The expanded role of radiotherapeutics and widespread utilization of adjuvant or neoadjuvant chemotherapy have contributed to improved patient outcome. Furthermore, recent discovery of breast cancer genes and the dramatic efforts to identify risk factors may ultimately lead to the detection of precursor lesions and the prevention of breast cancer. More importantly, the enhanced public awareness of breast cancer has resulted in increased funding for biomedical research, behavioral science, education, research, screening, treatment and survivorship. Various factors contribute to the complexity of breast cancer issues. These include our limited understanding of the biology and natural history of breast cancer, variability in diagnostic criteria, significant diversity in management and therapy and lack of universal acceptability of screening procedures and follow-up therapy.
Breast cancer is one of the most poorly understood malignancies.
Prospective studies focusing on the natural history of precursor lesions are limited. Early detection of precursor lesions is, however, the key to the reduction of mortality from breast cancer. This involves understanding of the genetic events, the metabolic alterations and the morphologic changes which occur during the neoplastic progression. It is essential to find ways to detect these changes before a lesion becomes malignant. The major challenges involved in this discovery process include difficulty in the detection of precursor lesions by mammography alone and the inherent differences in clinical and radiologic presentations among precursor lesions, i.e., lobular carcinomas in situ versus ductal carcinoma in situ.