Research on Causes
Research on Prevention
Research on Detection and Diagnosis
Research on Treatment

Research has led to important advances in breast cancer. Doctors all over the country are conducting many types of clinical trials (research studies in which people volunteer to take part). These are studies of new ways to prevent, detect, diagnose, and treat breast cancer. Researchers are also studying the psychological effects of the disease and ways to improve a patient's comfort and quality of life.

Clinical trials are designed to answer important questions and to find out whether the new approach is safe and effective. Often, clinical trials compare a new method with a widely accepted approach.

People who join clinical trials have the first chance to benefit from new approaches. They also make an important contribution to medicine by helping doctors learn more about the disease. Although clinical trials may pose some risks, researchers take many steps to protect their patients.

Women who are interested in being part of a clinical trial should talk with their doctor. They may want to read the NCI booklets Taking Part in Clinical Trials: What Cancer Patients Need To Know or Taking Part in Clinical Trials: Cancer Prevention Studies. The NCI also offers an easy-to-read brochure called If You Have Cancer…What You Should Know About Clinical Trials. These NCI publications describe how clinical trials are carried out and explain their possible benefits and risks.

NCI's Web site includes a section on clinical trials at http://cancer.gov/clinical_trials with general information about clinical trials as well as detailed information about specific ongoing studies of breast cancer. The Cancer Information Service at 1-800-4-CANCER or LiveHelp at http://cancer.gov can answer questions and provide information about clinical trials. Another source of information is the NCI's Cancer Trials Support Unit (CTSU), which enables many more doctors and their patients to take part in large clinical trials. Patients can learn more about the trials at http://www.ctsu.org.

Research on Causes

The main known risk factors for breast cancer are listed in the Breast Cancer: Who's at Risk? section. Scientists are trying to learn more about other factors that may increase the risk of breast cancer, including:

• Diet: Some evidence suggests a link between diet and breast cancer. Women whose diets are rich in fruits and vegetables have a lower risk of getting breast cancer. Women whose diets are low in fat also seem to have a lower risk. More research is needed to better understand the types and amounts of fat that raise cancer risk. Researchers also are studying dietary supplements that may reduce the risk of breast cancer.
• Hormonal factors: In addition to the reproductive and menstrual history risk factors described earlier, other hormonal factors are under study. Scientists are studying how hormones, in general and during pregnancy, influence the development of breast cancer.
• Environmental factors: Researchers are studying whether certain substances in the environment can increase the risk of breast cancer.
• Not enough exercise: Scientists continue to study the effect of physical activity on the risk of breast cancer.

Research on Prevention

Scientists are looking for drugs that may prevent breast cancer. In one large study, the drug tamoxifen reduced the number of new cases of breast cancer among women who were at an increased risk of the disease. Doctors are now studying whether the drug raloxifene is as effective as tamoxifen. This study is called STAR (Study of Tamoxifen and Raloxifene). STAR includes women who are over age 35, have gone through menopause, and are at increased risk of the disease.

Research on Detection and Diagnosis

At this time, mammograms are the most effective tool we have to detect changes in the breast that may be cancer. A very large study is comparing the accuracy of standard mammography to that of digital mammography, which uses a computer (rather than x-ray film) to store the image of the breast. The images are displayed on a computer monitor and can be enhanced (lightened or darkened). Because the images can be adjusted, the doctor may be better able to detect abnormal tissue.

Researchers are also exploring other techniques, such as magnetic resonance imaging (MRI) and positron emission tomography (PET), to produce detailed pictures of the tissues in the breast.

In addition, researchers are studying tumor markers. These are substances that may be present in abnormal amounts in people with cancer. Tumor markers may be found in blood or urine, or in fluid from the breast (nipple aspirate). Some markers may be used with breast cancer patients to check for signs of disease after treatment. At this time, however, no tumor marker test is reliable enough to be used routinely to detect breast cancer.

Ductal lavage also is under study. This technique collects samples of cells from breast ducts. A catheter (a very thin, flexible tube) is inserted into the opening of a milk duct on the surface of the nipple. A salt water solution is put into the milk duct through the catheter. When the solution is withdrawn, it contains cells from inside the ducts. These cells are checked under a microscope to look for breast cancer or changes that may suggest an increased risk of cancer.

Research on Treatment

Researchers are studying surgery, radiation therapy, chemotherapy, hormonal therapy, biological therapy, and combinations of these types of treatment.

• Surgery: Different types of surgery are being combined with other treatments.
• Radiation therapy: Doctors are testing treatment with and without radiation therapy.
• Chemotherapy: Researchers are testing new anticancer drugs and doses. They are working with various drugs and drug combinations. They also are looking at ways of combining drugs before surgery and at new ways of combining chemotherapy with hormonal therapy or radiation therapy.
• Hormonal therapy: Researchers are testing several types of hormonal therapy, including aromatase inhibitors.
• Biological therapy: New biological approaches also are under study. For example, researchers are studying cancer vaccines that help the immune system kill cancer cells.

In addition, researchers are exploring ways to lessen the side effects of treatment (such as lymphedema from surgery), reduce pain, and improve the quality of patients' lives. One procedure under study is called sentinel lymph node biopsy. Researchers want to know whether this procedure can reduce the number of lymph nodes that are removed during surgery. First, a radioactive substance and a blue dye are injected into tissue near the tumor. These substances flow through the lymphatic system to the first lymph node or nodes where cancer cells are likely to have spread (the "sentinel" node or nodes). To find the sentinel node, the surgeon looks for the dye and uses a scanner to locate the radioactive substance. The surgeon removes only the node or nodes containing the radioactive substance or blue dye. A pathologist checks the sentinel lymph nodes for cancer cells. If sentinel lymph node biopsy proves to be as effective as the standard axillary lymph node dissection, the new procedure could reduce the chance of developing lymphedema.

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