Advances in breast cancer treatment

Breast cancer is the most common malignant tumour in women worldwide. Morbidity and mortality increases with age, significantly after the age of 45. Early detection of the disease is vital. The diagnosis and treatment of breast cancer today is significantly advanced. Magnetic resonance imaging has revolutionised diagnostics. If a biopsy shows invasive lobular carcinoma or even ductal carcinoma in situ, it is necessary to perform an magnetic resonance scan to rule out multicentricity or an extensive intraductal component, which may affect the surgical approach. Prognosis and treatment of breast cancer today depends on four molecular subtypes: Luminal A, luminal B, HER2-positive, and triple negative. Guidelines for surgical and oncological treatment today have also changed, patients with locally or systemically advanced breast cancer, with a tumour larger than 2.5 cm, confirmed as HER-2 positive or triple negative from biopsy results, should be subjected to neoadjuvant chemotherapy, and after the tumour is reduced, to surgery, at which point the operation can be considerably less involved than before. Furthermore, in the case of a positive sentinel lymph node, formerly mandatory axillary dissection can be replaced by axillary radiotherapy today with comparable prognosis and survival rate. Of new surgical techniques, skin- sparing mastectomy is worth mentioning, while intraoperative radiotherapy will be the future of treatment. The diagnosis and treatment of breast cancer has been significantly advanced. This review have revealed the current treatment of breast cancer on surgical, oncological fiels as well as in diagnosis

Historical review of breast cancer surgery

Breast cancer is the most common malignant tumour in women worldwide. It is said that one in eight women will develop breast cancer. Morbidity and mortality increases with age, significantly after the age of 45, with peak morbidity in the 50s. Breast cancer is known to be one of the earliest described malignancies in medicine. The first description of the disease and its treatment are found in the Edwin Smith Papyrus. Hippocrates, a Greek physician, considered the father of medicine, also differentiated ulcerative breast cancers, and noticed that the disease manifested on the skin, and resembled “crab legs”, hence the name cancer. The development of surgery stagnated during the Middle Ages, with a resurgence during the Renaissance and significant progression. Radical breast removal was advocated. Fabricius Acquapendente is credited with introducing informed consent for surgery for woman, which is a necessary and important document in medicine even today. Halsted introduced the radical mastectomy, which persisted as the surgery of choice for over a century, until it was proven that removing the chest muscles and third axilla did not have any affect on prognosis. The modified radical mastectomy was subsequently introduced which continues to be the approach for breast surgery to present day. Initial treatments advocated highly aggressive surgical techniques, believed to be necessary to ensure survival. Such attitudes have changed in the direction of conserving surgery for breast as well as for the axilla