Breast Cancer And Its Precursor Lesions

Rather than an exhaustive review of all the pathologic conditions of the female breast, Breast Cancer and its Precursor Lesions focuses on the current knowledge, understanding and issues related to breast cancer and its benign lesions that are associated with an increased risk for the subsequent development of cancer. This book targets the language, diagnostic terms and critical communication that must take place between primary care physicians, breast surgeons, oncologists, and general surgical pathologists interested in the pathologist’s perspective on these important diseases. The volume also reviews the current terminology and how to read or write meaningful pathology reports on these entities, the foils and nuances of the pathology and implications for management, and up to date issues in genomics and proteomics of these conditions. The text is succinct, fully informative, and written in “plain language”. All chapters are presented in a uniform fashion, and supplemented by high-quality illustrations and tables. Breast Cancer and its Precursor Lesions will be of great value to pathologists as well as primary care physicians, breast surgeons, and oncologists for understanding breast pathology and its implications for management.

This book focuses on precursor lesions, borderline lesions, and early carcinomas of female-specific organs from the standpoint of pathology. In 2012, WHO Classification of Tumours of the Breast was revised and subsequently, in 2014, the WHO Classification of Tumours of Female Reproductive Organs was revised. In these latest versions, several new concepts are addressed that were not described in the previous editions, and many of them are related to the awareness of the specific pathogenesis of tumors in female patients. Although some of these issues are still controversial, several paradigm shifts should be understood by medical scientists. Thus researchers, diagnostic pathologists, and clinicians must share current information about what is taking place in the field and what the next issue to resolve is. This volume greatly broadens the reader’s understanding of the new concepts and paradigm shifts, as it includes information on how to diagnose and make differential diagnoses on a practical basis and also provides a thorough explanation of the molecular–clinicopathologic basis of the new concepts. The book thus benefits gynecologists, breast surgeons, gynecologic–medical oncologists, and cytotechnologists.

The Breast Cancer Resource for Research and Banking has accrued breast cells or tissues from 1342 patients during the three year grant period to date. The emphasis of this project is on the collection of microscopic at risk and precursor lesions as imprints/scrapes. These constitute over half of our specimens. However, most investigators who have requested samples have requested frozen pieces of tumor tissue paired with normal tissue from the same patient, ie. their interest has been in invasive carcinomas and not in precursor lesions. We have also begun to fill requests for microdissection, which is emerging as a favored method for studying microscopic lesions.

Management of atypical breast lesions continues to evolve. There is considerable controversy as to whether these entities represent risk factors for future breast cancer or whether they are instead precursor lesions. A better understanding of the prognostic and therapeutic implications of each of these lesions is important for assessing subsequent breast cancer risk. Risk assessment tools are available for screening high risk patients and understanding the utility and limitations of these tools is important for all clinicians involved in the care of patients. There have been significant advances in breast cancer screening in the last several year including breast tomosynthesis, automated breast ultrasound, molecular imaging, as well as accelerated breast MRI protocols. This has raised the question: Do women at risk for breast cancer need additional breast cancer screening using these newer imaging modalities? In addition, with these advances in imaging, can women with atypical proliferative lesions be observed rather than undergoing surgical excision as some suggest? The role of observation, surgical excision and even prophylactic mastectomy in women with atypical proliferative lesions continues to be debated; however there is data that can guide physicians in the management of these patients. Pleomorphic Lobular carcinoma in-situ (PLCIS) is a distinct pathological entity within LCIS and there is no consensus regarding surgical margins or the need for adjuvant treatment to prevent recurrence. Recently, ductal carcinoma in-situ (DCIS) has been the subject of much controversy: is it truly a cancer or is it instead a precursor lesion. The traditional management of DCIS with lumpectomy and radiation is now being debated and recent data demonstrates that low grade DCIS can be managed with observation. Clinical trials are now accruing patients with low and intermediate grade DCIS to observation and close surveillance, and not surgical excision. Finally, new guidelines for chemoprevention with the use of tamoxifen and raloxifen for women with atypical proliferative lesions, LCIS, PLCIS, and DCIS are available and should be discussed as an option when guiding management of these patients. This book will provide a comprehensive review of this field and will serve as a valuable resource for clinicians, general surgeons, breast surgeons and surgical oncologists, as well as researchers with an interest in the management of atypical breast lesions. The book will review new data about breast cancer, risk factors for breast cancer, pathological features unique to each entity, the characteristic findings on imaging, risk stratification for genetic testing, as well as the current evidence-based management of each of these breast lesions. Our text will provide assessment tools for risk prediction of breast cancer. We will provide data on the current imaging modalities, as well as advanced screening options available for diagnosis and following these patients. Current management of many of these lesions continues to be controversial in regard to observation with close surveillance versus the need for surgical excision of these lesions based on future risk or whether these lesions are precursor lesion. For ductal carcinoma in-situ, the debate continues in regards to whether this disease entity is a precursor lesion that can be managed with observation or hormonal therapy, or is DCIS cancer and treated with lumpectomy and radiation. Several studies have been published where patients are managed with observation and treatment with hormonal therapy before surgical management. New trials have already begun accruing patients with low to intermediate grade DCIS where patients will be managed with observation versus hormonal therapy only. Management of DCIS continues to evolve and current management will be discussed This text will provide a concise but comprehensive summary of the current management of patients with atypical breast proliferative lesions and some benign breast lesions and will help guided management of these patients. All chapters in this text will be written by experts in the field in each of these disease entities. They will all include the most up to date research and clinical information to enhance our understanding and treatment of patients.

WHO Classification of Tumours of the Breast is the fourth volume of the WHO series on histological and genetic typing of human tumours. This authoritative, concise reference book provides an international standard for oncologists and pathologists and will serve as an indispensable guide for use in the design of studies monitoring response to therapy and clinical outcome. Diagnostic criteria, pathological features, and associated genetic alterations are described in a strictly disease-oriented manner. Sections on all recognized neoplasms and their variants include new ICD-O codes, epidemiology, clinical features, macroscopy, pathology, genetics, and prognosis and predictive factors. The book, prepared by 90 authors from 24 countries, contains more than 340 colour photographs, tables and figures, and more than 1600 references.

Cancer Precursors is a groundbreaking, multidisciplinary text containing a comprehensive overview of methodological issues associated with the study of pre-cancerous conditions, as well as reviews of the contributions of descriptive, analytical, and molecular epidemiological research to knowledge about cancer precursors at specific anatomical locations. The research focuses on the early natural history of cancers, by helping to define the etiology of precursor lesions, improving the means of detecting them either directly or via testing of surrogate biomarkers, and by elucidating the role of remote causes leading to the early onset of such lesions.

In this issue of Hematology/Oncology Clinics, guest editor Dr. Elizabeth K. O'Donnell brings her considerable expertise to the topic of Cancer Precursor Syndromes and Their Detection. Top experts focus on cancer precursors for different sites, with articles on the risk-benefit analysis of early interception; plasma cell precursors; early detection and interception of lung cancer, cervical cancer, GI cancers, skin cancer; and head and neck cancer; biomarkers and early detection; and more. Contains 12 relevant, practice-oriented topics including clonal hematopoiesis of indeterminate potential (CHIP); prostate cancer: early detection and intervention; ductal carcinoma in situ; cancer prevention; and more. Provides in-depth clinical reviews on cancer precursor syndromes and their detection, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

The latest, groundbreaking addition to the Advances in Surgical Pathology series, Breast Cancer offers a thorough overview of the disease and the most recent data and technologies used in breast cancer surgery and diagnosis. Whether you're a new or experienced pathologist or oncologist, or prepping for boards or certification, this is an irreplaceable volume. Key Features: NEW and updated information on molecular subtypes, predictive and prognostic markers, premalignant and precursor lesions. Coverage of topics including: intraductal papillary carcinoma and variants; microinvasive carcinoma; invasive micropapillary carcinoma More than 250 full-color photos and ultrasound images illustrate the content Special focus on the convergence of pathology and radiology Chapters cover areas including: cytology; imaging and gross features; histology; differential diagnosis; immunohistochemistry; pathogenesis; and molecular genetics of each cancer type

The complex landscape of breast cancer requires distinct strategies for the management of various molecular subtypes of this disease. Rapid advances in the field of molecular biology have been bewildering for those involved in its study and management. “Molecular Pathology of Breast Cancer” aims to close this knowledge gap by discussing comprehensively the evolution, biological basis and clinical applications with a focus on the “what, when, and how” of the most significant molecular markers known to date. These markers are evaluated in the context of genomic, transcriptomic and proteomic profiles, which is integral to the practice of precision medicine. The application of next generation sequencing (NGS) has provided new insights in the regulation of genomic and transcriptomic structure and function. Alterations in DNA such as mutations and single nucleotide polymorphisms (SNPs) have been correlated with outcomes and provide for novel therapeutic approaches. These NGS analyses have also revealed the extensive contributions of epigenetic mechanisms such as histone modifications, non-coding RNA and alternative splicing. All of these changes together contribute to alterations in proteome. Newer assays that allow greater stability and analytical consistency are emerging. These alterations in tumor profiles can be also now detected by imaging techniques. The heterogeneity of both tumor and tumor microenvironment, an inevitable reality, is discussed in detail with particular focus on cancer stem cells and immune signaling. A chapter is dedicated to the emerging technology of “liquid biopsy”, which opens a novel approach for “continuous” monitoring of cancer that might be superior to conventional diagnostics, “Molecular Pathology of Breast Cancer” provides a quick and easy, not to mention essential, tour for clinicians, pathologists and scientists who are seeking to understand the integration of molecular biology into the diagnosis, prognosis and management of breast cancer.