An update on breast cancer: evolving treatments and persistent questions
MAURIE MARKMAN, MD
JOSEPH P. CROWE, MDAddress reprint requests to J.P.C., Director, Breast Services, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195.
This review describes recent advances in imaging technology and treatment options, and discusses the persistent questions about the best strategies for preventing, diagnosing and treating breast cancer. Possible clinical implications of new research on the causes of breast cancer are also examined. The evolution of breast cancer management over the past century is summarized.KEY POINTS
The incidence of breast cancer has increased 1% to 2% per year over the past decade. The reason for this increase is not understood and cannot be explained solely by earlier detection of disease. Epidemiologic evidence points toward enviromental factors, particularly diet, as causes of breast cancer, but such links are difficult to confirm. A mutation in the BRCA1 gene is implicated in 5% of all breast cancers, but its discovery poses enormous ethical questions: should women be screened for this abnormality? If it is found, how should such women be followed up? Breast-conserving surgery leads to outcomes similar to those for mastectomy in patients with early-stage breast cancer. Whether all patients who undergo this surgery should also receive radiation therapy is a topic of debate. Conservative surgery without radiation therapy should be considered investigational. Two types of breast reconstruction are available to women during or after mastectomy: implant reconstruction and use of autologous tissue. Physicians should provide educational information at appropriate points in the patient’s care.