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New technologies in breast cancer.

New technologies are often slow to be incorporated into medicine and are not always developed from the medical perspective. Technologies are often developed and then an application sought. There is a need for more development of medicine-specific technology to accelerate the improvement that may be offered to patients.

Major research effort and finance are currently directed at new drug development. Without doubt there have been blockbuster success stories such as the targeting of human epidermal growth factor receptor 2 (HER2) and the rapid introduction of trastuzumab into the adjuvant setting of breast cancer within two decades of entering clinical trials. Other agents have been less successful and this may be akin to technologies looking for a home rather than being developed with a specific purpose. Peck, Kularatne and O'Brien describe the current areas of new drug technologies in breast cancer.

In the arena of breast cancer genetics, major advances in technology in the form of high-throughput genotyping platforms, including Affymetrix arrays and Illumina BeadChip, has allowed the analyses of hundreds of thousands of genetic variants [single nucleotide polymorphisms (SNPs)] in a single sample in a single assay, thus research previously taking decades can be achieved in hours.

Newman and Evans describe how genome-wide association studies (GWAS) have identified a number of common genetic variants which modestly increase the risk of breast cancer, and provide new insights into disease pathogenesis. They also describe how SNP analysis may have an important role for pharmacogenetics in predicting the patients who are most likely to benefit from breast cancer treatments, with the relationship between the cytochrome 450 CYP2D6 enzyme activity and tamoxifen treatment being the one that is closest to use in clinical practice.

Use of such technologies may provide much more useful information than attempts to develop drugs for the whole of the breast cancer population. The pharmaceutical industry has neglected patient as well as cancer variations to maximise profit. More thoughtful research is required in the future.

Technological advances have also resulted in significant improvement in imaging methods. Lim and Boggis describe how despite the technology for digital mammography being available since the early 1990s, the uptake and implementation has been slow. Digital mammography provides several advantages over analogue screen-film mammography in terms of detection rate and reducing unnecessary recall particularly in certain groups of women. They also describe the potential for digital tomosynthesis, contrast-enhanced mammography and computer-aided detection which could lead to improvements in detection and patient experiences.

Andrew Wardley

Christie Hospital, Manchester, UK

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Title Annotation:Editorial
Author:Wardley, Andrew
Publication:Advances in Breast Cancer
Geographic Code:4EUUK
Date:Jun 1, 2008
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