Highlights
- •Mortality rates in patients with breast cancer have dropped in the last 20 years.
- •Progress in understanding tumor biology has allowed personalized treatment decisions to be made.
- •A multidisciplinary approach is a prerequisite for breast cancer treatment.
- •A less radical treatment approach is becoming the current standard.
Abstract
Breast cancer is a common malignancy among women. Despite an increase in incidence,
breast cancer mortality has drastically dropped over the last 20 years. This change
has been attributed to advances in screening, diagnosis, and treatment. This review
summarises recent updates in the clinical approach to breast cancer. Advances in genetics
have facilitated the stratification of the risk of recurrence in early-stage breast
cancer. Advances in biology have led to the development of novel therapies (poly-ADP-ribose
polymerase inhibitors, cyclin-dependent kinase 4/6 inhibitors, HER2 targeted agents).
Their combination with endocrine (tamoxifen, aromatase inhibitors, GnRH-analogues,
fulvestrant) and systematic therapy (anthracyclines, taxanes) in early and advanced
disease have improved clinical outcomes. In the near future, neoadjuvant strategies
in specific breast cancer subgroups (triple-negative breast cancers) and novel strategies
(immune-modulatory agents) could further improve histopathological responses and survival.
Radical mastectomies have been widely replaced by breast-conserving operations, while
the traditional axillary dissection is being replaced with sentinel node techniques.
Breast cancer therapeutics represents a great challenge due to patients’ heterogeneous
molecular and clinical characteristics, while the identification of reliable and easily
reproducible predictive factors could further improve individualized treatment.
Abbreviations:
AI (aromatase inhibitor), ANC (axillary node clearance), ASCO (American Society of Clinical Oncology), CDK4/6 (cyclin-dependent kinase 4 and 6), DFS (disease-free survival), ER (estrogen receptor), ESMO (European Society of Medical Oncology), ET (endocrine therapy), FDA (Food and Drug Administration (United States)), HER2 (human epidermal growth factor receptor 2), mTOR (mechanistic target of rapamycin), OS (overall survival), PARP (poly (ADP-ribose) polymerase), pCR (pathological complete response), PD-L1 (programmed cell death-1 ligand-1), PFS (progression-free survival), PI3K (phosphatidylinositol 3-kinase), PR (progesterone receptor), SNB (sentinel node biopsy), TAD (targeted axillary dissection), TNBC (triple-negative breast cancer)Keywords
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Article info
Publication history
Published online: November 26, 2020
Accepted:
November 20,
2020
Received in revised form:
November 19,
2020
Received:
September 15,
2020
Identification
Copyright
© 2020 Published by Elsevier B.V.
