Introduction

Abstract

Given the continued evolution of our understanding of the biology of breast cancer, a paradigmatic shift in our approach to breast cancer therapy may soon be appropriate. With the current paradigm, local therapy is the primary treatment modality, the goal of systemic therapy being to destroy any tumor cells that remain after local therapy is complete. With the new paradigm, the emphasis would be reversed: The goal of local therapy would be to eradicate any residual tumor that imposes a significant risk to the patient after systemic therapy has been completed. This new paradigm opens the door to new strategies of systemic therapy that attempt to render the tumor a harmless parasite rather than to kill all the tumor cells outright. The other ramification of this new paradigm is that extensive surgery could largely be abandoned in favor of minimally invasive approaches, such as cryosurgery, laser ablation, stereotactic excision, and the application of thermal energy using magnetic resonance-guided focused ultrasonography. Progress in our understanding of breast cancer and its treatment has been built on observations from clinical trials. This book focuses on three of these observations.