The centenary of the discovery of radium]

Henri Becquerel presented the discovery of radium by Pierre and Marie Curie at the Paris Académie des Sciences on 26th December 1898. One century later, radium has been abandoned, mainly for the reason of radiation safety concerns. It is, however, likely that modern techniques of brachytherapy are the successors of those designed for radium sources, and that radium has cured thousands and thousands patients all over the word for about 80 years. The history of discovery and medical use of radium is summarised.     

Breast conservation in the 21st century

As breast cancers are diagnosed at increasingly early stages, and there is little biological rationale for mastectomy in most patients, breast conservation is likely to be practised with increased frequency in the future. Newer breast imaging techniques, particularly magnetic resonance imaging (MRI), should contribute to improved pretherapy planning, both aiding in the selection of patients for conservation approaches, and estimating the residual tumour burden following minimally invasive surgical interventions. Image-guided tumour mapping may permit local treatment to be individualised, most importantly allowing definition of subgroups not requiring treatment directed at the whole breast. Moreover, interventional radiology opens new possibilities for focalised treatments, which may come to be employed in the management of small lesions. The increasing use of primary chemo- or chemoendocrine therapy will also tend to favour the option of breast conservation. Functional imaging techniques, including MRI, may prove valuable in the assessment of response to medical therapy, allowing more individualised use of radiotherapy and surgery. Technical progress and the development of biological response modifiers may further improve the therapeutic ratio associated with radiation treatment.     

CMF revisited in the 21st century

Over the last 35 years, classical CMF (combination chemotherapy with cyclophosphamide, methotrexate and fluorouracil) has been a milestone in the adjuvant treatment of women with breast cancer. However, after an early burst of success lasted just over 10 years, classical CMF has been supplanted by ‘third-generation’ regimens containing taxanes and anthracyclines. Questions have been raised in the past years concerning the true effectiveness of adjuvant CMF for specific subgroups of patients and particularly, recent retrospective data support the fact that the CMF might have a role in the treatment of patients with triple-negative breast cancer. One possible justification for supporting this role of CMF may be sought in the mechanism of action of drugs used in the regimen, as triple-negative cells may be sensitive to alkylating agents that cause double-strand breaks in DNA. The lesson learned from the CMF could lead us to identify new combinations of drugs that could include the optimal chemotherapy backbone for triple-negative breast cancer such as platinum compounds or alkylating agents or Poly (ADP-ribose) polymerase inhibitors. In conclusion, although we have learned a lot from the use of CMF, many questions are still open and hopefully stimulate our thinking, as clinicians, leading us to find new and more effective ways to treat breast cancer.     

Cancer-related anaemia management in the 21st century

Anaemia has a high prevalence and incidence in patients with cancer receiving chemotherapy and is associated with a range of symptoms, including fatigue, drowsiness, depression, dyspnoea, tachycardia and dizziness. Fatigue, in particular, exerts a considerable impact on patient quality of life, affecting 80-100% of patients receiving chemotherapy and, potentially, delaying treatment. Until recently, red blood cell transfusions were the mainstay of treatment for cancer-related anaemia. While effective in ameliorating symptoms, transfusions are associated with short-lived benefits and a risk of infections and disease transmission. The development of the erythropoiesis-stimulating agent (ESA), recombinant human erythropoietin (rHuEPO), resulted in a 50% reduction in the number of transfusions required in anaemic cancer patients receiving chemotherapy. The subsequently introduced rHuEPO analogue, darbepoetin alfa, stimulates erythropoiesis by the same mechanism as rHuEPO but is associated with a prolonged serum half-life, allowing extended dosing intervals and less frequent administration. With the introduction of a number of ESAs and a growing wealth of data concerning their indications, dosing regimens and safety, European cancer organizations have recently developed guidelines for their effective use in clinical practice.     

Rabies vaccines: from the past to the 21st century

Since the first development of a rabies vaccine by Pasteur in the late 19th century, second- and third-generation vaccines with improved efficacy and less reactogenicity have been developed for use in humans and animals. Despite the availability of safe but rather expensive vaccines based on inactivated virus propagated in diploid cell cultures, much of the human vaccinations worldwide are still carried out with nerve tissue-containing vaccines, which have various side effects. A number of experimental vaccines are under development that may provide alternative safe and potent but less expensive vaccine options. These include DNA vaccines, recombinant viral vaccines, and recombinant protein vaccines. Further testing is needed to determine if and which one of these novel vaccines will make their way into mass production and application in the future.     

Epidemiology and prevention of Breast Cancer in the 21 st century

The incidence and mortality of breast cancer are high in Western industrialized countries and relatively low in Japan and other Asian countries. In Japan the incidence and mortality of breast cancer have gradually been increasing. Marrying later, having fewer children, a larger intake of fat, dairy products and meats and a larger body mass index in menopausal women may be related to the increased incidence of breast cancer in Japan. A review of risk factors identified from recent epidemiological studies in Japan indicates that obesity after 50 years of age is an important risk factor for postmenopausal breast cancer. Future estimations of cancer mortality and incidence predict that breast cancer will further increase to become a leading cancer in Japan in the 21 st century.     

New strategies for cancer therapy in the 21st century

The development of new anticancer drugs, radiation therapy devices, and surgical techniques has improved the survival and quality of life of cancer patients. Despite these advances, many adverse events prevent patients from receiving treatment in comfort, and a majority of patients die from recurrent disease. The limitations of treatment in terms of effectiveness and tolerability have driven researchers to develop new strategies to reduce treatment-related toxicity and improve the survival rates of cancer patients.     

21世纪乳腺癌治疗的展望

乳腺癌是女性最常见的恶性肿瘤之一,20世纪末的统计资料表明全世界每年约有130万人诊断为乳腺癌,而有40万人死于该病.同样在20世纪的最后10年里中国大陆京、津、沪等大城市的乳腺癌的发病率也已位居女性恶性肿瘤的第一、二位.尽管目前对乳腺癌病因的认识还不充分,但是回首过去100年乳腺肿瘤学的发展历程,我们还是取得了丰硕的成果.