Breast malignancy

Risks associated with oral contraceptive use have been shown for women who begin using them before age 25 and before their first full-term pregnancy. The effectiveness of chemoprevention is being studied. Screening may reduce mortality by 30% in women aged 50 to 69. Breast-conserving lumpectomy is indicated for small tumors. In some postmenopausal node-positive patients, a combination of hormonal and chemotherapy may be useful. In metastatic breast cancer, dose-intensification of chemotherapy has been investigated. Palliative treatment involves tamoxifen. Analysis of steroid hormone receptor status involves fine-needle aspiration, enzyme immunoassay, and a new autoradiographic procedure using radiolabeled estrogens. Prognostic factors under study include oncogene amplification, urokinase plasminogen activator level, expression of growth factors and growth factor receptors, proliferation parameters such as ploidy and S-phase fraction, mutations, and cathepsin D levels.