From the Guidelines
Invasive carcinoma of the breast should be managed with a multidisciplinary approach, including surgery, radiation, and systemic therapy, with treatment decisions based on tumor characteristics, lymph node involvement, and patient factors, as recommended by the most recent guidelines 1. The primary goal of treatment is to improve morbidity, mortality, and quality of life outcomes.
- The treatment approach should be individualized, taking into account the patient's age, menopausal status, comorbid conditions, and preferences.
- The pathological diagnosis should be based on a core needle biopsy, preferably obtained by US or stereotactic guidance, with a minimum of 2-3 cores obtained, and a marker placed into the tumor at biopsy to ensure resection of the correct site 1.
- The final pathological diagnosis should be made according to the World Health Organization (WHO) classification and the eighth edition of the American Joint Committee on Cancer (AJCC) tumor, node, metastasis (TNM) staging system, including prognostic information related to tumor biology, such as tumor grade, estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor 2 (HER2) status, and gene expression data if available 1.
- Systemic therapy may include chemotherapy, hormone therapy, or targeted therapy, with treatment decisions based on tumor characteristics, such as size, grade, hormone receptor status, and HER2 status, as well as lymph node involvement and patient factors 1.
- Early detection through regular screening mammography improves outcomes, and patients require long-term follow-up with regular clinical examinations and mammography to monitor for recurrence 1.
From the Research
Invasive Carcinoma of the Breast
- Invasive ductal carcinoma (IDC) is the most common type of breast cancer, primarily affecting women in the United States and across the world 2.
- The causes of IDC include mutations on BRCA1 and BRCA2, different levels of expression of specific genes in signaling pathways, menopause status, alcohol consumption, aging, and hormone imbalances 2.
- Prompt IDC diagnosis and early intervention have been reported to demonstrate a greater probability of eradicating IDC and preventing further recurrence in the future 2.
Treatment Options
- Radiation therapy plus tamoxifen versus tamoxifen alone after breast-conserving surgery in postmenopausal women with stage I breast cancer has been compared, with results showing a recurrence-free survival benefit of giving radiation therapy 3.
- Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer has been studied, with findings indicating that lumpectomy plus adjuvant therapy with tamoxifen alone is a realistic choice for the treatment of women 70 years of age or older who have early, estrogen-receptor-positive breast cancer 4.
- Mastectomy vs. lumpectomy-with-radiation has been compared, with results showing that mastectomy is associated with less chronic pain frequency and lower incidence of post-surgical side effects compared to lumpectomy, but also with lower cosmetic satisfaction 5.
Neoadjuvant Therapy
- Changes in management strategy and impact of neoadjuvant therapy on extent of surgery in invasive lobular carcinoma of the breast have been analyzed, with findings indicating that the use of neoadjuvant endocrine therapy (NET) is increasing, and is associated with more breast conservation surgery (BCS) and less extensive axillary surgery in those with invasive lobular carcinoma (ILC) 6.
- Long-course NET was significantly associated with increased BCS in patients with cT2-cT4 disease and less extensive axillary surgery in clinically node positive patients with HR+/HER2- tumors 6.