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What is new in the surgical management and prevention of breast cancer?

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Breast cancer is the most common malignancy in Australian women. Cancer Australia predicted there would be 15 740 new cases and 3065 deaths from breast cancer in 2015.1 Ideally, treatment is multidisciplinary, with cooperation between a range of medical, nursing and supportive care specialties combining to give each woman access to the best available individualised treatment. With refinements and developments in therapy and the reasonably widespread use of screening, breast cancer survival rates continue to steadily improve, with the overall 5-year survival now about 90%.1 Recent incremental improvements in survival and reduced morbidity have resulted from refinement of therapies related to the understanding of breast cancer subtypes (luminal A, luminal B, human epidermal growth factor receptor 2 [HER2]-enriched, and triple negative)2 and the more personalised application of adjuvant therapies to those most likely to benefit. Commercially available gene expression profiling tools add to that refinement and will hopefully soon become publicly funded in Australia.

As survival has improved, the focus of surgical management has rightly undergone a major evolution to recognise the importance of aesthetic and other quality-of-life outcomes, including less extensive axillary surgery and sentinel node biopsy for most patients. If the best treatment for breast…