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The Evolution Of Breast Cancer Treatment
The frequency of breast cancer detection has markedly increased over the past 50 years due to improvements in technology and screening techniques. Breast cancer is now detected at earlier stages than in the past. Techniques now available to treat cancer range from surgery, radiotherapy, chemotherapy, hormone therapy, to a multitude of “targeted” treatments.
Carefully designed clinical trials and basic research have changed the timing and options for treatment of breast (and many other) cancers. Not only have the medications used in the treatment of breast cancer changed and become more plentiful, but even the types of surgical procedures, timing of surgery, chemotherapy, and radiation have changed.
In the 1970s, the preferred surgical treatment for breast cancer was a radical mastectomy. Today, the majority of women who undergo surgery for breast cancer are offered one of several breast-conserving procedures.
By 1975, the concept of adjuvant chemotherapy for breast cancer was being studied for the management of breast cancer patients.
The initial clinical trials to determine if less radical surgery (lumpectomy vs. radical mastectomy) were under way.
The use of mammography as a screening tool for breast cancer was becoming a standard of care.
The FDA approved the first selective estrogen receptor molecule (Tamoxifen) in the treatment of breast cancer.
Additional studies in the 1980s demonstrated the appropriate patients to be treated with estrogen receptor inhibitor drugs. The value of adjuvant chemotherapy and local radiotherapy in specific patients was proven to increase our ability to improve local control and long-term survival. Proof that neoadjuvant (treatment prior to surgery) therapy could convert make some inoperable cases able to operable ones was demonstrated by the end of the 1980s.
Several major advances in our understanding of the biology of breast cancer have revolutionized its treatment.
The first humanized antibody (anti-HER2) was created and studied in clinical trials. The basis for understanding the differences in behavior of cancers that showed “over expression” of HER2 was evident.
In the 1990s a new group of chemotherapy compounds (taxanes) was studied and introduced into our armamentarium against breast cancer.
In the late 1990s, we learned the significance of certain genetic variants (BRCA).
In the past 20 years, a number of new effective chemotherapy agents have been introduced. The continued discovery of molecular targets continues to drive more research and development of medications to “target” cancer cells and spare “normal” cells. One of the current areas of intense research is the combination of antibody-drug complexes. This will allow delivery of chemotherapy agents directly to the cancer cells with even more sparing of healthy cells in the body.
Although we do not yet have guaranteed cures for advanced breast cancer, we have come a long way.
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