Patients and relatives often ask about the current status of breast cancer diagnosis and treatment, and what other new technologies will bring revolutionary changes in the future. In this article, we briefly review the history, current status and future development trend of various diagnosis and treatment technologies for breast cancer, so that we can have an overall concept of breast cancer treatment, and also can strengthen our confidence to overcome the disease.
35 years ago.
The 5-year survival rate of breast cancer was about 75%.
Total breast excision was the only surgical option.
There was only one randomized study of mammography for breast cancer screening.
For adjuvant therapy after surgery for early breast cancer, attempts at combination chemotherapy with multiple chemotherapeutic agents with different mechanisms of action and endocrine therapy with triamcinolone acetonide (tamoxifen) were initiated.
Initially, breast cancer radiotherapy techniques and methods were established.
Endocrine therapy with triamcinolone acetonide has been initiated for inoperable advanced breast cancer, but has not yet been formally approved by the FDA.
Genes associated with the risk of developing breast cancer have not been identified.
Now.
The 5-year survival rate for breast cancer patients is close to 90 percent. This is mainly due to the worldwide emphasis on breast cancer screening and the continuous improvement of screening tools, such as ultrasound, mammography, magnetic resonance, stereotactic biopsy and other technologies that make early detection of breast cancer possible. Among the diagnosed breast cancer patients, the proportion of early stage breast cancer is increasing.
For early stage breast cancer, breast-conserving surgery + local radiotherapy has replaced total mastectomy as the best surgical procedure.
Combination chemotherapy has become the standard adjuvant treatment for early-stage breast cancer to destroy cancer cells that may have spread beyond the breast; neoadjuvant chemotherapy (pre-surgical chemotherapy) is being explored to reduce tumor size and increase the chances of obtaining breast conservation.
For early or progressive breast cancer, endocrine therapy with triamcinolone acetonide or aromatase inhibitors has become the standard of care or adjuvant treatment for estrogen receptor-positive breast cancer. For estrogen receptor-positive breast cancer cells where estrogen stimulates growth, selective estrogen receptor modulators that block the binding of estrogen to the receptor and aromatase inhibitors that inhibit estrogen production in postmenopausal breast cancer patients can both prevent estrogen from stimulating cancer cell growth. Currently, the FDA has approved aromatase inhibitors including letrozole, alatriptan, and exemestane for endocrine therapy in postmenopausal breast cancer patients. Clinical studies have shown that aromatase inhibitors are superior to triptans in terms of both efficacy and side effects.
In clinical trials, the selective estrogen receptor modulators triamcinolone acetonide and raloxifene reduced the risk of breast cancer in high-risk groups, and the FDA has approved triamcinolone acetonide for the prevention of breast cancer.
Conformal intensity-modulated radiotherapy techniques with better radiotherapy targeting and less radiation damage to normal tissue have been used for radiotherapy of breast cancer.
Trastuzumab (Herceptin) has been used to treat Her2 (human epidermal growth factor receptor 2) overexpressed breast cancers, which account for approximately 20% of all breast cancers and exhibit a greater ability to invade and metastasize, and are more likely to recur. Trastuzumab targets Her2 in tumor cells, and the combination of chemotherapy with trastuzumab reduces the risk of recurrence by 50% compared to chemotherapy alone.
Large-scale familial breast cancer studies have led to the identification of a number of breast cancer susceptibility genes, including BRCA1, BRCA2, TP53, and PTEN/MMAC1. Mutations in the BRCA1 and BRCA2 genes account for 80% to 90% of all hereditary breast cancers, and women with these mutations are at 10 times greater risk of developing breast cancer than the general population.
Since the qualitative understanding of breast cancer has shifted from a local disease to a systemic disease, and since there is no single method that can absolutely cure breast cancer effectively, these results have formed the basic principles of standardized and holistic comprehensive treatment for breast cancer.
Future.
Gene expression analysis has allowed the classification of breast cancer into five subtypes with different biological characteristics, response to chemotherapy and prognosis. This knowledge has helped us to develop individualized treatment approaches for tumors with different characteristics.
The response of individual patients to chemotherapy is related to the genetic characteristics of tumors and genetic variants in genes that affect drug absorption, metabolism, and excretion. This knowledge has the potential to enable us to predict the efficacy and severe toxic effects of specific chemotherapeutic agents in individual patients before treatment, to avoid or reverse tumor resistance, and to design new chemotherapeutic agents with high efficiency and low toxicity.
With the progress of research on the mechanism of resistance of existing endocrine therapeutic agents, new endocrine therapeutic agents that can fight against drug-resistant tumors, such as fulvestrant, have entered clinical trials.
New radiotherapy techniques aimed at reducing treatment time and side effects, such as single high-dose intraoperative irradiation, or short-course postoperative radiotherapy, are also being investigated.
Some more effective targeted therapies, including a new generation of targeted therapies that can attack multiple targets of tumor cells at the same time, will continue to be developed.
Although the incidence of breast cancer in China is likely to increase in the future with the change of diet and lifestyle, with the rapid development of genetics, molecular biology and immunology and the continuous exploration of breast cancer, human beings will develop better targeted therapeutic products with high efficiency and low toxicity, and apply this knowledge to individualized treatment of breast cancer. The treatment of breast cancer will eventually enter the era of targeted and individualized treatment in the true sense. The treatment effect of breast cancer will continue to improve, and the quality of life of breast cancer patients will be more similar to that of normal people after standardized treatment, and humans will finally overcome breast cancer.