Breast cancer•Not a single disease.•Type and stage.•Grade/Lympho-vascular invasion•Molecular biology.•ER\PR•Her-2-neu•Other.•Gene expression profiling. (Tumor and Patient)

What causes cancer?•DNA damage. WHY? Always!•Radiation, random, metabolic, toxins.•Free radicals, adducts, breaks. •Incomplete DNA repair.•Error transmission.•Failure to recognize damage.•Failure to initiate programmed cell death.•Lack of immune response.•Suppression of normal genes•Promotion of cellular proliferation

Genetic Issues

• BRCA 1 and 2. • Other p53, AT. PTEN• Cancer susceptibility genes.

– Polymorphisms.– Polygenic risk (the individual’s genetic fingerprint)

Breast Cancer Types

• Basal-like

• Luminal A ER+ “good outcome”

• Luminal B ER+ “bad outcome”

• Normal breast-like

• HER2+/ER-

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The Future

• Microarrays

• Proteomics

• Positron Emission Mammography

• ?Percutaneous Lesion Destruction

• Personalized Therapy

Microarrays

• Amsterdam 70

• Oncotype Dx20

• Estrogen-regulated gene set 1E 2E

The Butterfly Effect

• Small initial changes can result in major variations in final conditions.

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