Changing Paradigms in Breast Carcinoma:A Review

• Main Author: Shameem Shariff
• Format: Article
• Language: English
• Published: ADICHUNCHANAGIRI INSTITUTE OF MEDICAL SCIENCES 2015-06-01
• Series: Journal of Medical Sciences and Health
• Subjects: :breast cancer; core biopsy; molecular classification
• Online Access: http://jmsh.ac.in/index.php?option=com_k2&view=item&id=15:changing-paradigms-in-breast-carcinomaa-review&Itemid=70
• ISSN: 2394-9481; 2394-949X

The journey of breast cancer a common malignancy the world over, is long drawn with several ups and downs finally resulting in patterns of management and therapy amounting to an attempt at breast conservation. Impressive advances have been made in the past 50 years in an effort to prevent, treat and cure breast cancer. Some of the major milestones include methods of screening modalities, newer classifications and a shift from mastectomy to breast conservation therapy. At most oncology centers the first line triple approach has come to mean tissue core biopsy instead of fine needle aspiration cytology, as the histological grade and receptor status can be easily defined and is closer to results obtained at resection. Imaging modalities like mammography have unmasked lesions whose biological behavior and association with cancer is not well defined - columnar cell hyperplasia, columnar cell change, flat atypia as well as complex sclerosing lesions. Reporting these on core biopsy pose a dilemma to, not only the pathologist, but also the treating physicians. Newer concepts like the molecular classification of breast carcinoma have overshadowed the conventional specific and not specific type. This encompasses the estrogen receptor (ER) positive and the ER-negative groups. Among the ER-positive are the luminal Types A and B with fairly good prognosis. Among the ER-negative group are the ones, which are Her2 neu positive and negative ones. The last group is the normal breast type, which is yet to be recognized as a specific entity. Such categories result in specific gene signatures of good prognostic and poor prognostic variants and response to targeted therapy.