MANAGEMENT OF EARLY MAMMOGRAPHICALLY DETECTED BREAST CANCER

Abstract

The most commonly diagnosed cancers worldwide were those of the lung (1.8 million, 13.0%), breast (1.7 million, 11.9%), and colorectal (1.4 million, 9.7%). The most common causes of death were cancers of the lung (1.6 million, 19.4%), liver (0.8 million, 9.1%), and stomach (0.7 million, 8.8%). Since the 2008 estimates, breast cancer incidence has increased by more than 20%, while mortality has increased by 14%. Breast cancer is also the most common cause of cancer death among women and the most frequently diagnosed cancer among women in 140 of 184 countries worldwide. It now represents one in four of all cancers in women. To reduce mortality, screening must detect life-threatening disease at an earlier, more curable stage. Effective cancer-screening programs therefore both increase the incidence of cancer detected at an early stage and decrease the incidence of cancer presenting at a late stage. In any patient who presents with a breast lump or other symptoms suspicious of carcinoma, the diagnosis should be made by a combination of clinical assessment, radiological imaging and a tissue sample taken for either cytological or histological analysis, the so-called triple assessment. The positive predictive value of this combination should exceed 99.9 per cent. The increased use of mammography and introduction of breast screening programmes have resulted in a rise in detection of clinically-occult breast cancer, with one-third of all breast carcinomata diagnosed being non-palpable. These types of cancer have a unique natural history and biology compared to symptomatic breast cancer and this needs to be taken into account when considering surgery and adjuvant treatment. The advent of "Halsted" radical mastectomy for management of breast carcinoma represented an initial landmark achievement in obtaining loco-regional control of a disease that had been considered inoperable and untreatable before the 1900s. This operation is now limited to locally advanced carcinoma for which primary chemotherapy is contraindicated. In 1948 a less aggressive surgery, with sparing of pectoralis major muscle, was described by "Patey" and was proved to be effective in the local control of most breast cancers Throughout the twentieth century, breast cancer awareness matured as a priority in public health messages and in oncology researches. And also as a result of widespread use of screening mammography, there has been stage shift in presentation of breast carcinoma, with an increase in pre-invasive ductal carcinoma in situ (DCIS) and small invasive breast carcinoma. These very early forms of breast carcinoma may be modified based on presentation and accepted prognostic factors Breast conserving surgery (BCS) is a treatment modality for early stage breast carcinoma that causes less physical disfigurement and psychological trauma to the patient. Postoperative RT after BCS with or without adjuvant systemic therapy has important role in treatment of early breast carcinoma. Postoperative RT as an addition to surgery prevent loco-regional recurrence and improve the disease-free interval, but makes little differences to overall survival. The optimal timing of surgery, RT and chemotherapy, particularly in patients with high risk for relapse, has to be evaluated in goal to obtain maximal effect from therapy and to avoid unfavorable effect.