Changing Paradigm in Breast Cancer Management

by Ajay Mehta

Today EBM (Evidence Based Medicine) is the buzz word. To treat a patient empirically would amount to negligence or would be a pointer to ones lack of knowledge. It’s really difficult to keep pace with the dynamic changes occurring around you in the midst of busy clinical practice. One has to make concerted efforts to update. Science and technology are progressing by leaps and bounds. Explosion in Molecular Biology has provided parameters like DNA ploidy, Tumour Markers, ER/PR, BRCA1, BRCA2, EGF, cErb1, CErb2, p 53 mutations so on and so fore. Armed with this knowledge, today we are in a better position to understand tumour behaviour, their aggressiveness, metastatic potential, response to chemotherapy, radiotherapy, hormones, etc. Today with availability of various Oncotype DNA testing it is possible to “Individualize” treatment for Breast Cancer. Trials all over the world are addressing this issue so that unnecessary Chemotherapy is avoided in these select groups of patients. In the conundrum of medical jargon “Changing Paradigm” has become very fashionable. Keeping pace with the time we will see in the coming chapters the “shift” in the treatment of Breast Cancer from the Halstedian era to the present day.

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