Breast Cancer

A review entitled Past, present and future challenges in breast cancer treatment, published in 2014 to mark the 50th anniversary of the American Society of Clinical Oncology (ASCO), reported that anti-oestrogen treatments have had a “greater global impact than any other treatment intervention in cancer medicine”. The flagship in hormonal, or endocrine, therapy has been tamoxifen, one of the World Health Organisation’s essential drugs.

Breast cancer surgery has a central role in the long history of cancer. The story of how operations became radical – with all that entailed in disfigurement and distress – and then conservative in line with new scientific understanding, is a mainly European one but with the insight too of one outstanding American.

How can breast tumours that have no ‘palpable’ lumps be located precisely during surgery? A radiotracer injected into the lesions guides the surgeon to the site and results in a higher rate of excision of all the cancer.

The idea that lymph nodes can be guarded by a single ‘sentinel’ node proved to be correct and in breast cancer the status of this key node has played a pivotal role in avoiding unnecessary lymph node surgery without compromising on further treatment decisions. But it’s an evolving story.