New Horizons in Diagnosis and Treatment of Early Breast Cancer:

By. Kambiz Dowlat, M.D.

Better imaging techniques have led to the detection of breast cancers at very early stages of development, allowing less radical intervention by the surgeon. Overall, the size of breast cancers and the incidence of axillary lymph node metastases are declining sharply. It is estimated that within a decade, the median diameter of invasive breast cancers will only be 1.0cm if mammographic screening of the population becomes more extensive or universal3a. The probability of an axillary metastasis in patients with a primary invasive breast cancer of that size is 10%.

Detection:

Screening mammography is the best method of detecting early breast cancer as illustrated below.

Diagnosis:

Stereotactic needle biopsy (x-ray guided) and ultrasound-guided needle biopsy can be used to sample a suspicious mass.

Prognosis:

Ancillary tests known as prognostic factors such as hormone receptor, growth rate, and others which predict the cancer's behavior may be done on the needle samples     

Staging (extent of cancer spread):

The main rationale for lymph node dissection in patients with breast cancer is to determine whether the cancer has spread and to provide information to aid in decisions about additional treatment such as chemo-hormonal therapy.  Should a patient have clinically enlarged, palpable nodes, dissection might be considered therapeutic.