Jitendar P Vij
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Changing Paradigm in Breast Cancer Management
© 2011, Jaypee Brothers Medical Publishers
All rights reserved. No part of this publication should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2011
Typeset at JPBMP typesetting unit
“Old is Gold” does not hold true in this fast moving “Digital-Microchip Technology”. Today EBM (Evidence- based Medicine) is the buzzword. To treat a patient empirically would amount to negligence or would be a pointer to one's lack of knowledge. It is 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.
The details visualized on digital mammography are far superior to conventional mammography. With capabilities of “Virtual Reality” and “Robotic Arm”, we can today pin-point a lesion in a large dense breast and take tissue for histology, receptor studies, tumor markers and other pharmacogenetic studies.
As we trace the changing face of medical practice, we find that 50s was the era of “Clinical Sciences” based on anatomicopathologic data and good clinical medicine. The 60s-70s was the era of “Technological Sciences” based on imaging and instrumentations. The 80s–90s was the era of “Biological Sciences—Molecular Biology, Molecular Genetics, based on laboratory medicine—Beyond Morphology.
Science and technology are progressing by leaps and bounds. Explosion in molecular biology has provided parameters like DNA ploidy, tumor markers, ER/PR, BRCA1, BRCA2, EGF, cErb1, cErb2, p53 mutations so on and so forth. Armed with this knowledge, today we are in a better position to understand tumor behavior, 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. It is now possible to select ER positive patients with negative axillary nodes who have high risk of distant metastasis for aggressive chemotherapy. Various trials all over the world are addressing this issue so that unnecessary chemotherapy is avoided in these select group of patients. One has to remember that technology comes with a price which is very relevant in a developing country like ours where priorities are different so we have to adopt treatment protocols to suit our group of patients coming from various socioeconomic background.
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.