Arimidex, Tamoxifen, Alone or in Combination trial of early breast cancer, which compared 5 years of treatment with tamoxifen alone, anastrozole alone, or the two drugs together, after initial surgery. Anastrozole has been shown to be as effective as tamoxifen as a first-line treatment for advanced breast cancer, extending length of time to disease progression, with fewer side effects. Another AI, letrozole (Femara®), has also received FDA approval for treatment of postmenopausal women with hormone-sensitive advanced breast cancer.
Combination Therapy. PACCT has developed a trial to identify patients with low-risk and early-stage disease who will not benefit from systemic adjuvant chemotherapy. Intermediate and high-risk participants with node-negative, hormone receptor-positive tumors between 1 to 3 cm will be treated with endocrine therapy plus or minus systemic chemotherapy.
"Dose Dense" Chemotherapy. Commonly used drugs in breast cancer treatment when administered under a dose dense regime, with increased frequency and the addition of filgrastim to prevent neutropenia showed decreased disease recurrence and significant survival benefits for patients in a study of node-positive women. Side effects were not found to be more severe in the dose dense groups.
Herceptin®. Trastuzumab (Herceptin) with standard chemotherapy, shown to be effective for the treatment of metastatic breast tumors that overexpress the HER2/neu protein, is now being studied in earlier stages of breast cancer. Several new Phase 3 clinical trials, which should have results in 2006 or 2007, are testing the addition of Herceptin to the postsurgery treatment of earlier stage breast cancer with standard chemotherapy agents (Adriamycin® and Cytoxan®) and Taxol®. Herceptin's effect on the heart is being assessed, since earlier studies suggested that it could cause problems in some women.
High Dose Chemotherapy with Stem Cell Transplant. The final analysis of data from one of the major U.S. trials of high-dose chemotherapy with stem cell transplant for breast cancer shows that it holds no survival advantage over intermediate-dose therapy. Early results from two other trials add to the growing evidence that high-dose regimens do not increase breast cancer survival. Several large, randomized trials are still ongoing. The current recommendation is that women should receive high dose chemotherapy with transplant only as part of a high priority clinical trial so that they can be followed for several years after treatment.
Effectiveness of Shorter Radiation Treatment. Results of a new study among node-negative lumpectomy treated women shows that reducing daily radiation therapy from 5 weeks to 3 weeks is equally effective in preventing cancer recurrence. Shortened radiation schedules lessen the overall burden for these patients in terms of personal costs, travel, and time off work, and for the health care system by reducing costs and freeing resources for use by more patients. The results of the study can only be applied to the subgroup of women in the trial.
Effectiveness of Lumpectomy Compared to Mastectomy. Two longitudinal studies, one initiated in the 70's and the other in the 80's report that women with early breast cancers, treated with breast conserving surgery plus radiation therapy were as likely to be alive and disease free 20 years later as women treated with mastectomy.
Other Research. Other ongoing therapeutic research includes studies of gene therapy strategies that target key stages of the cell cycle such as programmed cell death by using adenoviral vectors to transfer specific genes; use of angiogenesis inhibitors; chemoprotection by making drug resistant bone marrow cells to reduce potential bone marrow toxicities; immunotherapies designed to stimulate antitumor responses; and complementary and alternative medicine.
Cancer Control, Survivorship, and Outcomes Research
NCI's Office of Cancer Survivorship (OCS) conducts and supports research that both examines and addresses the long- and short-term physical, psychological, social, and economic effects of cancer and its treatment among survivors of cancer and their families. For example, we know that patients exposed to systemic chemotherapy are at increased risk for problems with cognitive functioning (e.g., memory, concentration, executive capacity) and some may be genetically more susceptible to this chronic effect of treatment.
Treatment Decisions. NCI's Office of Education and Special Initiatives and NCI's Office of Women's Health have partnered with the National Center for Policy Research for Women and Families, the Agency for Health Research Quality, the Office of Women's Health, Department of Health of Human Services, and the Office of Research on Women's Health, NIH, to develop education and communication materials to assist women with early-stage breast cancers and their health care providers to make informed treatment decisions. Information provided, will describe the standard surgical options of mastectomy and lumpectomy plus radiation, and the factors that can be considered when making treatment choices.
The OCS supports development of tailored print and interactive health communications, such as the Comprehensive Health Enhancement Support System, which provides a computer-based system of integrated services designed to help individuals cope with a health crisis or medical concern. This system has resulted in several important outcomes, including reduced hospital days.
Pain, Depression, and Fatigue. These were the focus of a July 2002 NIH State of the Science meeting, Symptom Management in Cancer, examining the current state of knowledge on the management of pain, depression, and fatigue in individuals with cancer, and identified directions for future research. The final statement of the conference is available online.
Health Disparities and Cancer Survivors. NCI is supporting projects, 3 of which are on breast cancer, in Cancer Centers to promote research in cancer survivorship among minorities and underserved populations in their communities after the completion of initial treatment, and/or the families of such patients; to strengthen linkages between researchers and community representatives; and to disseminate research findings to targeted community and members of the Cancer Center. NCI is also funding projects on issues such as menopausal symptom relief in breast cancer patients, breast cancer and function in aging women, and quality of life in long-term cancer survivors.
