The goal of this conference is to be an educational forum that attempts to answer current and future concerns to the clinician.

There has been a greater understanding of the natural history of breast cancer in the past decade than there has been in millenniums past. The impetus in great part has been due to the Human Genome Project, Proteomics and Microarray Technology.

We now know that breast cancer is a genetic disease initiated by gene mutuations with progressive genetic changes as the lesion becomes more aggressive. Once the data to determine this evolutionary process is available, the ability to design preventive, diagnostic, predictive and therapeutic tools will be within reach.

Even though this is extremely exciting and will probably change breast cancer management in the near future, we must continue to treat today’s patient with today’s armamentarium. Here also, we have had great achievements:

In Radiology... new imaging, localization and biopsy techniques to more accurately diagnose and assess the local extent of the disease within the breast and axilla.

In Surgery... the goal still remains to a) locally remove all clinically detectable disease and achieve microscopically clear margins and b) to define the role of sentinel node biopsy and the implications of micrometasteses. Novel techniques will be discussed.

In Medical Oncology... new drug and endocrine development, the ATAC trial, integrating biologic agents, increasing emphasis on targeted therapy, the role of bisphosphonates, all will be discussed. In Pathology... the expanding emphasis on patterns of gene expression rather than on morphologic characteristics alone.

In Radiotherapy... new challenges to total breast irradiation with radiation to the index lesion alone. Identifying a subset who may not need radiation and conversely a subset who may require post-mastectomy radiotherapy.

The care of breast cancer patients now demands an understanding of risk sssessment, prevention strategies, as well as diagnostic and therapeutic options, and the risks and benefits need to be told to the patient in a more understandable way, emphasizing absolute benefit rather than risk reduction. This may further encourage women to enter into the decision-making process.

Thank you for attending,

Daniel A. Osman, M.D. Director

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