Personalized Management of Breast Cancer, In the Era of Precision Medicine

Abstract

This is an era of technological advancement and its use to provide a precise and safe patient care. Our knowledge of disease pathogenesis as well as approach to manage patients has changed significantly with recent scientific developments and breakthroughs so that we can now offer a more predictable, precise and powerful health care according to individual patient needs [1]. A very widely used definition of precision medicine (PM) as defined by President’s Council of Advisors on Science and Technology (PCAST) is; “the tailoring of medical treatment to the individual characteristics of each patient to classify individuals into subpopulations that differ in their susceptibility to a particular disease or their response to a specific treatment. Preventative or therapeutic interventions can then be concentrated on those who will benefit, sparing expense and side-effects for those who will not” [2]. In simple words, Precision medicine is a way of offering specific and individualized care to the patients, based on their genes and thus making a more accurate diagnosis and patient specific treatment [3]. Breast cancer is the most common cancer of the women. Breast cancer is very heterogeneous, that means within same tumour, we can find different subtypes. Treatment of breast cancer is therefore very challenging. Advancements in molecular medicine, has now enabled us to differentiate between these different intrinsic subtypes and tailor the breast cancer treatment according to molecular characteristics of individual tumours. This approach has done a significant contribution to improve disease outcomes. Offering personalized care starts with screening. Women with family members affected by breast cancer are at increased risk of developing the disease. This risk increases further if such women carry genetic mutations e.g.; the BRCA1 or BRCA2 gene mutation. So women with a history of breast or ovarian cancer in their families and test positive for BRCA mutations or other high penetrance genes should undergo a more frequent screening. Especially addition of MRI breast to mammography in these patients improves the detection of breast cancer at an early stage [4].