Jacobs: Early Diagnosis and Treatment of Cancer: Breast Cancer Expert Consult - Online and Print

Breast cancer is the most common malignancy to occur in women. It is estimated that in 2009 approximately 192,500 women were diagnosed with invasive breast cancer and 62,300 were diagnosed with in situ disease. Breast cancer is the second most common cause of cancer death in women, with an estimated 40,000 women dying of the disease in 2009. The combination of the high incidence of the disease, strong grassroots advocacy, and consistent, focused research has resulted in numerous advances in the treatment of breast cancer over the past several decades. This book provide a comprehensive review of current recommendations for the clinical management of early breast cancer, including prevention, diagnosis, and treatment. There are also include some of the new and innovative interventions on the horizon that have not yet become standard.
The battle against breast cancer mortality begins with prevention. The decision to pursue breast cancer prevention must be based on an accurate assessment of risk, and this risk assessment is aided by risk assessment models. For patients at very high risk, genetic assessment with germ-line gene mutation testing such as BRCA becomes important. Even for those patients without a genetic mutation or at low risk for a mutation, interventions for breast cancer prevention may still be desirable. Previously, surgery was the only option for risk reduction, but now hormonal therapies are available. In addition, evidence is building for lifestyle changes that each individual woman can adopt to reduce her personal risk of developing breast cancer.

These options provide the patient and the physician with a range of effective risk reduction strategies that can then be selected to meet the patient’s desired level of risk reduction while taking into consideration the risks and process involved in the strategy. It is possible that new biomarkers will be developed that will further improve risk assessment for individual patients and further allow us to tailor our recommendations for prevention based on the degree of risk and potentially to select the mechanism of prevention most effective for a given patient.
Diagnostic evaluations of patients at risk for breast cancer are also evolving, and controversial changes in screening recommendations have recently been published. The goal of screening is to diagnose and treat patients with breast cancer before there has been systemic spread. The biggest challenge with our current screening techniques is the high rates of false positives.
These result in a large number of women undergoing biopsies for benign disease. Another challenge in our screening process is the diagnosis and management of ductal carcinoma in situ (DCIS). Although we are able to identify DCIS as a very early breast cancer, the natural history of this disease process is not well understood, and the need to pursue aggressive treatment is being questioned. This has prompted some groups to recommend changes in the screening recommendations to reduce the number of patients with DCIS who are diagnosed and treated. Methods of screening and diagnostic imaging are included in this text to further define the current standard of care.
Pathologic assessment of diagnostic tissue and surgical specimens is critical to understanding the prognosis for the patient and for making treatment recommendations to the patient. Stage of diagnosis based on the Tumor, Node, Metastasis (TNM) staging system provides basic prognostic information on which many treatment recommendations are made. We fortunately now have other prognostic markers such as grade and Ki-67 and genetic markers such as oncotype DX that provide further prognostic accuracy and allow more informed treatment recommendations.
The importance of pathologic assessment in the treatment recommendations for patients supports the extensive review of pathologic assessment included in this text.
The treatment of breast cancer continues to be based on surgery, chemotherapy, hormonal therapy, and radiation therapy: each approach remains a mainstay in the overall treatment plan. Modifications in the recommendation for each of these components are based on estimates of local, regional, or systemic recurrence. Each of these therapies has become more targeted.
Surgical management now involves improved selection for breast preservation by using improved diagnostic tests and neoadjuvant therapy to encourage patients to seek breast preservation. The broad improvements in screening, diagnosis, and systemic therapies have allowed surgeons to decrease the extent of surgical therapies both in the regional nodal basin and in the breast. The same concepts apply to the use of radiation therapy.
The selection of patients for elimination of radiation therapy or reduction in the extent of radiation therapy has become possible through research in patient selection and improvements in radiation therapy techniques that reduce complications, field of exposure, and time commitment required for treatment. Systemic adjuvant therapies have also become more targeted, with far more patients avoiding chemotherapy with the use of hormonal therapy. In addition, newer systemic agents that provide improved systemic control with reduced risk are being utilized.
The selection of patients for systemic hormonal therapy now has many additional possibilities,
and patients and their physicians are able to select their treatment choices based on therapeutic benefit and side effect profile in a much more informed manner.
Prevention, diagnosis, and management of breast cancer are all continually evolving, and we include each of these subjects in this book. One of the most satisfying aspects of caring for patients with breast disease is that in each step of the process we are able to offer a variety of options with differing levels of risk and benefit. Patients and their health care providers are able to weigh the risks and benefits of their options and then make well-informed decisions. This is the result of an extensive research effort into all aspects of breast cancer prevention, diagnosis, and treatment. Fortunately, even with the array of options currently available, even more are on the horizon that promise further reductions in risk by more targeted therapies, better predictors of risk of disease development or progression through biomarkers, and improved diagnostic accuracy.

Contents 

• Chapter 1 The Normal Breast and Benign Diseases of the Breast
• Chapter 2 Ductal and Lobular Proliferations: Preinvasive Breast Disease
• Chapter 3 Invasive Breast Cancer
• Chapter 4 Risk Factors and Risk Assessment
• Chapter 5 Genetics
• Chapter 6 Strategies for Risk Reduction
• Chapter 7 Nutrition and Lifestyle
• Chapter 8 Radiologic Techniques for EarlyDetection and Diagnosis
• Chapter 9 Screening of High-Risk Patients
• Chapter 10 Minimally Invasive Breast Biopsy
• Chapter 11 Surgical Biopsy
• Chapter 12 Surgical Therapy of Early Breast Cancer
• Chapter 13 Breast Reconstruction after Mastectomy
• Chapter 14 Oncoplastic Surgical Techniques for the Partial Mastectomy
• Chapter 15 Axillary Management
• Chapter 16 Radiation Oncology
• Chapter 17 Neoadjuvant Therapy
• Chapter 18 Cost-Effective Staging of Breast Cancer
• Chapter 19 Adjuvant Systemic Therapy
• Chapter 20 Surveillance and Detection ofRecurrence of Breast Cancer
• Chapter 21 The Use of Molecular Profiles in the Management of Breast Cancer
• Chapter 22 Partial Breast Irradiation
• Chapter 23 Breast Cancer and Pregnancy
• Chapter 24 Mammary Ductoscopy
• Conclusion
• Index

Book Details

• Hardcover: 408 pages
• Publisher: Saunders; 1 Har/Psc edition (2011)
• Language: English
• ISBN-10: 1416049320
• ISBN-13: 978-1416049326
• Product Dimensions: 10.4 x 7.5 x 0.8 inches

List Price: $152.00