Considering the impact of translational breakthroughs on the early detection, diagnosis, prevention, and treatment of breast cancer, this all-encompassing guide collects cutting-edge research on the most promising strategies and agents likely to impact the management and long-term outcomes of women with breast cancer. This book will provide current information on rapidly evolving translational therapies, as well as improved strategies for the selection of patients for these treatments.
The past 30 years have seen considerable progress in the detection, diagnosis, treatment and prevention of breast cancer. Such progress followed developments on two parallel tracks: empirical observations and, increasingly, translational research. Empirical observations have been at the heart of medical progress for millennia and, until the middle of the 19th century, were largely responsible for all progress in medicine. The emerging fields of biology and genetics have achieved increasing importance, and over the past 30 years the explosion of knowledge about the process of malignant transformation has been dramatic. We now understand that all cancers, including all breast cancers, are ultimately the result of one or more molecular genetic anomalies that result in the loss of customary control processes for cell growth and communal organization. These molecular genetic anomalies can result from a variety of inherited conditions, or external or internal influences. Certainly exposure to environmental carcinogens is one obvious mechanism, but dysregulation of physiologic processes is another common pathway. Research in this area has revealed the central importance of steroid hormone physiology and, in its diseased state, pathophysiology in the development of premalignant and malignant changes of breast tissue. Further research has identified other critical growth hormone and receptor systems, including the type I tyrosine kinase receptor family. Other growth hormone families and the intricate network of intracellular signaling steps that govern cellular behavior and survival have acquired more prominent roles in our global understanding of breast cancer. All these pieces of the puzzle also serve to open opportunities for identifying therapeutic targets and lead to the development of molecularly targeted therapies. The past few years have witnessed the coming together of these various discoveries and led to a substantive paradigm change in our approach to breast cancer. Tamoxifen, as a targeted approach to the estrogen receptor signaling network, and trastuzumab, as a molecular modulator of HER2 signaling, became the prototypes of what many of us hope will be an increasing stream of smart drugs that will approach breast cancer treatment by identifying specific molecular targets that are critical to the survival of the malignant cell and cutting that lifeline.