Hosseini A, Khoury A L, Esserman L J
University of California, 1600 Divisadero, 2nd Floor Box 1710, San Francisco, CA 94115, USA.
Eur J Surg Oncol. 2017 May;43(5):938-943. doi: 10.1016/j.ejso.2017.02.003. Epub 2017 Feb 11.
Over-diagnosis and over-treatment are consequences of greater awareness about breast cancer, more intensive screening, and the resultant identification of more cases of breast cancer that are low or ultralow risk. This area represents an important opportunity to optimize the delivery of appropriate targeted therapy for breast cancer patients. Despite the evolution of breast cancer care over the last few decades and our ability to tailor treatment to biology, a one-size fits all approach is still prevalent in the local and regional management of and screening for breast cancer, failing to reflect the unique biology and tumor characteristics of each patient. In this review, we explore how we can use new tools to better define tumor biology and also how we can change current clinical practices based on already available data. Every surgeon should be knowledgeable about how to craft personalized breast cancer care in the areas of systemic therapy, adjuvant radiation therapy, management of ductal carcinoma in situ (DCIS), precision surgery, and breast cancer screening.
过度诊断和过度治疗是对乳腺癌认识提高、筛查更加密集以及由此发现更多低风险或超低风险乳腺癌病例的结果。这一领域为优化乳腺癌患者适当的靶向治疗提供了重要契机。尽管在过去几十年里乳腺癌治疗有所发展，且我们有能力根据生物学特性定制治疗方案，但在乳腺癌的局部和区域管理及筛查中，一刀切的方法仍然普遍存在，未能反映每个患者独特的生物学特性和肿瘤特征。在本综述中，我们探讨如何利用新工具更好地定义肿瘤生物学特性，以及如何根据现有数据改变当前的临床实践。每位外科医生都应了解如何在全身治疗、辅助放疗、导管原位癌（DCIS）管理、精准手术和乳腺癌筛查等领域制定个性化的乳腺癌治疗方案。
