Introduction: late effects of treatment and surviorship issues in early-stage breast carcinoma

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SINCE THE EARLY 1990s, population-based studies have shown that the incidence of breast cancer is leveling off, and breast cancer mortality is decreasing. As a welcome consequence of these trends, there are more than 2 million breast cancer survivors currently in the United States alone, millions more worldwide, and the majority of women treated for breast cancer today will be long-term survivors. This serves to underscore the importance of several aspects of survivorship research, namely, recognizing the specific problems of survivorship and their relationship to specific treatments, identifying individuals at higher (or lower) risks of developing these problems, and evaluating interventions to treat the problems of breast cancer survivors.

Based on existing information, most breast cancer survivors do not seem to have significant health impairments, and studies show that the overall quality of life returns to the pretreatment baseline measured at 1 to 2 years after completing therapy. However, there is little doubt that for some women the diagnosis and treatments prescribed for breast cancer will have long-lasting effects on physical and psychological functioning. For example, adjuvant chemotherapy primarily results in reversible short-term side effects such as alopecia, lowering of the blood counts, and fatigue. Other side effects with potential for long-term adverse health consequences include early menopause, weight gain, and cognitive dysfunction. For some women, psychological and sexual difficulties predominate, and these tend to be under-reported and unrecognized.

In this issue of Seminars in Oncology, we have assembled a collection of papers authored by those who have contributed to survivorship research. Each contribution addresses a specific topic of relevance to breast cancer survivors, including cardiac, cognitive, nutritional, skeletal, secondary malignancy, psychosocial/sexual, estrogen deficiency symptom management, and follow-up care. We also have included a personal story from one who is both a researcher (in survivorship) and a breast cancer survivor. Beyond providing a review of the literature, our intent was to raise awareness among health care providers about these survivorship issues, and to highlight what we do and do not know about these issues. We hope that the latter will prove particularly useful in responding to questions from women about survivorship issues, and contribute toward a more informed discussion about the risks and benefits of breast cancer treatment. Lastly, we did not intend this issue to comprehensively cover all there is to address about breast cancer survivorship. The chapters chosen primarily reflect the Editors’ interests and priorities, with full recognition that equally relevant topics were left out.

We have many to thank for making this issue possible. The authors of these chapters who put up with us, Dr Michael Mastrangelo, Editor of Seminars of Oncology, for his Job-like patience, our wives and families, and especially the women for whom we provide care who continually inspire us with their grace and courage.