The demonstration that tumour characteristics, eg oestrogen receptors, are important in choosing therapies makes it imperative that further studies take into consideration the molecular taxonomy of the disease. Breast cancer may be caused through different molecular pathways. Understanding these pathways will allow new therapies to be developed. I envisage the management of patients with breast cancer will change to a situation where the tumour of each individual is analysed, and treatment is tailored to that individuals tumour. Modelling of past trends predicts a continuing large rise in breast cancer incidence, which will be even higher if screening of the 65-69 year olds is taken into account.
Mortality is predicted to continue to decline.
The most optimistic scenario is that by 2015 we have available the results of studies identifying some of the environmental and genetic factors that cause breast cancer and that we can institute programmes of prevention reducing the incidence of breast cancer to about 1500 cases per year. Most cancer would be detected at an early stage by improved screening programmes. As more cancers are detected when small and the screening programme is extended, relatively more patients will have breast conservation, which will increase the demand for radiotherapy. Adjuvant systemic therapy will be increasingly tailored to the tumour, but may involve the use of multiple agents. The potential for reducing the incidence and mortality of breast cancer is enormous.