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Surgery has always been the backbone of breast cancer management. Throughout the past century, there have been great advances in chemotherapy regimens, especially in the neo‐adjuvant setting. As a result of this progress, a patient's disease can be potentially down‐staged and thus surgical intervention can therefore be de‐escalated for the breast as well as the axilla. Current clinical trials are evaluating the role of imaging and core needle biopsy as predictive tools for the efficacy of neo‐adjuvant chemotherapy. Results from these trials may help to clarify how the intricate relationship among imaging, pathology, radiotherapy, and surgery will affect the future management of patients undergoing neo‐adjuvant chemotherapy for invasive breast cancer. [ABSTRACT FROM AUTHOR]

The surgical management of breast cancer has changed considerably since the use of the Halstedian radical mastectomy early in the 20th century. Over the last 50 years, several landmark clinical trials from the USA and Europe have resulted in a paradigm shift in the management of breast cancer toward less radical forms of surgery with the combined use of multi-modality treatments including systemic chemotherapy, endocrine therapy, and radiotherapy. Advances in such research have established a new worldwide standard of care for breast cancer surgical management and treatment, which has become more patient centric and which places a higher emphasis on cosmesis and improved patient quality of life. In this chapter, we review the landmark clinical trials that have influenced surgical management for non-invasive and invasive breast cancer and that serve to guide current clinical practices to date. [ABSTRACT FROM AUTHOR]

Breast-conserving therapy consisting of segmental mastectomy followed by whole-breast irradiation ( WBI) has become widely accepted as an alternative to mastectomy as a treatment for women with early-stage breast cancer. WBI is typically delivered over the course of 5-6 weeks to the whole breast. Hypofractionated whole-breast irradiation and accelerated partial breast irradiation have developed as alternative radiation techniques for select patients with favorable early-stage breast cancer. These radiation regimens allow for greater patient convenience and the potential for decreased health care costs. We review here the scientific rationale behind delivering a shorter course of radiation therapy using these distinct treatment regimens in this setting as well as an overview of the published data and pending trials comparing these alternative treatment regimens to WBI. [ABSTRACT FROM AUTHOR]

Neo-adjuvant endocrine therapy has opened new alternatives for locally advanced breast cancer. Such therapy, which has permitted us to expand the treatment role of neo-adjuvant therapies, may be of great benefit to patient groups such as the elderly, those not suited for chemotherapy, and those whose response may not be optimal. This therapy also may be able to help us identify agents that could improve outcomes in the adjuvant setting as well as possible biologic predictors for outcome. The latest generation of endocrine therapy for breast cancer, aromatase inhibitors, has proved superior to tamoxifen in terms of toxicity and efficacy in the adjuvant setting and is currently being studied in other clinical trials. Current findings indicate that these agents are less toxic and better tolerated than neo-adjuvant chemotherapy and that third-generation anti-hormomal therapy offers improved tumor response compared with tamoxifen, which has resulted in increased breast conserving surgery. Biomarker findings of improved response in tumors that are both estrogen receptor positive and HER-2 positive as well as progesterone receptor positivity only will be important for planning future selective treatment and clinical trials. [ABSTRACT FROM AUTHOR]

The article presents report of the working groups on breast magnetic resonance imaging (MRI). Breast MRI may be employed before, after, and during the course of chemotherapy to evaluate chemotherapeutic response and the extent of residual disease prior to surgical treatment. Localization tissue markers prior to neo-adjuvant chemotherapy may be helpful in the event of complete response and no definable tumor for resection. Accurate post-treatment size determinations may be problematic since tumors do not typically reduce concentrically in size and often islands of tumor are intermixed with non-enhancing fibrosis and necrosis. Automated tumor volume calculations would be helpful in quantitating tumor response and aid in the generation of data for chemotherapeutic trials.

The ability to accurately perform Magnetic resonance imaging (MRI)-guided breast localization and biopsy procedures is essential to the further development of breast MRI procedures, and ultimately to clinical use. Real-time and accurate surrogate markers are critical for the development of MRI as a diagnostic tool, but they are even more imperative for the development of percutaneous minimally invasive procedures. Development of MRI biopsy and localization techniques also impacts on the development of breast cancer staging and high-risk screening trials. Collaboration between industry and researchers in the development of magnets, coils, contrast agents, biopsy devices and techniques and surrogate and real-time markers will expedite the development of improved products and techniques.