Synopses & Reviews
This overview of diagnostic aspects of breast cancer focuses on high-risk features and risk determinants of newly disease. It offers a unique update enabling the quantification of the risk at diagnosis. This book differs from others on breast cancer by its focus on risk, and by providing a comprehensive summary of modern diagnostic approaches to the disease. Individual chapters provide not only an update on more conventional diagnostic techniques such as those derived from epidemiology, mammography, pathology and hormone receptors, but also insight into the newest aspects of modern technological approaches, including kinetic determinations with the help of flow cytometry, labeling index, oncogenic assessment, immunology, chromosomal assessment and in vitro cultures. There is increasing evidence that a refined analysis of all risk factors will offer clinicians valuable information on the type and degree of disease aggressiveness in a given patient. Such information will be essential in deciding the individual therapeutic strategy so as to avoid overtreating low risk individuals and undertreating high-risk cases. Correct determination of the risk at diagnosis will likely lead the way to an increase in cure rates and to improvement of the overall cost-benefit ratio of breast cancer treatment.
The most meaningful reward to clinicians and researchers is the absence of recurrent malignancy in their patients. While in some patients the disease will be cured by resection alone, in other similarly staged cases the disease will recur despite adequate loco regional and systemic therapies. Hence, risk assessment is a complex issue with many related or unrelated prognostic factors determining outcome. The purpose of this volume is to review some of the most relevant prognostic factors of newly diagnosed breast cancer, focusing on fea- tures determining the magnitude of risk. The ultimate value of establishing the significance of each prognostic factor in a given patient will be the resulting ability to plan individu- alized therapies for patients at different risk of recurrence at the time of diagnosis. To secure the maximum benefit for high-risk patients, while avoiding undue toxicity in those with low-risk lesions, a well-integrated analysis of all known prognostic factors will be essential in the early postdiagnos- tic period. In addition to well-established staging criteria such as axillary nodes, tumor size, receptors, scanning and radiographic examinations, the more sophisticated labora- tory techniques, as discussed by several authors herein, will playa crucial role in risk assessment. Most of them, - ploidy determination, oncogenes, tumor markers, monoclonal anti- bodies, growth factors, etc. -are presently available in only a minority of treatment centers.