The last three decades have witnessed tremendous advances in the understanding
and treatment of breast cancer. As a result, starting shortly before the 1990s, a persistent decrease in breast cancer mortality has been documented, primarily in the
United States and in several European countries. Breast cancer, however, remains
an important health problem. In this book, which is mainly dedicated to nuclear
medicine, experts have thoroughly reviewed the achievements made in the diagnosis,
monitoring and treatment of this disease. There is no doubt that breast cancer has
always been one of the most appealing areas of cancer research; the vast number of
new clinical and preclinical studies published every day in the medical literature is
an example.
More recently, the development of molecular biology techniques has allowed the
identification and analysis of molecular factors that play an important role in normal
cell growth and differentiation. Such factors have also been shown to influence the
behavior of tumors in terms of cellular differentiation, growth rate, metastatic pattern and response to therapy. Furthermore, they will be instrumental in the development of new agents for targeted therapies. Using molecular tracers to characterize
neoplastic tissues and to select, among the available effective regimens, the one with
the highest probability of cure for the individual patient, is an appealing way to conduct new research. The ability to predict who will need medical therapy and who will
or will not respond to a given drug or drug regimen will serve to guide clinical decision-making and treatment recommendations. Although predictive accuracy may
not be an all-or-none phenomenon, patients can be spared treatments that are devoid
of efficacy but are associated with toxicity instead. Besides this, delivering treatments that have a more pronounced activity against tumors with specific molecular
features will lead to improved benefit for the patient, making the difference between
cure and palliation.
In this area nuclear medicine follows the new developments in oncology: the
modern term “molecular imaging” means to visualize a biological phenomenon at
the molecular level according to the specificity and the specific biodistribution of a
molecular probe. Cancer can be imaged through metabolic pathways (such as glucose
and amino-acid transport, DNA precursor incorporation, hormone receptors, angiogenesis, hypoxia, antigen expression) targeted by radioactive tracers. This makes it
possible to supplement the morphological description of a tumor with a considerable
amount of biological information. Nuclear medicine images may provide prognostic indications, predict the response to different treatments, and detect the presence
and activity of viable cancer cells in already treated patients. The same radiopharmaceuticals that target neoplasia and are used in diagnostic imaging can carry high
amounts of radioactivity to cancer cells and thus selectively deliver a lethal irradiation dose to a tumor. For all these reasons nuclear medicine techniques have acquired
an important role in the study and management of breast cancer, and are becoming
more and more integrated in the new developments of molecular biology, pharmacology, diagnostic imaging and therapy