PRIMEVIEW

BREAST CANCER
For the Primer, visit doi:10.1038/s41572-019-0111-2

Breast cancer is the most frequent DIAGNOSIS

MANAGEMENT
malignancy in women. At the molecular
level, it is a heterogeneous disease with
Advanced A positive screening mammography (X-ray
molecular features that are used to guide
(metastatic) imaging of the breasts), or the development
treatment. 'CTN[|DTGCUV
cancer is breast cancer is not of breast symptoms or breast changes (lump,
contained in the curable; supportive, localized pain or skin changes), requires
breast or has only palliative and psycho- appropriate diagnostic evaluation. A ‘triple
MECHANISMS social support are crucial test’ — comprising clinical examination,
spread to the axillary
lymph nodes and from the time of imaging and needle biopsy — is used to
All breast cancers arise in the terminal duct lobular KU|EWTCDNG diagnosis confirm a diagnosis. Full characterization
units (the functional unit of the breast) of of the cancer requires assessment of the
the collecting duct. Dozens of genetic tumour histology; grade; ER, PR and
mutations have been identified #NN|RCVKGPVU HER2 receptor status; size; lymph
in women with breast cancer, with ER-positive node involvement; extent of
Endocrine
including amplifications, disease receive adjuvant vascularization; and surgical
therapy, with or
loss-of-function mutations, endocrine therapy after margin status (which is
without targeted therapy,
gain-of-function mutations surgery. If patients are at high obtained once the tumour
is used for luminal-like disease
risk of recurrence, chemotherapy
and deletions. The clinically before monochemotherapy. is excised). These details
is recommended. In triple-
relevant molecular features For triple-negative disease, are indispensable
negative and HER2-positive
are human epidermal growth chemotherapy is the main treatment; HQT|OCPCIGOGPV
cancer, subtype-specific
factor receptor 2 (HER2), immunotherapies show early signs
systemic neoadjuvant
hormone receptors (oestrogen of improving survival as well. For
VJGTCR[KU|UVCPFCTF
receptor (ER) and progesterone HER2-positive disease, HER2
receptor (PR)) and BRCA mutations. pathway blockade and OUTLOOK
Combining these features with chemotherapy are
histological characteristics guides treatment Postoperative preferred. Treatments are becoming more
and is used for research purposes. radiation individualized based on tumour
The
therapy improves cell characteristics, with the promise
presence
survival of patients of improved outcomes. However, the most
.QDWNG Surgical of BRCA mutations
Luminal A-like YKVJN[ORJ|PQFG pressing global challenge in the breast cancer
removal of may trigger family risk
· ER and/or PR, no HER2 and involvement field is to ensure patients in all parts of the world
low proliferation the primary tumour counselling, prophylactic
Luminal B-like is the cornerstone of surgery, increased surveillance have access to high-quality standard diagnosis
· ER and/or PR, no HER2 and and choice of targeted (imaging and pathology)
curative breast cancer
high proliferation
Triple-negative treatment, with breast therapy; PARP inhibitors are and treatment
· No ER, no PR and no HER2 conservation as a an option in metastatic (surgical, radiation
HER+ OCLQT|IQCN disease and systemic
· Luminal-like or nonluminal-like EPIDEMIOLOGY therapy),
%QNNGEVKPIFWEV avoid late
In 2018, an estimated 2.1 million countries, owing to population Risk factors for breast cancer diagnosis and
Breast cancer presents earlier in women were newly diagnosed growth and an ageing include family history, early are provided
Asian women than in their western with breast cancer; ~625,000 population, but the highest menarche, lack of breast with adequate
EQWPVGTRCTVURQVGPVKCNN[TGȯGEVKPI women with breast cancer died. incidence is in North America, feeding, late-onset menopause, supportive
FKȭGTGPEGUKPIGPGVKERTGFKURQUKVKQPNKHGUV[NG The global breast cancer burden Australia, New Zealand and obesity, physical inactivity and and palliative
CPFGPXKTQPOGPVCNHCEVQTU in women is increasing in most northern and western Europe. CNEQJQN|WUG ECTG|UGTXKEGU

doi:10.1038/s41572-019-0122-z; Article citation ID: (2019) 5:67 Written by Mina Razzak; designed by Laura Marshall
© 2019 Springer Nature Limited. All rights reserved.