Feature Articles: Advances In
Breast Cancer
Feature Articles: Advances In
Breast CancerDespite the long standing worldwide attention given to the fight against breast cancer, this disease has remained a serious illness affecting not only physical, but also the emotional well-being of many individuals across the world. The physical, psychosexual and financial consequences of breast cancer also have a far reaching social impact on relatives, friends and associates of the diseased individual. It appears that almost no one in society is unaffected by breast cancer.
Breast cancer is a heterogeneous disease with a rather unpredictable outcome and is now the second leading cause of cancer death among women in the United States. Over 150,000 women are diagnosed with breast cancer each year and 45,000 women die of this disease every year in the United States alone.
Over the past four decades, substantial progress has been made in the diagnosis and treatment of breast cancer. Advances in breast imaging and emphasis on screening programs have led to increased detection of in situ lesions and small breast carcinomas. Minimally invasive and cost effective diagnostic sampling procedures such as fine needle aspiration and core biopsies have almost replaced open surgical biopsies. Breast conservation therapy and reconstructive surgery have enhanced cosmetic results with a positive impact on the sexuality and self-image of breast cancer patients.
Sentinel node biopsy has provided an improved alternative to the traditional axillary node dissection. The expanded role of radiotherapeutics and widespread utilization of adjuvant or neoadjuvant chemotherapy have contributed to improved patient outcome. In addition, advances in molecular biology testing and recognition of predictive/prognostic factors have provided new opportunities for novel, effective, and individualized breast cancer therapy.
Furthermore, recent discovery of breast cancer genes and the dramatic efforts to identify the risk factors may ultimately lead to the detection of precursor lesions and to the prevention of breast cancer. More importantly, the enhanced public awareness of breast cancer has resulted in increased funding for biomedical research and behavioral science, education, research, screening, treatment and survivorship.
However, the insignificant decline in mortality rate for breast cancer in the last 20 years remains a challenge as well as the unanswered question of "why women still die from breast cancer?" An oversimplified response to this latter question is the recognition of obvious barriers which include incomplete understanding of the biology and natural history of breast cancer, variability in diagnostic criteria, significant diversity in management and therapy and lack of universal accessibility to screening and follow up therapy.
Further progress requires better understanding of breast cancer biology and the development of new strategies for breast cancer detection and prevention. Until then, we must remain aware of the existing limitations and welcome the opportunities for learning about the new discoveries and treatment modalities.
This issue of Jacksonville Medicine is devoted to the introduction of a few new concepts in detection and management of breast cancer patients. A report of the "Joint Task Force of the American College of Radiology, American College of Surgeons and College of American Pathologists on Stereotactic Core-Needle Biopsy of the Breast" is meant to familiarize the readers of this journal with a national guideline on this technique. The article on "Breast Cancer Risk Assessment and Genetic Testing" is to provide a fundamental knowledge about the value and limitations of genetic testing. Sentinel node biopsy is reviewed by Drs. Gary J. Bowers and Robert F. Butler, who have provided the latest information about this procedure. The impact of radiotherapy after mastectomy is discussed by Drs. Marc S. Rudoltz, Ryan S. Perkins, Robert W. Luthmann, Rick Croley and Scot N. Ackerman, who generously shared their experience with us.
As always, it has been a pleasure to work on this issue of Jacksonville Medicine. The experience has been educational and exciting and I remain grateful for the opportunity. Many thanks to the authors of the articles published in this issue.
Shahla Masood, M.D.
Professor and Associate Chair , Department of Pathology
Assistant Dean for Research
University of Florida Health Science Center / Jacksonville
Chief of Pathology, University Medical Center
