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Dr. Rasha Hamza Hussein Al Saffah*, Dr. Slar Noori Hasan Albarazanchi and Dr. Amel Faraj Flaih


1. Breast cancer is a complex heterogenous disease with increasing rationalization of treatment pathways. 2. Mammogram and ultrasound remain the mainstay of screening programs. The concept of overdiagnosis relates to the understanding that there are certain cancers (and ductal carcinoma in situ) that will not progress without treatment, however, we are still unable to identify, which will progress and those that will not. 3. MRI and tomosynthesis are newer modalities for breast imaging that are continuing to be investigated and defined as to their indications in screening, surveillance, prophylaxis and operative planning. 4. Cosmesis in breast surgery is improving with evolving techniques and neoadjuvant therapies. 5. High-risk patients should be counseled on the benefits and potential risks of surveillance, chemoprophylaxis and risk reducing surgical techniques. 6. Rationalization of management of node positive axillary management continues to be defined. There is a trend toward less axillary surgery based on recent multicenter studies. Further studies are continuing to define the group who can avoid axillary treatments (surgery and radiotherapy). 7. The role of chemotherapy in estrogen receptor positive disease is being based not just on classical pathological markers but also gene-expression analysis (multigene assays). Further definition in node negative and node positive disease is continuing to be analyzed in well-designed multicenter studies.

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