title: Primary Systemic Treatment in the Management of Operable Breast Cancer: Best Surgical Approach for Diagnosis, Biological Evaluation, and Research.
abstract: Despite the ever-changing breast surgeon's technical role, the surgeon forms an indispensible link between imaging, diagnostics, pathology, and the medical oncologist. Biomarkers of prognosis, prediction of response, and resistance to treatments, including imaging, tissue and circulating markers apply to the primary diagnostic and treatment settings as well as scenarios which include disease recurrence, both in the early and advanced settings. Whether it is via the diagnostic clinic referred by the primary care physician or via a breast screening service, primary early breast cancer is referred for initial treatment and/or diagnosis and currently remains the domain of the surgical oncologist. The surgeon is privileged by this unique "window of opportunity" to consider the biological aspects of the diagnosis and guide the patient appropriately toward initial therapy, only one of which is primary surgery. Options of neoadjuvant endocrine, cytotoxic, or targeted therapy as either standard of care or else in the clinical trial context should be considered to optimize treatment in all patients.
authors.affiliation: The Royal Marsden NHS Foundation Trust, Breast Unit, London, UK (PAB, GS); The Institute of Cancer Research, London, UK (PAB, GS); Translational Science, Oncology iMed, AstraZeneca, Cambridge SciencePark, Cambridge, UK (GS). peter.barry@rmh.nhs.uk.
authors.forename: Peter A
authors.initials: PA
authors.lastname: Barry
authors.affiliation: The Royal Marsden NHS Foundation Trust, Breast Unit, London, UK (PAB, GS); The Institute of Cancer Research, London, UK (PAB, GS); Translational Science, Oncology iMed, AstraZeneca, Cambridge SciencePark, Cambridge, UK (GS).
authors.forename: Gaia
authors.initials: G
authors.lastname: Schiavon
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis / Q000601:surgery* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000379:methods; D003657:Decision Making; D005260:Female; D006801:Humans; D058990:Molecular Targeted Therapy / Q000379:methods; D020360:Neoadjuvant Therapy / Q000379:methods*; D010819:Physician's Role; D010817:Physician-Patient Relations; D057285:Precision Medicine / Q000379:methods; D011379:Prognosis; D066231:Surgeons