Patient Pathway for Breast Cancer: Turning Points and Future Aspirations

Ruth Mary Parks; Kwok-Leung Cheung


Future Oncol. 2015;11(7):1059-1070. 

In This Article

Abstract and Introduction


Improved survival from breast cancer can be attributed to a number of advances in the patient pathway from screening to advanced disease. The benefit of population screening has been established with national programs implemented. There has been improvement in the methodology of diagnostic assessment, relating to imaging techniques, methods of obtaining histological evidence and evaluation of lymph node status. Sentinel node biopsy is now routine, as is oncoplastic surgery. New forms and improved adjuvant systemic therapies are being explored. The prognosis of breast cancer can be more reliably evaluated to provide individualized information and to personalize treatments. Developments have also been seen in other areas improving the treatment and care of patients with advanced disease.


Globally breast cancer is the most common female cancer and the number one cause of death from cancer among women;[1] one in eight women in the USA is diagnosed with breast cancer in their lifetime.[2] Incidence rates vary geographically from 19.3 per 100,000 women in eastern Africa to 89.7 per 100,000 in western Europe.[3] Despite the high incidence rates, survival from breast cancer has increased;[4] 1-year survival in England and Wales during 1971–1975 was 82% and 5-year survival was 52%; this has increased during 2005–2009 to 95.8 and 85.1%, respectively.[5]

The reasons for these findings are multifactorial, including the introduction of screening programs, earlier diagnosis, greater awareness of the disease by the general population, increased efforts in research into breast cancer and improved treatments, notably adjuvant therapies.[6]

The importance of the multidisciplinary team (MDT) has become more recognized in treatment decision-making.[7] The concept of patient-centered care is more widely accepted. This includes specialist nursing support. Clinical guidelines exist for the management of breast cancer from diagnosis to follow-up care.[6,8]

The improved outcomes despite an increased incidence of breast cancer are attributed to a number of significant turning points in the whole patient pathway, which will be discussed in the remainder of this article.