Esserman Laura, Gallant Etienne, Alvarado Michael
From the University of California, San Francisco, San Francisco, CA.
Am Soc Clin Oncol Educ Book. 2016;35:e5-e10. doi: 10.1200/EDBK_159060.
Personalized medicine is emerging as an important guiding principle in diagnosis and treatment. This means not just doing more for some, but safely doing less for others. The lessons learned about the biology of breast cancer over the last 2 decades have enabled us to understand the incredible heterogeneity of breast cancer and its associated behavior. Although much work remains, there is an emerging opportunity to identify and recognize more indolent forms of breast cancer, made more prevalent through the widespread adoption of screening. With our improving systemic therapies and improved molecular tools, we now have the opportunity to reduce the burden of treatment in women with lower-risk tumors. Our surgical treatments have evolved, with less morbid and more cosmetic procedures. In this article, we review the indications for further reducing local therapy, including adjuvant radiation.
个性化医疗正在成为诊断和治疗中的一项重要指导原则。这意味着不仅要为一些人做更多，还要安全地为另一些人做得更少。过去20年里我们从乳腺癌生物学中学到的知识，使我们能够理解乳腺癌令人难以置信的异质性及其相关行为。尽管仍有许多工作要做，但通过广泛开展筛查，识别和认识更多惰性形式乳腺癌的机会正在出现。随着我们的全身治疗方法不断改进以及分子工具不断完善，我们现在有机会减轻低风险肿瘤女性的治疗负担。我们的手术治疗也在不断发展，采用的手术方式创伤更小、美容效果更好。在本文中，我们将回顾进一步减少局部治疗（包括辅助放疗）的指征。
