DNA Fingerprints Provide a Patient-Specific Breast Cancer Marker

ANNOTATED BIBLIOGRAPHY Effect of a Computer-Based Decision Aid on Knowledge, Perceptions, and Intentions About Genetic Testing for Breast Cancer Susceptibility: A Randomized Controlled Trial Green MJ, Peterson SK, Baker MW, et al

Reference 1. Newman LA, Sahin AA, Cunningham JE, et al: A case-control study of unilateral and bilateral breast carcinoma patients. Cancer 91:1845-1853, 2001.

JAMA 292:442-452, 2004 Green and colleagues deserve kudos for evaluating a new therapeutic intervention in a well-designed randomized clinical trial. They evaluated a computer-based decision aid for genetic testing of women either at high risk and at low risk of developing breast cancer. The effectiveness of this new computer-based intervention was compared with that of standard genetic counseling on a human-tohuman basis. Essentially, the authors found the computer aid produced better information transfer, and they surmised that this probably was because the women could learn at their own pace using different formats of their own choosing. However, the computer aid did not take the place of the genetic counselors, who were much better at individualized risk assessment and at dealing with anxiety and other psychosocial problems. Although the generalizability of the use of this computer-aided counseling may be limited, to me the take-home message is that this novel program is an effective method for sharing knowledge transfer and, when used with expert genetic counseling, will likely provide improved care. However, even though the authors feel that the computer program has the potential to stand alone as an educational intervention, I do not think that it will replace the counselors, even for women at low risk of developing breast cancer. D. R. McCready, MD, MSc, FRCSC

Contralateral Breast Cancer: Factors Associated With Stage and Size at Presentation Mertens WC, Hilbert V, Makari-Judson G Breast J 10:304-312, 2004 Using the Baystate Medical Center tumor registry, Mertens and colleagues identified and analyzed patients with unilateral breast cancer who later developed contralateral breast cancer between 1980 and 1999. Their findings in this study largely confirmed those of others, indicating that most second breast cancers are detected at earlier stages than the initial tumor. These findings are consistent with the impact of screening and the close follow-up of patients after a first cancer diagnosis. In a study conducted by The University of Texas M. D. Anderson Cancer Center,1 we similarly found that nearly 90% of contralateral tumors were detected at an earlier stage than were the initial cancers. The survival analysis in the study by Mertens and colleagues also revealed that survival was similar for patients with unilateral versus bilateral breast cancer and was dictated by the stage of the first cancer. Collectively, the M. D. Anderson and Baystate reports support the utility of close surveillance for patients with breast cancer; prophylactic contralateral mastectomy would decrease the risk of a second tumor but would not be likely to affect overall survival. L. A. Newman, MD, MPH

Variation in Estradiol, Estradiol Precursors, and EstrogenRelated Products in Nipple Aspirate Fluid From Normal Premenopausal Women Chatterton Jr RT, Geiger AS, Khan SA, et al Cancer Epidemiol Biomarkers Prev 13:928-935, 2004 Although nipple aspirate fluids have been analyzed in a systematic fashion for more than 50 years, interest in this area has been renewed as more and more powerful technologic advancements allow the contents of this fluid to be analyzed in more exacting detail. One interesting finding from this investigation of nearly 50 women at Northwestern University is that correlations in the levels of estradiol and estrogen-related products were lower between breasts than within breasts. This finding supports the notion that local factors have an important role in determining the relative concentration of these substances in the breast, and it has implications for carcinogenesis as well as for monitoring the effects of potential novel chemopreventive agents. I have no doubt that analyses of breast ductal fluids will play a pivotal role in the selection of optimal chemopreventive and therapeutic strategies in the future. H. M. Kuerer, MD, PhD

DNA Fingerprints Provide a Patient-Specific Breast Cancer Marker Toth-Fejel SE, Muller P, Ham B, et al Ann Surg Oncol 11:560-567, 2004 The development of a simple blood test that could detect the presence of systemic breast cancer would likely revolutionize the adjuvant and surgical treatment of breast cancer. Several investigators have used various techniques to approach this concept. Toth-Fejel and colleagues chose an approach that uses patient-specific tumor DNA fingerprinting that may be able to identify patients with large numbers of circulating tumor cells. This is an early report, and the technique in its current form seems to have significant limitations. The authors are presently working to improve upon their current results and to determine how the technique might best augment our current “tool kit” for breast cancer research, detection, prevention, and treatment. Patient-specific tumor DNA fingerprinting may ultimately prove most useful in drug development. Using this technique, TothFejel and co-investigators have already identified thousands of abnormal base-pair fragments that were present in the tumors of the patients they evaluated. In the future, these data may prove useful in the development of novel therapies for the targeted treatment of specific types of breast cancer. D. R. Brenin, MD

®

Breast Diseases: A Year Book Quarterly Vol 16 No 1 2005

29 29