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Impact of molecular breast cancer portraits on new treatment strategies for gynecologic malignancies.

DOI:10.1097/GCO.0b013e32835c5e36 In most regions of the world treatment of breast cancer is primarily the responsibility of surgical oncologists and medical oncologists. As such, the question arises why would gynecologists or gynecologic oncologists, whose primary focus of interest is to treat gynecologic malignancies such as ovarian, endometrial or cervical cancer, be interested in learning about new developments for the treatment of breast cancer. The five reviews on breast cancer included in this issue of Current Opinion in Obstetrics and Gynecology will give us an answer to this question. It can be assumed without doubt that understanding successful breast cancer treatment approaches and applying these same strategies to gynecologic malignancies could transform the dismal prospects patients face when diagnosed with ovarian cancer or advanced endometrial and cervical cancer. The need to learn from breast cancer is further underscored by the fact that the mortality rates for ovarian cancer are essentially unchanged over the past 30 years [1–3]. Similarly, the mortality rates for endometrial cancer are unchanged over the past decades [4], and in fact have risen by almost a fifth over the past 10 years in some developed countries [5]. In stark contrast, in most developed nations breast cancer mortality has been dropping over the past decade and researchers say this is not solely due to improved breast cancer screening but due to better treatments that have become available over the past decade [6]. The successes that have been achieved in the treatment of breast cancer are in part due to the fundamental appreciation that breast cancer does not represent a single pathologic entity. Depending on the genes/pathways responsible for driving a specific subtype, the therapeutic approaches should be and are significantly different. Examples for breast cancer include the original appreciation that some breast cancers are driven by steroid hormones and their cognate receptors, whereas others are not, leading to use of tamoxifen only in tumors driven by hormone receptors. This was the first example of a useful molecularly targeted