This book discusses the principles and practice of breast cancer management within the context of multidisciplinary team working and places emphasis on pragmatism. The text provides a comprehensive and contemporary account of the subject and should permit the reader to develop a firm understanding of the disease from epidemiology, genetics and screening, to pathology, diagnosis, treatment, and prevention. This in turn will enable healthcare personnel to deliver a high quality and up-to-date service to breast cancer sufferers.
Medicine is in the midst of a revolution which will greatly modify our attitudes towards the patients of tomorrow. The three major areas of new development are: (i) the biomolecular approach; (ii) the achievements of imaging technology; and (iii) stem cell research. The first and second will have a substantial influence on oncology in general and on breast cancer in particular. Breast cancer, the most common cancer in women worldwide, is in fact undergoing a considerable upheaval in terms of its biological concepts, such as the predictive value of gene profiling and the cancer stem cell hypothesis and, even more importantly, the revolution in imaging, which has totally changed the possibilities for the detection of early breast lesions.
On the other hand we also have to consider that the greatest change in breast cancer treatment can be summarized in the transition from the ‘maximum tolerable treatment’ paradigm of the 1960s to the ‘minimal effective treatment’ paradigm of today. In other words the old concept that treatment should be as aggressive as possible (extended mastectomies, very extensive radiotherapy fields, hypophysectomy, adrenalectomy and high dose chemotherapy) was the result of our limited knowledge on the biology of breast cancer.