New approaches to the management of early breast cancer

Major changes are occurring in the approach to the management of early breast cancer. Although the incidence is rising steadily, nevertheless mortality is falling significantly in the United Kingdom and throughout the Western world. To a considerable extent this is because of the use of adjuvant medical therapies along with local treatments for early breast cancer. These include the traditional approaches of endocrine therapy and chemotherapy along with newer approaches including so-called targeted biological therapies including trastuzumab (Herceptin). The challenge now is to select which patients benefit best from each of these treatments. It is clear that breast cancer is no longer one disease but a heterogeneous group of subtypes, each with their own biology and pattern of clinical behaviour.