Professor PG Roy
Consultant Oncoplastic Breast Surgeon, Oxford University Hospitals NHSFT,
British Association of Surgical Oncology – The Association for Cancer Surgery
Abigal Tomlins
Consultant Breast Surgeon, Gloucestershire Royal Hospital,
British Association of Surgical Oncology – The Association for Cancer Surgery
Discover the latest in personalised breast cancer care and treatment options. Learn about imaging advancements and targeted therapies for improved outcomes.
Breast cancer, the most prevalent cancer globally, has seen enhanced survival rates following collaborative efforts and targeted therapy breakthroughs. Personalised care tailors treatment and prevention to individuals, considering genetic tumour variations, lifestyle factors and health conditions.
Imaging increasingly guides decision-making and treatment planning — from diagnosis to management of advanced disease, reducing the extent of surgical treatment and minimising cosmetic impact and potential long-term sequelae.
Personalised breast screening and early diagnosis
Breast screening has traditionally been via mammogram with geographical variations in the intensity and age groups screened. Variations in breast density, even in postmenopausal women, increasing use of HRT and rising incidence of breast cancer in perimenopausal women question the validity of this approach and the need for density-stratified/adapted breast screening.
The BRAID trial is evaluating modalities such as MRI, CESM and ABUS. High-risk surveillance using MRI for those with genetic alterations facilitates earlier diagnosis.
Imaging is crucial for breast screening in developed nations, yet, it is impractical in many countries. Early diagnosis through patient education and adequate healthcare resources are key to reducing breast cancer mortality.
Oncoplastic treatment choices and de-escalation of treatment
DBT, CESM and MRI enhance surgeons’ confidence in extending breast conservation through wider adoption of oncoplastic breast conservation surgery techniques, improving patient quality of life.
Wire-guided localisation of impalpable lesions has broadly been replaced by modern techniques like RFID, magnetic and radar localisation for increased patient comfort and theatre efficiency.
De-escalating axillary surgery, supported by evidence, can reduce complications such as lymphoedema; and MRI has been shown to predict response to neoadjuvant chemotherapy, driving down the need for mastectomy.
Imaging is crucial for breast
screening in developed nations,
yet, it is impractical in many countries.
Targeted therapies must be cost-effective for global access
The development and adoption of genomic assays for ER-positive and HER2-negative cancers to assess chemotherapy benefits has been a big step forward for personalised care. The advent of targeted therapies (anti-HER2) and immunotherapy (for ER-positive and triple-negative cancers) can potentially improve outcomes for breast cancers. The cost of these therapies must be decreased to allow ‘all-inclusive’ global access to minimise variation.
Role in advanced disease management
PET-CT enhances distant disease assessment over standard imaging, identifying oligometastatic disease treatable with modalities such as SABR, potentially improving curative outcomes and duration of progression-free survival.
The rising incidence of breast cancer, coupled with better treatment, means more people are living longer. Individualising cancer care, minimising morbidity and maximising benefits through early diagnosis and tailored therapies can lead to optimised, evidence-based breast cancer management.
