Early Breast Cancer 2nd Edition PDF: From Screening to Multidisciplinary Management
|Author||Guidubaldo Querci della Rovere and John R. Benson|
|File size||9.3 MB|
Despite a modest decrease in mortality rates over the past two decades, the incidence of breast cancer continues to rise inexorably in Western society where it remains the commonest malignancy amongst women with a lifetime risk of approximately 10%. Almost half a million women die of the disease annually worldwide with 15,000 and 45,000 deaths per annum in the United Kingdom and United States, respectively. Though breast cancer is predominantly a disease of post-menopausal women, almost one-third of cases occur in women under 50 years of age and it represents a major cause of death in the age group 40-50 years. Breast cancer diagnosis has an emotional dimension which is manifest disproportionately in younger women for whom the psychosocial impact of the disease can reverberate collectively amongst family members, friends and colleagues. Many of these patients are not only a wife and mother, but nowadays often have demanding careers and may be the primary breadwinner for the family.
The fall in mortality from breast cancer in the face of rising incidence rates is testimony to the success of interventional strategies in the form of screening and adjuvant systemic therapies, which reduce the burden of micrometastatic foci and perturb the natural history of this enigmatic disease. Though the radical mastectomy has been abandoned in favour of less invasive surgical procedures (skin-sparing modified radical mastectomy and breast conservation), the Halstedian paradigm is now acknowledged as pertinent to the behaviour of some breast cancers. There is an emerging ‘spectrum’ paradigm which incorporates elements of Halsted’s centrifugal theory of cancer spread and Fisher’s hypothesis of biological predeterminism. Modern methods of molecular profiling may permit tumours to be assigned to a particular group with appropriate intensities of locoregional and systemic treatments. An increasing proportion of patients are presenting with node negative disease and in situ forms of cancer. This ‘stage migration’ is due to better public awareness of the disease combined with screening programmes. The technique of sentinel node biopsy has found relevance in this era of earlier stage disease but there
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