Objective To understand breast cancer 1 (BRCA1) gene and relationship between BRCA1 gene and breast cancer, and analyze its effect on clinical comprehensive therapy of breast cancer. Method The domestic and international studies relevant BRCA1 and breast cancer in recent years were reviewed and summarized. Results BRCA1, a tumor suppressor gene, its mutations caused structural changes and functional abnormalities, which were closely related to breast cancer. And the expression situation and mutation of BRCA1 were associated with the therapeutic effect. Conclusions Mutation of BRCA1 is closely related to occurrence and development of breast cancer in female. Comprehensive therapy ideas should be found in clinical therapy according to expression or mutation of BRCA1. Further research on BTCA1 is beneficial to explore gold standard for treatment of breast cancer.
ObjectiveTo synthesize recent advances in surgical management of breast cancer, focusing on five key issues: axillary surgery de-escalation, margin control in breast-conserving surgery (BCS), prophylactic surgery for BRCA1/2 gene mutation carriers, local therapy for oligometastasis, and intraoperative radiotherapy (IORT), aiming to guide individualized clinical decisions. MethodsA comprehensive analysis of high-quality evidence (RCTs, prospective cohorts and multicenter studies) was conducted, comparing efficacy and safety across strategies. ResultsFor patients with positive sentinel lymph nodes (SLN) undergoing BCS, axillary lymph node dissection (ALND) can be safely omitted if they present with clinical stage cT1–2, cN0 disease, have not received preoperative chemotherapy, exhibit 1–2 positive SLNs, and are planned for whole-breast radiotherapy. The Memorial Sloan Kettering Cancer Center nomogram quantitatively predicts non-SLN metastasis risk by integrating features like tumor size and SLN metastatic burden. Omission of ALND is particularly safe for SLN micrometastasis (≤2 mm), demonstrating a 5-year overall survival rate of approximately 97.5%. In patients achieving clinically node-negative (ycN0) status post-neoadjuvant therapy, techniques such as dual-tracer mapping or pre-treatment marking of suspicious nodes reduce the false negative rate of SLN biopsy. Treatment decisions for elderly patients require multidisciplinary assessment of surgical risks versus benefits. The integration of multiparametric MRI, artificial intelligence with intraoperative ultrasound significantly reduces positive margin rates in BCS from 25% to 8%–15%, markedly decreasing reoperation rates. For BRCA1/2 mutation carriers, prophylactic mastectomy reduces breast cancer risk by 90%–95%, while prophylactic bilateral salpingo-oophorectomy (PBSO) reduces ovarian cancer risk by 80%–90%; the timing of PBSO is stratified by genotype (BRCA1: 35–40 years; BRCA2: 40–45 years) and integrated with fertility plans and psychological assessment. Local therapy provides clear survival benefits for oligometastatic breast cancer patients with hormone receptor positive disease and bone/soft tissue metastases, with stereotactic body radiotherapy being preferred for low-burden metastases. IORT for early breast cancer is strictly limited to low-risk patients, achieving long-term survival rates equivalent to conventional radiotherapy but necessitating stringent patient selection. ConclusionsPrecision surgery is evolving through axillary de-escalation, real-time margin assessment, risk-adapted prophylactic surgery, selected local therapy for oligometastasis, and strict patient selection for IORT. Multidisciplinary integration is essential for future optimization.
Objective To summarize the progress of clinical research on triple-negative breast cancer (TNBC). Methods Domestic and international publications on the study of TNBC in recent years were collected and reviewed. Results The patients with TNBC were younger, and their prognosis was poorer. Besides operation, chemotherapy was the major therapeutic tool for them. Currently the targeted therapy for epidermal growth factor receptor and its signal conducting system was applied to clinical therapy gradually， and it might benefit the patients with TNBC. Conclusion The study on TNBC may bring a new way for therapy.