nohistochemistry, fluorescence in situ hybridization
(FISH), and other broadly available assays. Progress in molecular diagnostics and therapeutics is
evolving quickly and is likely to result in additional
improvements in targeted therapies and outcome.
The theme of the past 2 decades will continue
to dominate: we will continue to move away from
maximal tolerated treatment and a one-size-fits-all approach to minimum effective treatment, less
invasive procedures, and more tailored therapy.
A refined classification of breast cancer based on
molecular features may allow a better prediction of
prognosis and response to several types of treatment and would allow a more optimal design of
future clinical trials.
1. Peto R, Boreham J, Clarke M, et al. UK and USA breast
cancer deaths down 25% in year 2000 at ages 20–69 years.
progress against cancer. PLoS One 2010;5:e9584.
3. Bilal E, Dutkowski J, Guinney J, et al. Improving breast
cancer survival analysis through competition-based multidimensional modeling. PLOS Comput Biol 2013;9:e1003047.
4. Kerlikowske K, Grady D, Rubin S, et al. Efficacy of screening
mammography: a meta-analysis. JAMA 1995;273:149–54.
5. Fisher B, Bauer M, Margolese R, et al. Five-year results of
a randomized clinical trial comparing total mastectomy and
segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 1985;312:665–73.
6. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up
of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of
invasive breast cancer. N Engl J Med 2002;347:1233–41.
7. Early Breast Cancer Trialists’ Collaborative Group. Effects
of adjuvant tamoxifen and of cytotoxic therapy on mortality
in early breast cancer: an overview of 61 randomized trials
among 28 896 women. N Engl J Med 1988; 319:1681–92.
8. Early Breast Cancer Trialists’ Collaborative Group (EBCTCG).
Effects of chemotherapy and hormonal therapy for early
breast cancer on recurrence and 15-year survival: an over-
view of the randomised trials. Lancet 2005;365:1687–717.
9. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening
and adjuvant therapy on mortality from breast cancer. N
Engl J Med 2005;353:1784–92.
10. Sorlie T. Molecular portraits of breast cancer: tumor subtypes
as distinct disease entities. Eur J Cancer 2004;40:2667–75.
11. Slamon DJ, Clark GM. Amplification of c-erbB- 2 and ag-
12. Slamon DJ, Leyland-Jones B, Shak S, et al. Use of che-
motherapy plus a monoclonal antibody against HER2 for
metastatic breast cancer that overexpresses HER2. N Engl
J Med 2001;344:783–92.
13. Romond EH, Perez EA, Bryant J, et al. Trastuzumab plus
adjuvant chemotherapy for operable HER2- positive breast
cancer. N Engl J Med 2005;353:1673–84.
14. Piccart-Gebhart M, Procter M, Leyland-Jones B, et al.
Trastuzumab after adjuvant chemotherapy in HER2- positive breast cancer. N Engl J Med 2005; 353:1659–72.
15. Bilynskyj BT. The breast cancer treatment as a marker of
progress in oncology. Exp Oncol 2010;32:190– 4.
In: Devita VT, Hellman S, Rosenberg SA, eds. Principles
and practice of oncology. 6th ed. Philadelphia: JB Lippincott
17. Bedard PL, Cardoso F. Recent advances in adjuvant systemic therapy for early-stage breast cancer. Ann Oncol
18. National Institute of health Consensus Statement. Adjuvant
therapy for breast cancer. J Natl Cancer Inst 2001;93:979–89.
18. Perou CM, Sorlies T, Eisen MB, et al. Molecular portraits of
human breast tumors. Nature 2000;406:747–52.
19. Harris L, Fritsche H, Mennel R, et al. American Society of
Clinical Oncology 2007 update of recommendations for
the use of tumor markers in breast cancer. J Clin Oncol
20. Paik S, Tang G, Shak S et al. Gene expression and benefit of
chemotherapy in women with node negative, estrogen receptor positive breast cancer. J Clin Oncol 2006;24:3726–34.
21. National Comprehensive Cancer Network. NCCN guidelines version 2.2015. Invasive breast cancer.
tions for human epidermal growth factor receptor 2 testing
in breast cancer: American Society of Clinical Oncology/
College of American Pathologists clinical practice guideline
update. J Clin Oncol 2013;31:3997–4013.
23. Bonadonna G, Brusamolino E, Valagussa P, et al. Combination chemotherapy as an adjuvant treatment in operable
BOARD REVIEW QUESTIONS
Test your knowledge of this topic.
Go to www.turner-white.com and select Oncology
from the drop-down menu of specialties.