Staging of breast cancer: is it still necessary?

Traditionally, breast cancer has been staged to give an idea of prognosis (outcome) of the disease and to guide us as to what treatment is necessary.  In brief, early breast cancer that has not spread is stage 1.  Breast cancer that has spread around the body is stage 4.  Stage 2 and 3 are in between.

Ideally, a multidisciplinary team should discuss every woman with a diagnosis of breast cancer and plan the ideal management of women who have been diagnosed with breast cancer.  Surgeons, oncologists, radiotherapists, radiologists, pathologists and a social worker should attend the meeting.  Each individual should be discussed and the best management advised. This happens in the better resourced centres, but we would like to see it becoming the norm across South Africa.

The decision to advise a woman to have chemotherapy after surgery, for example, is based on the chance of the cancer cells having spread around the body.  The smaller the cancer, the less chance that would have happened.  But it is not as simple as that.

Grade of the cancer refers to how busy a cancer is, how lose the cells are and therefore how likely the cancer cells are to spread to a distant place.  The grade of the cancer is therefore factored into the equation.  Despite using all the traditional markers (including ER receptors), some women will not be advised to have chemotherapy and will develop distant spread at a later date.  Other women will be treated with chemotherapy and would never have had another problem.

There has been a lot of interest in trying to make the treatment more appropriate.  It is hoped that the genetics of the cancer will provide the answer. There are two tests that are available in South Africa: the Onco Dx test and Mammaprint.

They are both relatively expensive and many medical aids wont pay for them but there is no doubt that with time, the genetics of the cancer will become more and more important in determining the management of an individual.

Having individual treatment plans based on the genetic expressions of tumours is known as personalised medicine.

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