A HALF CENTURY OF PROGRESS IN BREAST CANCER: WHERE DO WE GO NEXT?

The past five decades have witnessed extraordinary advances in the management of early-stage breast cancer (stages 1, 2, and 3 operable disease) as well as metastatic disease. The disease was long viewed as a single disease with debilitating surgical approaches and limited systemic options, which were administered in a one-size-fits-all approach. Breast cancer is now understood as a heterogeneous family of biologically distinct diseases requiring individualized therapeutic approaches. At the same time, standards for local therapy have shifted dramatically. Disfiguring and debilitating surgeries are a thing of the past, and current approaches have focused on minimizing surgical procedures with equivalent results. Similarly, radiation therapy has also become far more tolerable without compromising efficacy. Molecular characterization has improved systemic therapy, and enhanced supportive care has contributed to substantial reductions in mortality and improvements in quality of life. Breast cancer advocacy played a major role in bringing the patient's voice to clinical care and research. Treatment of metastatic breast cancer has evolved substantially, and patients with advanced disease often live five years or longer. There are even trials seeking to develop curative approaches for select patients with de novo metastatic disease. Yet, despite remarkable progress, major challenges remain, including overtreatment, therapeutic resistance, late recurrence, and persistent disparities in outcomes. This review examines the evolution of treatment for breast cancer and highlights priorities for the next generation of research and clinical care.