• Breast cancer incidence among women increased 1.8 percent per year from 1973 to 1990, but remained level from 1990 to 1995.

• An estimated 178,700 American women will be diagnosed with breast cancer during 1998.

• Breast cancer death rates dropped 1.9 percent per year from 1990 to 1995 in white and Hispanic women.

• About 43,500 American women will die as a result of breast cancer this year.

Accomplishments

• Mastectomy has been replaced by less radical surgery for many women with early stage breast cancer.

• Chemotherapy or hormonal therapy in addition to surgery has improved overall survival for many breast cancer patients.

• For early stage disease, studies have shown that long-term survival after lumpectomy plus radiation therapy is similar to survival after modified radical mastectomy.

• Improved mammography screening and imaging technologies like ultrasound and computed tomography are now used during diagnosis, sparing some women surgical biopsies.

• Scientists have found that alterations in two important genes, BRCA1 and BRCA2, are associated with most inherited breast cancers.

• The first genetically-engineered antibody therapy for advanced breast cancer, Herceptin® (Trastuzumab), has been approved by the Food and Drug Administration (FDA).

• Tamoxifen, taken for five years, has been shown to reduce the risk of recurrence of breast cancer.

• The Breast Cancer Prevention Trial, a study of the use of tamoxifen as a breast cancer prevention agent, showed that tamoxifen reduced the incidence of breast cancer by 49 percent in women at high risk of the disease. On Sept. 2, 1998, the FDA's Oncologic Drug Advisory Committee recommended approving tamoxifen for reduction of breast cancer risk in high-risk women.

Ongoing Research

• Molecular markers are being developed to detect signs of breast cancer in blood, urine, or nipple fluid. Unique identifiable characteristics of a particular cancer will make it easier to choose appropriate treatments and predict the outcome.

• NCI-sponsored trials with Herceptin are now under way in breast and ovarian cancer and other solid tumors. Additional studies are planned to test the new drug in other types of cancer and in combination with other agents.

• A large-scale study is set to begin in early 1999 to compare five years of tamoxifen to five years of raloxifene for the prevention of invasive breast cancer in high-risk women. Nearly 200 institutions across the United States are expected to participate in the study of 22,000 post-menopausal women over age 35. The study is known by the acronym STAR (Study of Tamoxifen and Raloxifene).

• NCI is comparing high-dose chemotherapy with autologous bone marrow or stem cell transplants to standard therapy to determine whether it is more or less effective in treating breast cancer.

• NCI is funding a study, known as the Triana Community Health Initiative, to look at the possible relationship between exposure to the pesticide DDT and risk for breast cancer and non-cancerous breast conditions among heavily exposed women in Triana, Ala.

• NCI has established the Cancer Genetics Network, a national network of centers specializing in the study of inherited predisposition to cancer, including breast cancer. The network will support collaborative investigations into the genetic basis of cancer susceptibility, explore mechanisms to integrate this new knowledge into medical practice, and identify means of addressing the associated psychosocial, ethical, legal, and public health issues. The network will also facilitate the exchange of information on cancer genetics and research resources and provide broad access to information about genetics services and educational materials.

• NCI has established a Cooperative Family Registry for Breast Cancer Studies to collect family history information, epidemiologic and clinical data, and biological specimens from individuals at high, intermediate, and low risk for breast cancer and their families. A long-term objective of the registry is to prevent or delay breast cancer development in genetically susceptible people through increased knowledge about the genetic and lifestyle factors modulating cancer susceptibility and understanding of their interactions. A second objective is to identify an at-risk population that could benefit from novel treatment strategies.

• In mammography research, NCI is funding studies to reduce the already low radiation dosage in mammograms, enhance image quality, and develop and evaluate digital mammography as an improvement over conventional, film-based techniques. In addition, NCI is funding studies on computer-assisted interpretation of digitized images, and on enabling long-distance image transmission technology, or teleradiology, for clinical consultations. NCI also funds research on other imaging technologies such as magnetic resonance imaging (MRI) and breast-specific positron emission tomography (PET) to detect the disease.

• NCI is organizing a multicenter trial of sentinel node biopsy, a surgical technique in which only one or a few under-arm lymph nodes are removed during mastectomy or lumpectomy. The trial will determine whether the technique is as safe and effective as more extensive lymph node removal, which is now standard.

• About 2 million American women are breast cancer survivors. New studies seek to understand the physical, social, and emotional issues confronting these women. That understanding will help develop counseling and education networks.

Education and Outreach

• NCI has developed a computer program that allows health care providers to project a woman's risk of breast cancer over a five-year period and over her lifetime. The program is designed to assist in medical counseling about the use of tamoxifen, the drug shown to reduce the risk of breast cancer in the Breast Cancer Prevention Trial.

• NCI has developed information for doctors to help women between ages 40 and 50 decide when to begin having regular mammograms. A paper published in the September issue of the Journal of Clinical Oncology describes methods to determine a woman's individual risk for breast cancer.

• NCI will continue to support the national education campaign Not Just Once, But For a Lifetime launched last October to increase awareness of the importance of mammography screening for all women in their 40s and older.

• NCI and the U.S. Public Health Service Office on Women's Health have produced and disseminated a booklet and fact sheet on genetic testing for breast cancer. The two agencies are also promoting and disseminating a video on genetic testing produced by the National Action Plan on Breast Cancer.

• NCI and the Health Care Financing Administration (HCFA) have partnered to expand NCI's Not Just Once, But For a Lifetime national education campaign to increase awareness of the importance of regularly scheduled mammography screening for women 65 and older and the expanded Medicare benefit. The campaign will be launched in October and a joint announcement and background information will be distributed to the media, particularly those targeting older, minority and underserved populations, and to the Cancer Information Service and HCFA's regional networks.

• The U.S. Postal Service's (USPS) new breast cancer research "semipostal stamp" went on sale this summer at the nation's 32,000 post offices. The stamp, which is valid for postage at the 32-cent, first-class rate, sells for 40 cents. The additional 8 cents, less USPS costs, will be donated to breast cancer research, with 70 percent of the proceeds going to the National Institutes of Health and 30 percent to the medical research program of the Department of Defense. In addition, American Express announced Aug. 17 that, through October, the company will donate 5 cents to NCI every time the American Express card is used to make any purchase at a post office. American Express will donate a maximum of $100,000 and a minimum of $50,000. In addition, the company will be partnering with more than 430 retailers and 40 malls throughout the country during October to raise additional funds for breast cancer research.

• The NCI's Cancer Information Service (CIS), a national information and education network, provides the latest, most accurate cancer information for patients, the public, and health professionals. Approximately 25 percent of all CIS calls are related to breast cancer. Specially trained staff provide the latest scientific information in understandable language, and will provide the location of the caller's nearest FDA certified mammography facility. CIS staff answer questions in English and in Spanish and distribute NCI materials. The toll free number for the CIS is 1-800-4-CANCER (1-800-422-6237). People with TTY equipment may call 1-800-332-8615. Through its Outreach Program, the CIS reaches the medically underserved, including minority groups and people with limited access to health information. The CIS has numerous partnerships with state and regional organizations that serve these audiences focused on breast health education.

• A new Web site at the NCI helps women consider whether to enter a clinical trial for the treatment of their cancer. Launched in May 1998, the Web site quickly helps women and their doctors sort through the hundreds of research studies under way on breast cancer to find those of interest to them. The Web site address is http://cancertrials.nci.nih.gov.

For more information about cancer visit NCI's Web site for patients, public and the mass media at http://rex.nci.nih.gov or NCI's main Web site at http://www.nci.nih.gov.