Management Options in Breast Cancer: Case Histories, Best Practice, and Clinical Decision-Making PDF

Preface

The incidence of breast cancer continues to increase, and the heterogeneous nature of this disease presents unique management challenges. Treatments are increasingly being tailored to meet the needs of individual patients, although cost issues may influence the decision-making process in some circumstances. Notwithstanding these comments, there are standards of best practice, which are accepted by breast cancer experts in communities around the world, and much consensus now exists in several key areas. This is evident at international meetings, where leading opinion formers share the same principles and philosophies. It is now recognized that diagnostic accuracy, management, and survival rates for breast cancer are superior when practiced within specialized breast teams. Multidisciplinary team (MDT) meetings have helped ensure that as many patients as possible receive optimum standards of care, which can be audited prospectively. These MDT meetings are underpinned by shared protocols and guidelines, though some flexibility and clinical discretion is permissible. There are situations where there is no "right treatment" based on published evidence, and a degree of clinical judgment and personal experience (and even bias) will prevail.

This book exemplifies how guidelines should be followed and the role of clinical judgment in determining management plans for breast cancer patients within the context of the MDT. It is based on a selection of actual clinical cases that have passed through the MDT or "tumor board" meetings. These represent a spectrum of clinical scenarios frequently encountered in routine practice, together with some more unusual and atypical cases. These cases have been grouped under headings with a dominant theme, and each one will be presented in a standard format with (1) clinical history, (2) examination, (3) investigations (mammogram, ultrasound, core biopsy, fine needle aspiration cytology, and tests as appropriate, such as MRI, bone scan, CT scan chest/abdomen/ pelvis), (4) treatment, and (5) discussion. Illustrative material includes schematic diagrams, breast imaging results, pathological slides, and clinical photographs (pre-/postoperative). Each case will be followed by a list of summary points, which is intended as a learning tool. Most cases involve multimodality therapies, and cross-referencing has been included to allow the reader to compare and contrast similar aspects of treatment between different cases.

This book is aimed for surgeons and oncologists trained in breast disease together with established specialists and clinical nurse practitioners. In addition, physicians in various other disciplines such as radiology and gynecology may find the book a useful guide that highlights problematic and controversial areas within this field.