On behalf of the organizing committee of Kyoto Breast Cancer Consensus Conference, I express my sincere gratitude to all of the participants of this international convention for your excellent presentation and enthusiastic discussion.
In 1804, Seishu Hanaoka, a Japanese surgeon, succeeded resection of breast cancer under general anesthesia using herbal medicine or Chinese medicine. And in the late 1880s, William Halsted established radical mastectomy as a standard surgical treatment. Since then, surgeons have made efforts to improve the efficacy of surgical treatment for breast cancer. However, extended radical mastectomy failed to improve survival of breast cancer patients compared with standard radical mastectomy. In 1980 Barnard Fisher confirmed the efficacy of breast-conserving treatment from the viewpoint of patients’ QOL, considering that breast cancer is not a local disease but a general disease from an early stage.
And now the paradigm has shifted from standardized breast cancer treatment to individualized breast cancer care. Risk reduction of BRCA mutation carrier is a kind of individualized breast care and surgery plays an important role in this individualized breast care. Therapeutic efficacy of axillary lymphnode dissection has been limited to the patients with extensive axillary lymphnode metastasis, while radiation therapy to regional lymphnodes showed a significant effect on survival of the patients with a small number of axillary lymphnode metastases. Nomograms may become a useful tool to select patients who will get therapeutic benefit of axillary lymphnode dissection or axillary irradiation. Whole breast irradiation after partial mastectomy is in the middle of individualization.
In spite of recent advances in breast cancer diagnosis and treatment, we still have many issues to be clarified to improve therapeutic efficacy, especially in the field of neo-adjuvant hormone therapy, neo-adjuvant HER2 targeted treatment, and treatment for triple negative breast cancer. Researchers including the participants of this convention are striving to establish efficient treatment strategies and make them individualized.
So, we never miss any opportunity to exchange information and learn from each other to improve breast cancer patient care in this new paradigm.
I would like to close this international convention 2014. Thank you again for your attendance and cooperation.
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Takashi Inamoto |
