The changing face of survivorship.
Around 46,000 women are diagnosed with breast cancer each year in the UK, and the incidence is still rising. Although there are some 12,000 deaths per year from breast cancer, the survival rate has improved steadily since the 1950s: current 10-year estimates suggest that around 75% of women are successfully treated, and this figure is set to rise further.
The most recent evidence, based on patients diagnosed up to 2004, suggests that there are over half a million women alive in the UK who have had a diagnosis of breast cancer. Most of these patients will not suffer relapse but live with the consequences of treatment, including possible late effects of surgery, endocrine therapy, radiotherapy, chemotherapy and, increasingly, biological therapy.
This issue of Advances in Breast Cancer includes in-depth reviews of a number of the important areas that are relevant to women surviving breast cancer.
Nigel Bundred discusses the effects of endocrine agents such as aromatase inhibitors (AIs) given long term, and the effect on bone health. He points out the importance of assessing risk factors for premature osteoporosis--and of recognising that the majority of fractures occur in osteopaenic women on AIs, and we need to better diagnose and manage this group.
Alison Jones highlights the problem of infertility after systemic therapy for breast cancer and the fact that the increasing age at which women experience childbirth means these problems are more relevant than ever before. She gives important guidance on the impact of chemotherapy on fertility, and covers the issues surrounding pregnancy after a diagnosis of breast cancer.
Mark Verrill reviews an area of increasing concern: cardiac health. As many patients now undergo systemic chemotherapy and some also receive adjuvant trastuzumab with increasing chances of long-term survival, so the potential for late cardiac effects becomes greater. He highlights the important types of cardiac dysfunction, their consequences and possible therapeutic interventions. Also covered are very significant new cardiac guidelines for patients receiving adjuvant trastuzumab.
Finally, Jane Maher and Debbie Fenlon present a wide-ranging review of the psychosocial aspects of long-term survival in breast cancer patients, starting with a very helpful discussion about the term 'survivorship'. Particularly important to recognise is the sense of abandonment felt by many patients when they complete their primary treatment, and how this might be alleviated. They end on a positive note--that, despite all these potential problems, many breast cancer survivors do report positive growth and an increased appreciation of life following treatment, with re-evaluation of their world in general!
Correspondence to: Peter Barrett-Lee
Academic Breast Unit
Velindre Cancer Centre
Cardiff CF14 2TL
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|Publication:||Advances in Breast Cancer|
|Date:||Jul 1, 2010|
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