Current Guidelines for the Diagnosis and Treatment of Breast Cancer
Teresa G. Hayes
Leif E. Peterson
Armin D. Weinberg
The management of breast cancer is a significant public health issue. Early detection of breast cancer through screening mammography, physician clinical examination and breast self-examination can reduce breast cancer mortality by approximately 30%. Most major health organisations agree that yearly mammographic screening should begin at the age of 40 years, although there is some controversy about the need for mammography between the ages of 40 and 49 years. The use of mammographic screening is influenced by physician recommendation, cancer-related fears, time constraints and patient age. Genetic screening is appropriate for patients with familial cancer syndromes and certain high-risk population groups such as Ashkenazi Jews. Treatment for breast cancer depends on many factors, including the microscopic characteristics of the tumour, the tumour stage, whether it is sensitive to hormonal treatment or chemotherapy, and the age and menopausal status of the patient. The most important variable is the tumour stage. Early stage cancers are treated surgically by mastectomy or breast conservation surgery plus radiation therapy. For cancers with unfavourable prognostic factors such as larger size, aggressive histology, or rapid doubling times, adjuvant treatment is recommended with chemotherapy or tamoxifen. When breast cancer has spread to the axillary lymph nodes, adjuvant chemotherapy should be given, followed by tamoxifen for 5 years for patients with hormone receptor-positive tumours. Cancers that are locally advanced are treated with preoperative chemotherapy, surgery, and then postoperative chemotherapy and radiation therapy. The therapy for metastatic cancer can be radiation therapy, chemotherapy or hormonal therapy, depending on the site of spread and the hormone receptor status of the tumour. Most oncologists treat breast cancer in men in a similar fashion as women, with the understanding that breast cancer in men is likely to be hormone receptor-positive.
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