Smarter surgery for better cancer outcomes: Leading the way with breast cancer


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Alastair M Thompson1
1Dundee Cancer Center, Dundee, UK

Abstract

Breast cancer exemplifies a smarter approach to improving surgical outcomes in oncology. Historically, the move from radical mastectomy, through mastectomy to breast conservation has recently been matched with sentinel node biopsy replacing axillary node clearance for most women. Oncoplastic approaches have improved cosmetic outcomes and tailored neoadjuvant approaches allow wide excision where mastectomy would have been required.

The neoadjuvant approach has been developed to allow comparisons of chemotherapy, endocrine therapy and more recently targeted therapy regimens. Indeed neoadjuvant drug therapy has become standard of care to downsize primary breast cancers over 2cm in size, not purely for locally advanced breast cancer. The neoadjuvant setting can also complement the adjuvant clinical setting with 20-fold fewer patients required to generate comparable data.

The few days or weeks prior to surgery offer a ‘window of opportunity' to examine the in vivo effects in women of one or more drugs. Such studies can examine on target, anticancer and systemic effects in a range of tumour, normal and blood samples. Pre-treatment, on-treatment and post-treatment tissues can be analysed using a range of biomarker techniques. This approach can be useful not only to test hypotheses but also to generate data requiring further in vitro and in vivo study.

Smarter surgery in breast cancer has evolved into multidisciplinary interactions overcoming many challenges in research design and delivery. Similar approaches to other anatomical surgical sites present challenges requiring interdisciplinary collaboration, but offer substantial opportunities for therapeutic development with great potential to improve patient care.