title: Preventing Overdiagnosis and Overtreatment: Just the Next Step in the Evolution of Breast Cancer Care.
abstract: The problem of overdiagnosis and overtreatment has been highlighted in breast cancer and many other cancer types, most notably prostate cancer. Addressing this problem presents an opportunity to continue the evolution of breast cancer care. Advances in technology, such as molecular subtyping, have increased the understanding of breast cancer biology and the range of associated behavior, and have provided tools that allow greater personalization of treatment. This article identifies 3 areas of breast cancer care where opportunity currently exists to refine management strategies and help decrease overtreatment and overdiagnosis: the use of adjuvant-external beam radiation in invasive breast cancer, the application of aggressive treatment for all ductal carcinoma in situ, and the authors' approach to breast cancer screening. Personalizing treatment based on patient and tumor characteristics holds promise for minimizing harms and maximizing benefits. This approach will allow continual improvement and ultimately result in providing the right treatment for each patient.
authors.affiliation: From the Department of Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Rita A
authors.initials: RA
authors.lastname: Mukhtar
authors.affiliation: From the Department of Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Jasmine M
authors.initials: JM
authors.lastname: Wong
authors.affiliation: From the Department of Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000628:therapy*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D000069342:Medical Overuse / Q000517:prevention & control*; D012306:Risk