The multidisciplinary approach to breast cancer management

The goal of multidisciplinary breast cancer treatment is to optimize therapeutic effectiveness while minimizing acute and long-term toxic effects. The treatment of breast cancer is becoming more individualized. Multidisciplinary care improves patient outcomes, increases guideline-concordant care, and should be considered standard of care for the treatment of breast cancer patients. Medical oncologists, surgical oncologists, and radiation oncologists are the core group of medical providers for the multidisciplinary treatment approach of breast cancer. Consideration of the unique aspects of the patient's history, physical examination, and family history are prerequisites for providing superior care. This chapter describes the multidisciplinary management of ductal carcinoma in situ, early-stage breast cancer, and locally advanced breast cancer. We discuss the critical steps in formulating a multidisciplinary treatment plan, including how to choose the most appropriate surgical intervention, how to determine if adjuvant radiation therapy is warranted including eligibility for alternative methods of radiation delivery, and how to determine the appropriate sequencing strategies for systemic therapy. Finally, we describe surveillance for breast cancer patients who have completed curative therapy. Communication between all teams involved in the patient's care and coordination of care is necessary to provide the best individualized treatment possible to breast cancer patients.