Riis M
Department of Oncology, Section of Breast- and Endocrine Surgery, Oslo University Hospital, Oslo, Norway.
Department of Cancer Genetics, Institute for Cancer Research, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway.
Ann Med Surg (Lond). 2020 Jun 23;56:95-107. doi: 10.1016/j.amsu.2020.06.016. eCollection 2020 Aug.
Breast cancer is the most frequent cancer in women all over the world. The prognosis is generally good, with a five-year overall survival rate above 90% for all stages. It is still the second leading cause of cancer-related death among women. Surgical treatment of breast cancer has changed dramatically over the years. Initially, treatment involved major surgery with long hospitalization, but it is now mostly accomplished as an outpatient procedure with a quick recovery. Thanks to well-designed retrospective and randomly controlled prospective studies, guidelines are continually changing. We are presently in an era where safely de-escalating surgery is increasingly emphasized. Breast cancer is a heterogenous disease, where a "one-size-fits-all" treatment approach is not appropriate. There is often more than one surgical solution carrying equal oncological safety for an individual patient. In these situations, it is important to include the patient in the treatment decision-making process through well informed consent. For this to be optimal, the physician must be fully updated on the surgical options. A consequence of an improved prognosis is more breast cancer survivors, and therefore physical appearance and quality of life is more in focus. Modern breast cancer treatment is increasingly personalized from a surgical point of view but is dependent on a multidisciplinary approach. Detailed algorithms for surgery of the breast and the axilla are required for optimal treatment and quality control. This review illustrates how breast cancer treatment has changed over the years and how the current standard is based on high quality scientific research.
乳腺癌是全球女性中最常见的癌症。其预后总体良好，各阶段的五年总生存率均超过90%。但它仍是女性癌症相关死亡的第二大主要原因。多年来，乳腺癌的外科治疗发生了巨大变化。最初，治疗需要进行大型手术且住院时间长，但现在大多作为门诊手术完成，恢复迅速。得益于精心设计的回顾性研究和随机对照前瞻性研究，相关指南不断变化。我们目前正处于一个越来越强调安全降低手术规模的时代。乳腺癌是一种异质性疾病，“一刀切”的治疗方法并不合适。对于个体患者，通常有不止一种手术方案具有同等的肿瘤学安全性。在这些情况下，通过充分知情同意让患者参与治疗决策过程很重要。要达到最佳效果，医生必须全面了解手术选择。预后改善的一个结果是乳腺癌幸存者增多，因此身体外观和生活质量更受关注。从外科角度来看，现代乳腺癌治疗越来越个性化，但依赖于多学科方法。为了实现最佳治疗和质量控制，需要详细的乳房和腋窝手术算法。本综述阐述了多年来乳腺癌治疗的变化情况以及当前标准是如何基于高质量科学研究的。
