Inns, Joseph and James, Victoria (2015) Circulating microRNAs for the prediction of metastasis in breast cancer patients diagnosed with early stage disease. The Breast, 24 (4). pp. 364-369. ISSN 1532-3080 Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/36999/1/YBRST_2141_edit_report.pdf
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IntroductionBreast cancer is the second most common malignancy diagnosed worldwide, accounting for approximately 23% of all cancer diagnoses per year and 465,000 cancer-related deaths [1]. These cases will include early stage disease, local recurrence or metastasis in patients previously treated with a curative intent, and advanced stage disease, characterised by the significant spread of the cancer within the breast or systemically [1,2]. The metastatic cascade initiates with localised invasion of surrounding tissue, followed by systemic spread via the blood and lymphatic system and finally dissemination of tumour cells to other organs [3]. At the point of diagnosis up to 5% of patients present with metastatic disease and of those patients who show no lymph-node involvement at diagnosis, approximately 30% will develop metastases [4,5]. This subset of individuals who potentially have metastasis of early disease (MED) represent an at risk group, who may benefit from additional monitoring and augmented treatment strategies. We currently need markers to distinguish these patients from those who do not go on to develop disease recurrence.
Clinical staging and molecular classificationClinical staging is essential for establishing surgical approaches and treatment regimes. The current TNM system assess primary tumour size and extent of invasion (T), the absence or presence of palpable axillary lymph nodes and indications of local invasion (N), and evidence of distant metastasis (M) [6]. The TNM system is further supplemented by the allocation of stages I-V depending on size and metastatic spread [6]. Molecular factors are also employed to assist prognosis and direct treatment strategies. Breast cancers are categorised based on the expression of oestrogen and progesterone receptors (ER and PR) and the receptor tyrosine kinase erbB-2 (ERBB2 or HER2). Further categorisation defines four molecular subtypes [Refs. 33,34]: luminal A whi...