Further Expansion of the AJCC/UICC Breast Cancer Staging System to Encompass Unique Problems in the Developing World

Excerpt

Breast cancer is the most common cause of cancer death among women in both developed and developing countries. A strong relationship between cancer stage and 10-year relative survival has been reported by Bland and colleagues using data from the 1.3 million cases in the National Cancer Data Base (NCDB).1 The last three decades have witnessed significant progress in our ability to diagnose and treat breast cancer, concurrent with an increasingly complex staging system that provides and permits more precise treatment and prognostic information. Since publication in 2002, there have been numerous changes to all three components (T, N, and M) of the American Joint Committee on Cancer (AJCC)/International Union against Cancer (UICC) staging system, used both to select and report on patients in clinical trials and to aid clinicians in making reasoned judgment about appropriate treatment strategies. The 7th edition of the AJCC staging manual has incorporated important changes into the staging of breast carcinoma, which include the use of specific imaging modalities to estimate clinical tumor size, recommendations that microscopic measurement is the most accurate and preferred method to determine pT, the use of a modifier (sn) for sentinel lymph nodes, and a new M0(i+) category for the presence of circulating tumor cells detectable in blood or bone marrow. Although the 7th edition of the AJCC cancer staging manual is robust and incorporates advanced technologies such as sentinel lymph node biopsy, immunohistochemical staining, and reverse-transcription polymerase chain reaction, we believe that the current system falls short of its stated goal of addressing the global cancer burden, especially in low- and middle-income countries (LMCs) (AJCC cancer staging manual, 7th edition, p. 351). Despite sufficient expansion, the current system does not fully deal with common tumor patterns encountered in LMCs such as: …