A Representative Clinical Course of Progression, with Molecular Insights, of Hormone Receptor-Positive, HER2-Negative Bone Metastatic Breast Cancer

Despite treatment advances, breast cancer remains a leading cause of death of women in the United States, mostly due to metastatic disease. Bone is a preferential site for breast cancer metastasis, and most metastatic breast cancer patients experience bone involvement at the time of death. The majority of patients with bone metastatic breast cancer are first diagnosed with and treated for early-stage disease, and from development of early-stage breast cancer to the recurrence of cancer in the bones, up to 30 years may elapse. Throughout this timeframe, a typical patient undergoes many treatments that have effects on the bone microenvironment. Therefore, this review explores the clinical course of a representative patient with hormone receptor-positive bone metastatic breast cancer, examining key treatment options at each stage and their effects on preventing and treating bone metastases

Sex steroids, bone loss and non-vertebral fractures in women and men : the Tromsø study

When this thesis was planned in 2000-2001 it was well known that bone loss accelerates after menopause, and is prevented by using hormone replacement therapy (HRT). Case reports of young men with estrogen receptor dysfunction or aromatase deficiency showed that estrogen was important for normal growth and maturation of the male skeleton. However, there were few prospective studies examining the contribution of endogenous sex steroids on bone loss and fracture risk in women, and no prospective study in men. We wanted to know if levels of sex steroids were relevant as predictors of bone loss and fractures and whether this knowledge could be useful for developing future treatment by low dose of HRT. During the work on this thesis results from a large randomized controlled trial assessed the risks and benefits of estrogen plus progestin treatment in 16,608 healthy postmenopausal women. The investigators concluded that the overall health risks exceeded benefits from the use of estrogen plus progestin in this group. They estimated hazard ratios with 95% confidence interval as follows: coronary heart disease 1.29 (1.02- 1.63); breast cancer 1.26 (1.00-1.59); stroke 1.41 (1.07-1.85); pulmonary embolism 2.13 (1.39-3.25); colorectal cancer 0.63 (0.43-0.92); endometrial cancer 0.83 (0.47-1.47) and hip fracture 0.66 (0.45-0.98). This publication led to a reassessment of the role of HRT, which was no longer recommended in women for fracture risk reduction alone. Left unresolved was the question whether women and men with low levels of circulating sex steroids have higher risk of bone loss or fractures. This was still relevant for our understanding of the contribution of sex steroids on bone fragility. From a clinical point of view it was interesting to know, if sex steroids are relevant predictors of bone loss or fractures, if these measurements could be useful in signalling the need for further investigation or treatment

Mammography

In this volume, the topics are constructed from a variety of contents: the bases of mammography systems, optimization of screening mammography with reference to evidence-based research, new technologies of image acquisition and its surrounding systems, and case reports with reference to up-to-date multimodality images of breast cancer. Mammography has been lagged in the transition to digital imaging systems because of the necessity of high resolution for diagnosis. However, in the past ten years, technical improvement has resolved the difficulties and boosted new diagnostic systems. We hope that the reader will learn the essentials of mammography and will be forward-looking for the new technologies. We want to express our sincere gratitude and appreciation?to all the co-authors who have contributed their work to this volume