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Precision surgery and avoiding over-treatment
A Hosseini1, A L Khoury1, L J Esserman1
1University of California, 1600 Divisadero, 2nd Floor Box 1710, San Francisco, CA 94115, USA.
Abstract:
Over-diagnosis and over-treatment are consequences of greater awareness about breast cancer, more intensive screening, and the resultant identification of more cases of breast cancer that are low or ultralow risk. This area represents an important opportunity to optimize the delivery of appropriate targeted therapy for breast cancer patients. Despite the evolution of breast cancer care over the last few decades and our ability to tailor treatment to biology, a one-size fits all approach is still prevalent in the local and regional management of and screening for breast cancer, failing to reflect the unique biology and tumor characteristics of each patient. In this review, we explore how we can use new tools to better define tumor biology and also how we can change current clinical practices based on already available data. Every surgeon should be knowledgeable about how to craft personalized breast cancer care in the areas of systemic therapy, adjuvant radiation therapy, management of ductal carcinoma in situ (DCIS), precision surgery, and breast cancer screening.
Insights
Over-diagnosis of low-risk breast cancer is increasing. This review explores using new tools and data to personalize breast cancer care, moving beyond a one-size-fits-all approach for better patient outcomes.
Area of Science:
- Oncology
- Breast Cancer Research
- Personalized Medicine
Background:
- Increased breast cancer awareness and screening lead to over-diagnosis of low and ultralow-risk cases.
- Current breast cancer management often employs a one-size-fits-all approach, neglecting individual tumor biology.
- There is a critical need to optimize targeted therapy delivery for breast cancer patients.
Purpose of the Study:
- To explore novel tools for precise definition of tumor biology.
- To advocate for changes in clinical practices based on existing data for personalized breast cancer care.
- To emphasize the importance of tailoring treatment to individual patient and tumor characteristics.
Main Methods:
- Review of current literature and clinical practices in breast cancer management.
- Exploration of emerging technologies for detailed tumor biology assessment.
- Analysis of existing data to support the shift towards personalized treatment strategies.
Main Results:
- Identification of over-diagnosis and over-treatment as significant issues in current breast cancer screening and management.
- Highlighting the potential of new tools to better define tumor biology and guide treatment decisions.
- Demonstrating the prevalence of a standardized approach despite advancements in personalized medicine.
Conclusions:
- Personalized breast cancer care is essential, integrating systemic therapy, radiation therapy, ductal carcinoma in situ (DCIS) management, and surgical approaches.
- Surgeons must be equipped with knowledge to implement personalized strategies for screening and treatment.
- Optimizing breast cancer care requires a move towards individualized treatment plans reflecting unique tumor characteristics.
