It is projected that by there could be 27 million people with cancer leading to more than 17 million cancer deaths each year. India had over 10 lakh new cancer cases and 6. Cancer happens due to the uncontrolled growth of the cells that are the basic building blocks of the body. Cancer occurs whenever a fault or a mutation happens in a gene. Mutations are caused by the natural processes in our cells, and by various other risk factors such as tobacco smoke, radiation exposure, ultraviolet radiation from the sun, diet, chemicals in our environment etc.
Sometimes people inherit certain faulty genes from their parents which put them on an increased risk of developing cancer. Scientific advancements in molecular biology and genetics of cells have triggered the discovery of a novel approaches for an improved diagnosis as well as management of this disease. The improved understanding of various genes responsible for causing certain cancers has triggered the discovery and development of targeted therapies.
Radiation is also recommended for patients who have 1—3 positive nodes and other risk factors for local—regional recurrence, such as lymphovascular invasion, young age, high-grade tumors, or hormone receptor—negative breast cancer The past decade has seen advances in techniques for the delivery of postoperative radiation that aim to preserve high rates of local control but shorten overall treatment time, reduce cost, and improve convenience of care.
Hypofractionation is the use of radiation treatments with fewer, larger doses than the conventional radiation fraction sizes of 1. Hypofractionated whole-breast irradiation WBI has been firmly established as a standard of care for postlumpectomy radiation for early-stage breast cancer, in large part because of the favorable y results of 4 prospective randomized trials from Canada and the United Kingdom 75 , These trials showed equal y local control as well as comparable or better cosmetic outcomes and late toxicities with hypofractionation.
One of the issues regarding more widespread acceptance of WBI has been the relatively low accrual into the 4 major trials of certain subgroups of patients, such as those younger than 50 y and requiring a boost or systemic chemotherapy. The Radiation Therapy Oncology Group completed a phase III randomized trial RTOG of hypofractionated WBI with a concurrent boost that had the goals of expanding the use of hypofractionation by enrolling a patient population broader than that enrolled in the existing hypofractionated WBI studies and further reducing the treatment time to only 3 wk.
Accelerated partial breast irradiation APBI represents a departure from whole-breast irradiation because only the area around the primary tumor, including a small margin, is targeted with radiation. The major techniques used for APBI can be divided into external-beam radiation therapy and delivery of radiation through sources placed inside temporary internal catheters brachytherapy 78 , Because of the much smaller treatment volume, the radiation dose is increased and the treatment time is reduced, commonly twice a day for 10 fractions over 1 wk.
Not all patients with early-stage breast cancer are suitable for APBI; in past trials with promising 5-y results, enrollment was generally limited to patients with small tumor sizes and favorable histologic characteristics. The degree to which young age or adverse pathologic features will influence local control with APBI is unknown. The treatment of breast cancer patients can be personalized by integrating analysis of standard immunohistochemical markers and gene expression with information from anatomic imaging as well as targeted functional imaging studies to tailor both treatment planning and response assessment Fig.
Precision medicine is the future of cancer therapy. Structural and functional information from imaging is combined with immunohistochemical and genomic information to make personalized treatment decisions. A Breast cancer arrow is largely obscured on mammography. B Variable uptake of gadolinium contrast agent on breast MRI arrow indicates heterogeneity of intratumoral blood flow.
D This information is combined with that from immunohistochemical assays, and mRNA expression E to determine a full tumor profile for treatment planning. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. No other potential conflict of interest relevant to this article was reported. McDonald 1 , Amy S. E-mail: elizabeth.
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Overview of multidisciplinary breast cancer management. Previous Section Next Section. Screening Breast cancer is generally diagnosed through either screening or a symptom e. Pathologic Evaluation Specimen Processing and Evaluation In clinical practice, diseased tissue is usually obtained by fine-needle aspiration, core biopsy, or surgical excision.
Predictive Tumor Markers Critical treatment decisions are made on the basis of protein expression assays that are independent of tumor morphologic characteristics. Imaging and Staging Physical examination, mammography, or ultrasound for the diagnostic work-up of a patient with newly diagnosed breast cancer is usually sufficient for local—regional staging. Surgery The primary means of local and regional breast cancer treatment remains surgical intervention.
Non—Breast-Conserving Approaches For most women with screening-detected and early-stage breast cancer, mastectomy is a choice. Axilla Staging Procedure One of the major technical advances in breast surgery was the introduction of sentinel lymph node biopsy SLNB to replace the conventional axillary node dissection described by Giuliano et al. Medical Oncology Several broad classes of drugs for treating breast cancer are available; tumor characteristics and disease extent determine the recommendation for systemic chemotherapy, endocrine therapy, or HER2-directed therapy.
Chemotherapy Adjuvant chemotherapy after definitive surgery is generally recommended for patients with disease at high risk of recurrence. HER2-Directed Therapy For HER2-positive breast cancer, trastuzumab, a HER2-specific monoclonal antibody, improves the survival of patients with early-stage breast cancer and should be given in addition to chemotherapy Endocrine Therapy Patients with ER- or PR-positive breast cancer should receive endocrine therapy, such as an aromatase inhibitor.
Neoadjuvant Therapy There are a variety of indications for neoadjuvant therapy: a tumor larger than 5 cm in a patient desiring breast conservation, a tumor fixed to the chest wall, locally advanced disease, and inflammatory breast cancer. Therapy for Metastatic Disease Because metastatic disease is not considered curable, the goal of therapy in the setting of metastatic disease is to extend life while minimizing symptoms or side effects. Radiation Prospective randomized trials have confirmed that long-term mortality from breast cancer and overall patient survival are comparable for BCS plus radiation treatment and for mastectomy Radiation After BCS Randomized trials have confirmed that recurrence rates with BCS alone are higher than those with BCS plus radiation treatment, even in patients selected for favorable clinical and pathologic features 62 — Regional Node Radiation Radiation therapy has a role in the regional control of nodal disease in many patients with high-risk or node-positive stage II, and most patients with stage III, breast cancer.
Shortening Radiation Length The past decade has seen advances in techniques for the delivery of postoperative radiation that aim to preserve high rates of local control but shorten overall treatment time, reduce cost, and improve convenience of care. Previous Section.
Breast cancer screening: an evidence-based update. Med Clin North Am.
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Breast Cancer. A New Era in Management
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A New Era in the Diagnosis and Treatment of Breast Cancer 2015
Diagnostic accuracy of mammography, clinical examination, US, and MR imaging in preoperative assessment of breast cancer. A prospective study of the utility of magnetic resonance imaging in determining candidacy for partial breast irradiation. J Nucl Med. Mastectomy with or without immediate implant reconstruction has similar day perioperative outcomes.