Improving decision-making in early breast cancer: who to treat and how?

Recent advances in primary and adjuvant treatment for early-stage breast cancer have reduced mortality rates, and improved the overall prognosis. Many patients can be cured, while others may survive for 10 years or more beyond diagnosis, thanks to a combination of preoperative therapy, surgery, radiotherapy, and systemic adjuvant therapy. Minimally invasive procedures, more effective drugs, and improved treatment regimens are helping to reduce breast cancer recurrences and deaths, while minimizing side effects and maintaining quality of life. Despite such improvements, a significant number of patients with early disease will relapse, including those who are clinically disease-free after primary and adjuvant therapy. Advances in breast tumor biology have led to the discovery of many different tumor types, and a uniform approach to treatment is no longer appropriate. Potential markers have been identified for the risk of relapse and responsiveness to a given therapy, thus treatment decisions and clinical guidelines, previously based on data from large patient populations, are changing to reflect a movement towards individually tailored treatment. Refinements in clinical practice will help physicians to identify the patients who will benefit the most from a particular approach, reducing overtreatment, and sparing patients unnecessary therapy. Genetic studies are helping to increase our understanding of the metastatic potential of tumors, leading to the development of adjuvant therapies for the prevention of metastases in selected patients. This article reviews the latest advances in treatment for early breast cancer, and explores how research and clinical practice are evolving to improve therapies and treatment decision-making, allowing physicians to optimize patient care.