Clinical Review

An update on the medical management of breast cancer

BMJ 2014; 348 doi: https://doi.org/10.1136/bmj.g3608 (Published 09 June 2014) Cite this as: BMJ 2014;348:g3608
  1. Belinda Yeo, breast unit research fellow1,
  2. Nicholas C Turner, consultant medical oncologist12,
  3. Alison Jones, consultant medical oncologist3
  1. 1Breast Unit, Royal Marsden Hospital, London SW3 6JJ, UK
  2. 2Breakthrough Breast Cancer Research Centre, Institute of Cancer Research, London SW3 6JB, UK
  3. 3Royal Free Hospital, London NW3 2QG, UK
  1. Corresponding authors: A Jones (Alisonjones6{at}nhs.net) N C Turner (nicholas.turner{at}icr.ac.uk)

Summary points

  • Despite the increasing incidence of breast cancer, death rates are falling owing to earlier diagnosis, better surgical and radiotherapy techniques, and improved systemic therapies

  • The best management of the axilla in clinically node negative disease is unclear

  • Adjuvant decision making is driven by tumour biology, with particular attention to the distinct molecular subtypes of breast cancer

  • There is substantial evidence for extended hormone therapy in premenopausal and postmenopausal women with hormone receptor positive early breast cancer

  • In metastatic HER2 positive breast cancer there are now multiple lines of HER2 targeted therapies

Breast cancer remained the most common cancer in women in 2013 and its incidence continues to rise.1 Nonetheless, mortality is falling, partly as a result of earlier diagnosis through mammographic screening,2 improved surgical techniques and attention to margins, improved delivery of radiotherapy, and better adjuvant medical therapies (fig 1). Despite these improvements, breast cancer remains the second most common cause of death from cancer in women.

Fig 1 Incidence of breast cancer in women and mortality rates in the United Kingdom over the past 30 years. Data from Cancer Research UK1

This review focuses on the medical treatment of breast cancer in the adjuvant and metastatic settings, with particular attention to recent advances and changes in practice since our last review in 2008.3 4 We discuss how targeted therapies can be used to individualise and tailor the management of breast cancer according to tumour biology and molecular subtype.

Sources and selection criteria

We used PubMed to identify recent published updates on the medical management of breast cancer. We also referenced presentations from international conferences and consulted with other experts in the breast cancer field.

Early breast cancer

Diagnosis

Guidelines on the diagnosis of early breast cancer have changed little since our last review. Population based mammography screening for asymptomatic women is currently …

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