Current standards of breast cancer treatment in Europe

Abstract

Breast cancer varies widely in its incidence and associated mortality throughout the world. This paper reviews current breast cancer treatment in central and western Europe against a historic background of changing therapeutic theory and practice. Therapeutic options include radical or conservative surgery, radiotherapy, chemotherapy, hormone therapy, immunotherapy and emerging new modalities such as genetic therapy. Historically, mastectomy became accepted as standard treatment on the basis that breast cancer was a purely local disease. Only recently has the realization that breast cancer disseminates at an early stage led to an emphasis on breast-conserving surgery combined with systemic treatment; currently used modalities of these therapies are reviewed, including adjuvant treatment and chemotherapy, together with indications for breast-conserving therapy and mastectomy. The options in hormonal therapy for metastatic disease are also discussed. Key issues for the future include closer collaboration between oncologists and endocrinologists, prevention of breast cancer, improvements in early diagnosis and screening modalities, whether axillary dissection and radiotherapy are always needed, more information on systemic therapy, familial breast cancer and genetic counselling, quality of life for patients, and the advisability of hormone replacement therapy (HRT) in patients with breast cancer.

Key Words:

• BREAST CANCER
• SURGERY
• ADJUVANT THERAPY
• SYSTEMIC THERAPY