The Intraductal Approach to Breast Cancer

摘要

Breast cancer is a disease that has been common in the United States and Western Europe for many years. As countries around the world develop more prosperous economies, we are seeing rapid rises in the rates of breast cancer-especially in the younger generations who have "benefited" from the new prosperity during their pubertal growth spurts and young adult years.1 We can no longer see breast cancer as a disease of just aging Western populations. Our primary successful tool to increase diagnosis at earlier stages in the West has been mammography. In a postmenopausal woman in a relatively wealthy Western country, annual screening with mammography, although it may only give a lead time bias of 12-18 months over clinical exam, saves lives by finding tumors smaller, when our therapies are more effective. Unfortunately, for all our Western advances in breast cancer we still arguably do not have effective means of screening young premeno-pausal women for the earliest stages of this disease. Our best prevention strategies for premenopausal women are either bilateral amputation (alias prophylactic mastectomy) or a solitary SERM (tamoxifen), which may reduce incidence but hardly has an effect on death rates. At a time when the world needs effective screening for the earliest stages of breast cancer in the youngest women, we have little promising to offer