Clinical Review

Management of breast cancer—Part I

BMJ 2008; 337 doi: (Published 04 July 2008) Cite this as: BMJ 2008;337:a421
  1. Nicholas C Turner, oncologist 12,
  2. Alison L Jones, oncologist13
  1. 1Department of Medical Oncology, Royal Free Hospital NHS Foundation Trust, London NW3 2QG
  2. 2Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London
  3. 3University College London Hospitals NHS Foundation Trust, London
  1. Correspondence to: A L Jones alison.jones{at}

    Breast cancer remains the second most common cause of cancer related death in women in the United Kingdom, with over 12 000 deaths a year. However, substantial progress is being made: deaths from breast cancer in the Western world have fallen by over 25% in the past two decades,1 reflecting substantial improvements in management (fig 1). Incidence in Great Britain has risen by 50% over the past three decades, reflecting not only changes in population demographics and environmental factors but also an increase in diagnosis as a result of screening. Over a similar time period mortality has fallen.

    We review here the recent advances in the prevention, screening, and treatment of breast cancer and the recent efforts to individualise treatment. The review is published in two parts; in the second part we will review advances in the systemic treatment of breast cancer and how an increasing understanding of the biology of breast cancer is beginning to change the way we treat the disease.

    Fig 1 Age standardised (European) incidence and mortality rates of breast cancer in women in Great Britain, 1975-2005. Adapted from Cancer Research UK (

    Primary prevention

    What risk factors may be avoidable?

    Progress in primary prevention has come from improved understanding of the causes of breast cancer; identification of modifiable risk factors such as avoidance of post-menopausal obesity, increased exercise, reducing alcohol intake; and encouragement to breast feed (see and, which review these issues comprehensively). No conclusive evidence exists of risk from specific dietary components,2 such as dairy products and fat, other than that mediated through the link with obesity. Similarly, randomised studies examining reduced dietary fat in secondary prevention, after treatment for early breast cancer, have found no consistent effect on recurrence of breast cancer.3 4

    Prolonged exposure to exogenous oestrogen has now been confirmed as a risk …

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