New directions in surgery, treatment and reconstruction are changing breast cancer.
The field of breast cancer has been a model for innovation and discovery. The earliest randomized trials were launched in the 1950s to study whether the first generation of chemotherapy could improve curability after surgery. Then the very “out-of-the-box” idea of less radical surgery was tested.
Decades later, the field remains a hotbed of studies to elucidate biomarkers and genetic changes that are the drivers of cancer—and new targets for therapy. We have made contemporary advances that are producing an immediate impact in the diagnosis and treatment of breast cancer. CURE will tell you, in our usual CUREstyle, about the basic and clinical science behind the new developments and why they make a difference.
In this supplement, you will learn how less invasive sentinel lymph node surgery is proving to be just as effective, with fewer side effects, as more invasive surgery. The latest surprise—that even a positive sentinel node might not necessarily require further node surgery—is still being discussed and interpreted.
The “less is better” concept now also involves radiation therapy, where only part of the breast or a shorter time of radiation therapy—even just one day at the time of surgery—may be an option in selected cases.
Improving cosmetic outcomes after breast surgery is the goal of a new fusion discipline called “oncoplastics,” where the skills of breast and plastic surgery are combined in one doctor. And nipple-sparing surgery offers women the chance to keep all their skin for reconstruction.
We are moving toward personalized medicine, with gene patterns of breast tumors guiding us as to the value of chemotherapy, and it appears that we can treat fewer patients with chemotherapy as we identify those who don’t stand to benefit and will do quite well with hormonal therapy alone.
The most challenging arena in breast cancer is still the management of patients with advanced metastatic breast cancer, where progress has been the slowest. Still, we are seeing stepwise improvements in survival with new chemotherapy and biological drugs. In this supplement you will learn about the elegant science behind PARP inhibitors and about a drug derived from a marine sponge that has just been approved by the FDA.
The speed of research and change in practice are picking up. We invite you to read our choices about the advances that are having the biggest impact.
In subsequent CURE issues, you will read other important stories that will continue to deliver hope to all those with the most common cancer in women—one that is becoming more curable and treatable every year.
Debu Tripathy, MD
Professor of Medicine, University of Southern ­California
Co-Leader, Women’s Cancer Program at the USC/Norris Comprehensive Cancer Center