New diagnostic, staging, and therapeutic aspects of early breast cancer

Abstract

Many advances have occurred in breast cancer through research and clinical trials. More confidence in new biological consumptions about invasive breast cancer indicate that: (1) details of the primary breast cancer do not control survival; (2) breast-only failures after local excision do not bias against survival; and (3) cancer cell dissemination occurs at the same time via both lymphatic and hematogenous routes. Early detection with mammographic screening has indicated a greater number of smaller breast cancers, including sharp increases in ductal carcinoma in situ (DCIS). With proper analysis and control, DCIS of limited extent can be treated by local excision with or without radiation. Invasive breast cancer of limited extent can frequently be managed by lumpectomy and radiation therapy with survival rates equivalent to the more traditional mastectomy. Patient desires regarding breast preservation and quality of life are paramount. Risk: benefit analyses for individual patients need to be emphasized in issues of breast preservation and in selecting adjuvant therapy, both regional (radiotherapy) and systemic (chemotherapy) and hormonal therapy). We are entering an era of highly selective therapy based on more sophisticated analysis of the primary cancer. In the future, not only statistical predictions of outcome as achieved by flow cytometry, for example, will be more widely used, but individual prognostic factors may be developed such as with oncogene expression. Such individual prognostic factors will enable more selective therapy.

Breast surgery and neural tissue mechanosensitivity

“…Seventeen women had undergone breast conservation surgery and the remaining three, a modified radical mastectomy. The subjects were not divided into surgical groups, as it is suggested that the axillary dissection is the most significant factor involved in postoperative arm morbidity (Cady 1990).…”

“…Modified radical mastectomy and breast conservation therapy are two widely accepted forms of surgery for breast cancer (Fisher et al 1989). An axillary node dissection is often performed as part of a modified radical mastectomy or breast conservation therapy (Rosemond and Maier 1994) and is thought to be a primary source of postoperative upper limb complications (Cady 1990). The most common postoperative complications in the upper limb include lymphoedema, impaired shoulder motion, muscle weakness, arm pain and altered skin sensations (Vecht 1990).…”

DNA ploidy of primary breast cancer and local recurrence after breast-conserving therapy

“…One of the main concerns here is the continued risk of local recurrence in the retained portion of a breast. Unlike local recurrences after radical mastectomy, which usually coincide with a systemic disease, most local recurrences after BCT can be adequately treated (Barr et al, 1989;Cady, 1990). This means that follow up of patients treated by BCT and identification of women at high risk of local recurrence development are essential.…”

The Economic Impact of Technical Change in the Local Treatment of Breast Cancer

“…The effect on direct medical cost is an additional consideration. At the present time medical opinion on this matter seems to be in a state of flux (5). The trend may be toward administering chemical or hormonal therapy in most cases, regardless of staging.…”