A New Journal for the New Millennium: Clinical Breast Cancer

Abstract

Welcome to the inaugural issue of Clinical Breast Cancer, a peer-reviewed medical journal devoted to the care of patients with breast cancer. The practicing physician and the clinical or translational researcher already have several sources of information regarding breast cancer. Why another breast cancer journal, and why at this time? I would suggest that the breast cancer field stands on the edge of a new era. In this new era, the empiricism of the past will give way to an era of rational therapeutics. This new era will manifest itself in several ways: Biology will drive therapy. In the past, new agents (particularly chemotherapy agents) arrived through National Cancer Institute or drug company large-funnel drug screens. Mechanism of action frequently followed demonstration of efficacy: therapy drove biology. Our increasing understanding of the biology of breast cancer has resulted in multiple novel therapeutic targets, and these biologic targets now drive the development of novel therapies. The oncologist of the future will need to understand the biology to offer the therapy. Targeted therapy replaces general therapy. In the past, breast cancer drugs were given to all comers, regardless of tumor type. The future of breast cancer is what might be termed salami oncology. We will treat breast cancer in slices, with specific therapies for each biologic subtype. The beginnings of this approach are already here, of course: tamoxifen for estrogen receptor-positive breast cancer, trastuzumab for HER2positive breast cancer. Such advances are only the beginning. The availability of DNA chip technology should allow us to fingerprint the patient’s breast cancer: Ms. Jones, you have breast cancer type 23. We can treat you with tamoxifen, trastuzumab, cyclophosphamide, endostatin, and methotrexate. Chemoprevention will become increasingly important. Tamoxifen has led the way here, but it is clear that tamoxifen is, at best, only a partial solution. Novel chemopreventive approaches will require increasing diagnostic and therapeutic sophistication on the oncologist’s part. An understanding of molecular genetics, genetic counseling, the environmental bases of human breast cancer, risk factor modeling, and the appropriate use of selective estrogen receptor modulators are all becoming a standard part of the oncologist’s tool kit. So why another journal, and why at this time? Clinical Breast Cancer will try to provide the necessary intellectual tools for the oncologist dealing with breast cancer. The journal will focus on biology as it relates to therapy, on novel therapeutics as they relate specifically to breast cancer, and on important changes in the diagnosis of the disease. As a peer-reviewed journal, Clinical Breast Cancer represents a new venue for the presentation of highquality manuscripts by investigators in the field. We invite your papers on any subject related to the care of the breast cancer patient. We promise a top-quality, rapid review by members of our expert board of editors. The coming decades will, I am confident, see stunning and exciting changes in the management of the patient with breast cancer. Clinical Breast Cancer hopes to be a useful part of the revolution that will finally overthrow the reign of this disease. Please join us in this endeavor.