{"title":"从Halstedian乳房根治术到个性化医疗的范式转变。","authors":"Vahit Özmen","doi":"10.5152/tjbh.2017.312017","DOIUrl":null,"url":null,"abstract":"<p><p>Breast cancer management changed from radical mastectomy to precision medicine in a period longer than a century. The aims of these changes were to refrain from overdiagnoses and overtreatments as well as their harmful side effects and extra costs. Breast cancer is a heterogeneous disease and characterized by many morphological, clinical and molecular features. We now increasingly realise that a one-size-fits-all strategy does not apply to all breast cancer patients. Personalized medicine may be used for breast cancer screening, diagnosis and treatment. Individualized screening can decrease the number of unnecessary mammograms, additional radiologic studies, breast biopsies and false positivity rates. However, additional 15 to 20 years are necessary to reach the results of prospective randomized trials comparing low-risk and normal-risk women. We also should wait for outcomes of risk-based screening trials. The rates of overtreatment in patients with early-stage breast cancer have reached 40% in many studies. Personalized treatment has succeeded in reducing it substantially by using tumour genetic profiling and tumour receptors in early breast cancer patients. However, it has its limits and it is impossible to generalize it to all patients. New biomarkers and molecular classifications have also led to the development of novel therapies and treatment strategies. And, they can contribute to a more personalized management of breast cancer patients.</p>","PeriodicalId":91975,"journal":{"name":"The journal of breast health","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381674/pdf/jbh-13-2-50.pdf","citationCount":"5","resultStr":"{\"title\":\"Paradigm Shift From Halstedian Radical Mastectomy to Personalized Medicine.\",\"authors\":\"Vahit Özmen\",\"doi\":\"10.5152/tjbh.2017.312017\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Breast cancer management changed from radical mastectomy to precision medicine in a period longer than a century. The aims of these changes were to refrain from overdiagnoses and overtreatments as well as their harmful side effects and extra costs. Breast cancer is a heterogeneous disease and characterized by many morphological, clinical and molecular features. We now increasingly realise that a one-size-fits-all strategy does not apply to all breast cancer patients. Personalized medicine may be used for breast cancer screening, diagnosis and treatment. Individualized screening can decrease the number of unnecessary mammograms, additional radiologic studies, breast biopsies and false positivity rates. However, additional 15 to 20 years are necessary to reach the results of prospective randomized trials comparing low-risk and normal-risk women. We also should wait for outcomes of risk-based screening trials. The rates of overtreatment in patients with early-stage breast cancer have reached 40% in many studies. Personalized treatment has succeeded in reducing it substantially by using tumour genetic profiling and tumour receptors in early breast cancer patients. However, it has its limits and it is impossible to generalize it to all patients. New biomarkers and molecular classifications have also led to the development of novel therapies and treatment strategies. And, they can contribute to a more personalized management of breast cancer patients.</p>\",\"PeriodicalId\":91975,\"journal\":{\"name\":\"The journal of breast health\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2017-04-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5381674/pdf/jbh-13-2-50.pdf\",\"citationCount\":\"5\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The journal of breast health\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.5152/tjbh.2017.312017\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The journal of breast health","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.5152/tjbh.2017.312017","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Paradigm Shift From Halstedian Radical Mastectomy to Personalized Medicine.
Breast cancer management changed from radical mastectomy to precision medicine in a period longer than a century. The aims of these changes were to refrain from overdiagnoses and overtreatments as well as their harmful side effects and extra costs. Breast cancer is a heterogeneous disease and characterized by many morphological, clinical and molecular features. We now increasingly realise that a one-size-fits-all strategy does not apply to all breast cancer patients. Personalized medicine may be used for breast cancer screening, diagnosis and treatment. Individualized screening can decrease the number of unnecessary mammograms, additional radiologic studies, breast biopsies and false positivity rates. However, additional 15 to 20 years are necessary to reach the results of prospective randomized trials comparing low-risk and normal-risk women. We also should wait for outcomes of risk-based screening trials. The rates of overtreatment in patients with early-stage breast cancer have reached 40% in many studies. Personalized treatment has succeeded in reducing it substantially by using tumour genetic profiling and tumour receptors in early breast cancer patients. However, it has its limits and it is impossible to generalize it to all patients. New biomarkers and molecular classifications have also led to the development of novel therapies and treatment strategies. And, they can contribute to a more personalized management of breast cancer patients.