Is the breast-conserving treatment with radiotherapy appropriate in mutation carriers? Long-term results and review of the literature

International audienceAs tumours in mutation carriers might be more sensitive to radiation, we investigated after long-term follow-up whether mutation status influenced the rate of ipsilateral and contralateral breast cancers after breast-conserving treatment (BCT). and genes were screened for germline mutations in 131 patients with a family history of breast and/or ovarian cancer who had undergone BCT and radiotherapy. Patients were matched to 261 controls with sporadic breast cancer according to age at diagnosis and year of treatment. Controls were followed up for at least as long as the interval between diagnosis and genetic screening in familial cases. Rates of ipsilateral and contralateral cancer between groups were compared by the log-rank test. The mutations occurred in 20.6% of tested patients. Tumours in mutation carriers were more likely to be grade III ( < 10) and oestrogen receptor negative ( = 0.005) than in non-carriers and controls. Overall median follow-up was 161 months. There was no significant difference in ipsilateral tumours between mutation carriers, non-carriers and controls ( = 0.13). On multivariate analysis, age was the most significant predictor for ipsilateral recurrence ( < 10). The rate of contralateral cancer was significantly higher in familial cases: 40.7% (mutation carriers), 20% (non-carriers), and 11% (controls) ( < 10). After 13.4 years of follow-up, the rate of ipsilateral tumours was no higher in mutation carriers than in non-carriers or controls. As tumours in mutation carriers might be more sensitive to radiation, BCT is a possible treatment option

Lack of sufficient information on the specificity and selectivity of commercial phytoestrogens preparations for therapeutic purposes

Phytoestrogens (PEs) are polyphenols of plant origin among which flavones, flavanones, isoflavones, coumarins, chalcones, lignans and stilbenes are the best representatives. By interacting with specific residues of the estradiol-binding pocket of estrogen receptors (ERs), they induce estrogenic responses, supporting the concept that they could be of benefits against the menopausal disorders due to endogenous estradiol depletion. According to literature data, PEs target a panel of proteins, suggesting that their effects are not limited to ER-dependent transcription pathways. In this regard, commercial preparations usually contain a mixture of compounds of which nature and concentration are not specified. Such mixtures being freely accessible and escaping thereby medical survey, they could exert unwanted effects, depending on their qualitative and quantitative composition as well as the physiopathological status of the women. This work outlines the necessity to inform consumers of the exact nature of these PEs preparations. Moreover, women who want to take PEs should inform their practitioner to be under strict medical survey. In the case of hormone-dependent cancer antecedents or predispositions, use of PEs is extremely inadvisable. © 2010 Elsevier Ireland Ltd. All rights reserved.SCOPUS: re.jinfo:eu-repo/semantics/publishe

Controversies concerning the use of phytoestrogens in menopause management: Bioavailability and metabolism

It has been proposed that the use of phytoestrogens (PE) in menopausal therapy could be beneficial to woman health, particularly with respect to hot flushes. Indeed, PE may compensate the lack of endogenous 17β-estradiol occurring during menopause. However, therapeutic benefits remain questionable, as highlighted by recent publications. Indeed, data are often subjected to controversy since a number of exogenous and endogenous factors influencing the responsiveness of patients are not sufficiently taken into account. In the present paper, we will discuss the role of bioavailability and metabolism in the instability of individual response to PE. © 2009 Elsevier Ireland Ltd. All rights reserved.SCOPUS: re.jinfo:eu-repo/semantics/publishe

A critical view of the effects of phytoestrogens on hot flashes and breast cancer risk

The increased risk of breast cancer recently observed with some specific estro-progestin associations has raised concerns about the harmful effects of menopausal hormone replacement therapy (HRT). It has been proposed that phytoestrogens (PEs), which have a similar chemical structure to estrogens, could be used as HRT. The main selling points of these preparations concern the management of hot flashes and their potential beneficial effects on breast tissue. In this review, we will address the effects of PE on hot flashes and breast cancer risk as well as the questions raised on a chemical point of view. We conclude that the efficacy of a PE rich diet or nutritional supplements is not clearly established. The use of PE as an alternative for HRT cannot be advocated for now, due to insufficient and conflicting data on efficacy and safety. Moreover, due to the hormone dependence of breast cancer, PE use must be contraindicated in breast cancer survivors. © 2011 Elsevier Ireland Ltd. All rights reserved.SCOPUS: re.jinfo:eu-repo/semantics/publishe