Preface

The organization of this book reflects a logical, stepwise evaluation and treatment of the patient with breast cancer. It emphasizes the importance of early detection, but highlights a move toward risk identification and reduction. The understanding of the breast cancer patient has evolved from the radical mastectomy for all patients to a tailored approach employing aggressive applications of treatment modalities according to their respective risk reductions.

Despite shifting efforts to identify high-risk patients and address their risk with pre-emptive strategies, there remains a worldwide educational challenge to adopt early detection screening guidelines. Although there is continuing progress in implementing mortality reducing surveillance guidelines as reflected by the increased prevalence of preinvasive breast cancer, the full spectrum of disease remains a challenge to the medical community. The high prevalence of breast cancer continues to drive improvements in all areas of detection, diagnostic evaluation, disease characterization, multimodality therapy, quality of life issues, and, finally, in the treatment of patients whose disease has extended beyond our capabilities to detect or contain local or regional cancer.

One of the most important innovations in the understanding of breast cancer has been the identification of genetic mutations that have allowed the opportunity to intervene with proven surgical or chemopreventive strategies for high-risk patients. Diagnostic imaging technology continues to provide increased resolution and precision, resulting in an enhanced ability to preserve tissue. The surgical treatment of breast cancer is in the process of taking another significant step forward, with the development of sentinel lymph node biopsy. The definition of prognostic factors has helped to guide important adjuvant therapy decisions. Moving beyond the regimented doctrines of an overwhelming preoccupation of cancer treatment, immediate reconstruction with microvascular surgery and other techniques have provided an answer to some of the physical and psychological challenges of breast cancer. Recognition of other competing causes of mortality in the breast cancer survivor has led to a more comprehensive consideration of hormone replacement therapy to address quality of life issues and to reduce the risk of cardiovascular disease and osteoporosis. In the patient with metastatic disease, the introduction of novel forms of treatment, such as with Herceptin, has led to significant improvements in survival. In total, these innovations represent significant progress and provide important directions for future interventions.

One of the biggest challenges to the clinician has been the recognition of improved methods of diagnosis and treatment and utilization of these improvements despite ingrained practices. This pattern is well documented by the great variation observed nationally in the implementation of breast preserving surgery and the utilization of adjuvant treatment.

It is the goal of this book to identify significant improvements in each area of breast cancer diagnosis and treatment, and to help accelerate the dispersion of this knowledge to an ever-broadening spectrum of physicians and scientists who are dedicated to preventing and treating one of the most common afflictions of women.

We wish to thank our distinguished authors for their timely and expert contributions to this effort. We also wish to thank the American Cancer Society, particularly Ted Gansler, for a helpful review of this book.

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