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Atypical Breast Proliferative Lesions and Benign Breast Disease (Hardcover, 1st ed. 2018)
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Atypical Breast Proliferative Lesions and Benign Breast Disease (Hardcover, 1st ed. 2018)
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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.
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