Overview of the treatment of newly diagnosed, non-metastatic breast cancer
- Alphonse Taghian, MD, PhD
Alphonse Taghian, MD, PhD
- Professor of Radiation Oncology
- Harvard Medical School
- Moataz N El-Ghamry, MD
Moataz N El-Ghamry, MD
- Director of Brachytherapy Service
- Department of Radiation Oncology
- Baylor Scott & White Healthcare System
- Sofia D Merajver, MD, PhD
Sofia D Merajver, MD, PhD
- Professor of Internal Medicine
- University of Michigan Medical School
Globally, breast cancer is the most frequently diagnosed cancer and the leading cause of cancer death in women. In the United States, breast cancer is the most commonly diagnosed cancer and the second most common cause of cancer death in women. In addition, breast cancer is the leading cause of death in women ages 40 to 49 years.
Breast cancer is treated with a multidisciplinary approach involving surgical oncology, radiation oncology, and medical oncology, which has been associated with a reduction in breast cancer mortality .
This topic will provide an overview of the initial treatment of breast cancer and posttreatment surveillance. The epidemiology, clinical manifestations, diagnosis, staging of breast cancer, and specific discussions of the multimodality treatments for early breast cancer and the approach to metastatic disease are discussed elsewhere. (See "Clinical features, diagnosis, and staging of newly diagnosed breast cancer" and "Systemic treatment for metastatic breast cancer: General principles" and "The role of local therapies in metastatic breast cancer".)
Because ductal carcinoma in situ (DCIS) and invasive breast cancer are managed differently, we will restrict discussion in this topic to invasive breast cancer. A discussion on DCIS is covered separately. (See "Breast ductal carcinoma in situ: Epidemiology, clinical manifestations, and diagnosis" and "Ductal carcinoma in situ: Treatment and prognosis".)
The vast majority of patients with newly diagnosed breast cancer in the United States and developed countries have no evidence of metastatic disease. For these patients, the treatment approach depends on the stage at presentation. For treatment purposes, breast cancer is characterized using the Tumor, Node, Metastasis system (TNM). Where clinical guidance is provided in this topic, the anatomic staging system set forth in the eighth edition of the American Joint Committee on Cancer (AJCC) Staging Manual is used (table 1). This staging system is effective in the United States as of January 1, 2018, but was implemented elsewhere as of January 1, 2017. It is recognized that the studies cited in UpToDate topics may have used previous editions of the staging system, which is a limitation of existing data. Moreover, the AJCC recommends use of the prognostic staging system for breast cancer that incorporates biomarkers, if resources are available (table 2). This staging system is discussed in detail elsewhere. (See "Tumor, Node, Metastasis (TNM) staging classification for breast cancer".)
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- PATIENT STRATIFICATION
- EARLY-STAGE BREAST CANCER
- Breast-conserving therapy
- - Role of RT
- Evaluation of the axillary nodes
- Adjuvant therapy
- LOCALLY ADVANCED BREAST CANCER
- Neoadjuvant systemic therapy
- - Surgical approach after neoadjuvant treatment
- Primary tumor
- Regional nodes
- Primary surgery
- Adjuvant therapy
- SPECIAL CONSIDERATIONS
- Fertility preservation
- Older women
- Postmenopausal women
- Male breast cancer
- Breast cancer in pregnancy
- POSTTREATMENT SURVEILLANCE
- INFORMATION FOR PATIENTS
- Patient stratification
- Early-stage breast cancer
- Locally advanced breast cancer