Breast cancer management: Past, present and evolving

Abstract

Breast cancer is known from ancient time,and the treatment strategy evolved as our understanding of the disease changed with time. In 460 BC Hippocrates described breast cancer as a humoral disease and presently after a lot of studies breast cancer is considered as a local disease with systemic roots. For most of the twentieth century Halsted radical mastectomy was the "established and standardized operation for cancer of the breast in all stages, early or late". New information about tumor biology and its behavior suggested that less radical surgery might be just as effective as the more extensive one. Eventually, with the use of adjuvant therapy likeradiation and systemic therapy, the extent of surgical resection in the breast and axilla got reduced further and led to an era of breast conservation. The radiation treatment of breast cancer has evolved from 2D to 3D Conformal and to accelarated partial breast irradiation, aiming to reduce normal tissue toxicity and overall treatment time. Systemic therapy in the form of hormone therapy, chemotherapy and biological agents is now a well-established modality in treatment of breast cancer. The current perspective of breast cancer management is based on the rapidly evolving and increasingly integrated study on the genetic, molecular , biochemical and cellular basis of disease. The challenge for the future is to take advantage of this knowledge for the prediction of therapeutic outcome and develop therapies and rapidly apply more novel biologic therapeutics.

Epidemiology, Major Risk Factors and Genetic Predisposition for Breast Cancer in the Pakistani Population

“…Methylenetetrahydrofolate reductase (MTHFR) maintains the balance of circulating folate and methionine and blocks the formation of homocysteine, its regulation in relation to different cancers has extensively been studied in different populations therefore Akram et al (2012) designed a study on Pakistani breast cancer patients (Akram et al, 2012). The MTHFR gene has two most common mutations which result in change of amino acids C677T to Ala222val and A1298C to Glu429Ala.…”

Phase II Trial of Loubo®(Lobaplatin) and Pemetrexed for Patients with Metastatic Breast Cancer not Responding to Anthracycline or Taxanes

“…Response rates are ranged from 0-38% (M Akram et al, 2012). Presently, combined chemotherapy is mostly prescribed in neoadjuvant, adjuvant and in metastatic settings of breast cancer.…”

Differential Prognostic Indicators for Locoregional Recurrence, Distant Recurrence, and Death of Breast Cancer

“…This should be done by risk evaluation of recurrence based on knowledge, genetics, molecular, biochemical sciences, and cytology [7]. With medical resource limitation, clinicians in poor developing countries were forced to manage patients with additional treatments, in which many cases might have been unnecessary, resulting in overtreatment [8].…”