الفهرس 
COVEROnly 14 pages are availabe for public view
 |  | from | 182 |  |  |
| | | from | 182 | | |
Abstract
reast cancer is the most common cancer in women in Developed western countries and is becoming even more significant in many developing countries. In Egypt, breast cancer is the most common cancer among women, representing 18.9% of total cancer cases with an age-adjusted
rate of 49.6 per 100,000 populations.
Advances in molecular biology have facilitated the identification of tumor markers that not only predict prognosis and therapeutic response but
may also function as therapeutic targets. Gene expression profiling using high-throughput microarray technologies has led to an improvement in the cellular and molecular understanding of breast cancer. The so-called
molecular portraits of breast carcinomas recognized three main groups: one with the characteristics of luminal cells, one with a basal (and/or myoepithelial) differentiation and one that overexpresses HER2.
The general approach to evaluation has become formalized as triple assessment, involving clinical examination, imaging (usually mammography
and/or ultrasonography), and needle biopsy, but always perform this as part of a more general assessment beginning with clinical history.
Breast cancer management has become increasingly complex, and requires a comprehensive assessment of multiple tasks in addition to the simple extirpation of the primary tumor, including breast imaging, advanced
pathology, nuclear medicine and a variety of adjuvant therapies, both local and systemic. This has shifted breast cancer treatment into a multidisciplinary science.
Over the past 40 years, there has been a major change in the treatment of patients with early breast cancer, with breast conservation coming to the forefront as a viable option. Breast-conserving surgery (BCS) was initially performed to reduce the physical and psychologic morbidity of mastectomy.
Between 1980 and 2004, the mastectomy rate at the Mayo Clinic fell from 91% to 36,13% and currently about 66% of women with early breast
cancer will have BCS.BCS nationwide is probably performed less often than at this tertiary referral center, but the increased use of lumpectomy and
radiation therapy to treat early breast cancer is evident.
Local Recurrence represents an alarming event since it is associated with increased risk of distant disease and death. A recent report by the
National Surgical Adjuvant Breast and Bowel Project (NSABP), based on 259 patients with invasive IBTR after BCS, reported an OS at 5 years of 59.9%, and a hazard ratio for mortality associated with IBTR of 2.58.
Identifying patients at high risk for local recurrence in advance and individualizing treatment in these patients (for example, a higher
radiotherapy dose (’boost’) or a primary mastectomy) is desirable.
Several risk factors for local recurrence have been recognized. Margin status, young age, an incompletely excised extensive intraductal component and inadequate radiotherapy dose (boost) have been identified as important
risk factors for local recurrence. Adjuvant systemic treatment (chemotherapy or hormonal therapy) is known to reduce the risk of a local recurrence.
The treatment options for loco- regional recurrences are limited.
Chemotherapy might not be effective in pre-irradiated tissue because a decreased perfusion can be expected due to radiation-induced fibrosis.
Mastectomy or local excision and reconstructive surgery are, thus, the preferred therapies.
However, in recent years evidence accumulate that a second BCT might be feasible with long term local control. If cure is no longer achievable,
local regional recurrences might cause suffering due to severe pain, bleeding and ulcerations in up to 62% of patients, Furthermore, a growing tumour mass can be a stressful experience to a patient.