University of Washington School of Medicine, Seattle, Washington (USA).
Phys Med. 2006;21 Suppl 1:2. doi: 10.1016/S1120-1797(06)80011-6.
Carcinoma of the breast is the most common cancer in u.s. women (excluding skin cancer), and the second leading cause of cancer-related mortality. In 2004, it is estimated that 215,000 u.s. women will develop invasive breast cancer, and 40,000 women will die of the disease. Advancing age and female sex are the two greatest risk factors for the development of breast cancer, although family history, reproductive and hormonal history, lifestyle and environmental factors all contribute to risk. Models are available to help estimate risk of developing breast cancer in individual patients. Inherited mutations, specifically in the genes BRCA1 and BRCA2, account for approximately 5-10% of all breast cancer cases. Significant advances have recently been made in both the primary prevention of breast cancer (including chemoprevention), and secondary prevention (early detection through breast imaging). Breast mri as a tool for screening high risk women is a particularly exciting new tool. When breast cancer is diagnosed, optimal treatment involves a multidisciplinary approach, including surgery, radiation therapy, and systemic therapies. In the field of breast surgery, breast conservation and sentinel lymph node biopsy techniques have allowed substantially decreased surgery in appropriated selected patients with corresponding decreases in complication rates and long-term sequelae. Radiation oncologists are comparing partial breast irradiation versus conventional whole breast radiation in an attempt to minimize toxicity and treatment time, and maximize efficacy. The field of breast medical oncology has evolved at a rapid pace in the past decade, with numerous new hormonal agents, chemotherapeutic agents, and biologically targeted therapies in clinical use and under investigation. The addition of 'adjuvant' systemic therapy to the treatment of early stage breast cancer patients has dramatically reduced relapse and death rates. Unfortunately, metastatic recurrence still occurs. Once the cancer has spread beyond the breast and locoregional nodal areas it is felt to be incurable, although still treatable. A better understanding of breast cancer biology has led to the development of a host of new biologically targeted agents, many of which hold substantial promise for improving quality of life and survival rates in metastatic breast cancer patients.
乳腺癌是美国女性（不包括皮肤癌）最常见的癌症，也是癌症相关死亡的第二大主要原因。据估计，2004 年将有 21.5 万名美国妇女患有浸润性乳腺癌，4 万名妇女将死于该病。年龄增长和女性性别是乳腺癌发展的两个最大危险因素，尽管家族史、生殖和激素史、生活方式和环境因素都与风险有关。目前已有模型可用于帮助估计个体患者患乳腺癌的风险。特定于 BRCA1 和 BRCA2 基因的遗传性突变约占所有乳腺癌病例的 5-10%。最近，在乳腺癌的一级预防（包括化学预防）和二级预防（通过乳房成像进行早期检测）方面都取得了重大进展。作为筛查高危女性的工具，乳房磁共振成像（MRI）是一种特别令人兴奋的新工具。当诊断出乳腺癌时，最佳治疗方法包括多学科方法，包括手术、放射治疗和全身治疗。在乳房外科领域，乳房保留和前哨淋巴结活检技术允许在适当选择的患者中大大减少手术，相应地降低并发症发生率和长期后遗症。放射肿瘤学家正在比较部分乳房照射与常规全乳房照射，试图最大限度地减少毒性和治疗时间，并最大限度地提高疗效。在过去十年中，乳腺癌内科治疗领域发展迅速，许多新的激素药物、化疗药物和生物靶向治疗药物已在临床使用和研究中。将“辅助”全身治疗添加到早期乳腺癌患者的治疗中，大大降低了复发和死亡率。不幸的是，转移性复发仍然存在。一旦癌症扩散到乳房和局部区域淋巴结以外，就认为是无法治愈的，尽管仍可治疗。对乳腺癌生物学的更好理解导致了许多新的生物靶向药物的开发，其中许多药物有望改善转移性乳腺癌患者的生活质量和生存率。
