Breast Cancer Biology And Behavior

Malignant cells are characterized by altered growth control (both proliferation and apop-tosis), and the ability to invade and metastasize. Research into the many components of these processes could identify novel prognostic and predictive markers.

The prognostic value of proliferation, apop-tosis, cell cycle and apoptotic proteins is discussed in Chapter 3, with the conclusion that although there are many ways to assess proliferation, mitosis counting in histological preparations is the most reproducible, with independent prognostic value. Methodological fine-tuning and larger prospective trials are needed to establish the clinical value of other markers.

There is growing understanding of the importance of the interactions between cells, and between cells and the surrounding stro-mal environment. Breast cancers frequently exhibit altered cell adhesion molecule expression, have altered matrix protein expression, changes in the cellular components of the tumor microenvironment, and extensive remodeling of the stroma. Chapter 5 focuses on key changes in cell adhesion molecules and stromal components, which have been shown to modulate breast cancer cell function, the potential for such features to act as prognostic and predictive factors for behavior, and the opportunity to use such alterations as therapeutic targets.

p53 is well recognized as 'guardian of the genome', and alterations to the gene are common in cancers, including breast cancer. The precise clinical importance of p53 in breast cancer as a prognostic factor or predictor of disease response remains controversial and is discussed in Chapter 12, which concludes that substantial progress has been made in the understanding of p53 and therapeutic benefits are awaited.

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