Skip to main content

Advertisement

SpringerLink
Log in

Pathology Meets Biology: the New Era of Breast Cancer Staging

  • Local-Regional Evaluation and Therapy (DM Euhus, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Breast cancer is now recognized to be a very heterogeneous disease. This complexity was recently reflected in the newest American Joint Committee on Cancer (AJCC) breast cancer staging, implemented in 2018. Although it seems very daunting, the new staging is based on both the anatomical extent of the disease and the prognostic factors such as hormonal and HER2 status, grade of the tumor, and genomic assays providing information regarding risk of recurrence. The purpose of this review is to illustrate the reasoning for the change in previous, solely an anatomically based breast cancer staging system and to report the updates.

Recent Findings

The research showed that evaluation of breast cancer through immunohistochemistry and utility of genomic assays provides substantial prognostic information.

Summary

The combination of anatomic and prognostic factors has a tremendous impact on outcome predictive abilities of the staging system for each affected individual.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. •• Hortobagyi G, et al. Breast AJCC cancer staging manual. In: American College of Surgeons (ACS) Chicago Illinois 2017. 8th ed. This is the breast chapter published by AJCC and addressing all the updates in the eighth edition of the breast cancer staging.

  2. • Giuliano A, et al. Breast cancer-major changes in the American Joint Committee on Cancer eighth edition cancer staging manual. Ca Cancer J Clin. 2017. https://doi.org/10.3322/caac.21393. This is the editorial summary of the eighth edition AJCC breast cancer staging changes.

  3. Polyak K. Heterogeneity in breast cancer. J Clin Invest. 2011;121:10–3788. https://doi.org/10.1172/JCI60534.

    Article  CAS  Google Scholar 

  4. Parker JS, et al. Supervised risk predictor of breast cancer based on intrinsic subtypes. J Clin Oncol. 2009;27(8):1160–7. https://doi.org/10.1200/JCO.2008.18.1370.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Gautam M, et al. Histological, molecular and functional subtypes of breast cancers. Cancer Biol Ther. 2010;10:955–60. https://doi.org/10.4161/cbt.10.10.13879.

    Article  Google Scholar 

  6. Goldhirsch A, et al. Strategies for subtypes—dealing with the diversity of breast cancer: highlights of the St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2011. Ann Oncol. 2011;22(8):1736–47. https://doi.org/10.1093/annonc/mdr304.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Hon JDC, et al. Breast cancer molecular subtypes: from TNBC to QNBC. American Journal of Cancer Research. 2016;6(9):1864–72.

    CAS  PubMed  Google Scholar 

  8. Russnes H, et al. Breast cancer molecular stratification. From intrinsic subtypes to integrative clusters. Am J Pathol. 2017;187(10):2152–62. https://doi.org/10.1016/j.ajpath.2017.04.022.

    Article  CAS  PubMed  Google Scholar 

  9. Dias K, Dvorkin-Gheva A, Hallett RM, Wu Y, Hassell J, Pond GR, et al. Claudin-low breast cancer; clinical & pathological characteristics. PLoS One. 2017;12:1. https://doi.org/10.1371/journal.pone.0168669.

    Article  CAS  Google Scholar 

  10. Perou CM. Molecular stratification of triple-negative breast cancers. Oncologist. 2011;16:61–70. https://doi.org/10.1634/theoncologist.2011-S1-61.

    Article  PubMed  Google Scholar 

  11. Lehmann B, et al. Identification of human triple-negative breast cancer subtypes and preclinical models for selection of targeted therapies. J Clin Invest. 2011;121(7):2750–67. https://doi.org/10.1172/JCI45014.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Stemmer S, et al. Clinical outcomes in ER+ HER2 -node-positive breast cancer patients who were treated according to the recurrence score results: evidence from a large prospectively designed registry. NPJ Breast Cancer. 2017;3:32. https://doi.org/10.1038/s41523-017-0033-7.

    Article  CAS  PubMed  Google Scholar 

  13. Paik S, et al. Gene expression and benefit of chemotherapy in women with node-negative, estrogen receptor-positive breast cancer. J Clin Oncol. 2006;24:3726–34. https://doi.org/10.1200/JCO.2005.04.7985.

    Article  CAS  PubMed  Google Scholar 

  14. Morrow PK, Theriault R. Chapter 82. General NCCN guidelines. In: Kuerer HM, editor. Kuerer’s breast surgical oncology. New York, NY: McGraw-Hill; 2010.

    Google Scholar 

  15. Cardoso F, et al. The MINDACT trial: the first prospective clinical validation of a genomic tool. Mol Oncol. 2010;1(3 (2007)):246–51. https://doi.org/10.1016/j.molonc.2007.10.004.

    Article  Google Scholar 

  16. Whitworth P, et al. Chemosensitivity and endocrine sensitivity in clinical luminal breast cancer patients in the prospective Neoadjuvant Breast Registry Symphony Trial (NBRST) predicted by molecular subtyping. Ann Surg Oncol. 2017;24:669–75. https://doi.org/10.1245/s10434-016-5600-x.

    Article  PubMed  Google Scholar 

  17. Cardoso F, et al. 70-gene signature as an aid to treatment decisions in early-stage breast cancer. N Engl J Med. 2016;375(8):717–29. https://doi.org/10.1056/NEJMoa1602253.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Breast Surgery Department, Johns Hopkins Hospital, 1800 Orleans St., Baltimore, MD, USA

    Agnieszka Dombrowska

Authors
  1. Agnieszka Dombrowska
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Agnieszka Dombrowska.

Ethics declarations

Conflict of Interest

The author declares that there are no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by the author.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

This article is part of the Topical Collection on Local-Regional Evaluation and Therapy

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dombrowska, A. Pathology Meets Biology: the New Era of Breast Cancer Staging. Curr Breast Cancer Rep 11, 185–189 (2019). https://doi.org/10.1007/s12609-019-00325-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-019-00325-3

Keywords

Search

Navigation