A significant effect of hospital case volume on perioperative mortality has been documented for a variety of malignancies that require technically challenging operative procedures and complex perioperative management. The effect of case volume on outcome is less clear for the more common cancers, such as breast and colon cancers, that are less technically challenging and require little in the way of specialized care in the postoperative period. For these cancers perioperative mortality is minimal and one must look at other end points such as long-term survival and functional results. The literature demonstrating improved outcomes in terms of mammographical sensitivity, breast-conservation rates, specimen to tumour volume ratios in breast-conserving surgery, sentinel node biopsy success rates, and 5-year survival is reviewed.

A large number of studies in the last three decades have identified only a handful of biological features in the evolution of human premalignant breast lesions (PBL). They have shown that PBL have a positive growth balance, which may be driven/regulated by oestrogen receptor, erbB-2, and p53. There is marked genetic diversity in PBL, and use of newer technologies such as SAGE, DNA microarrays, and high-throughput proteomics will significantly improve our understanding of evolution of PBL over the next decade.

Efficacy of preoperative (primary, neoadjuvant) systemic chemotherapy significantly improved over the last two decades. Only about 3% of patients reached a pathological complete remission after preoperative treatment with cyclophosphamide, methotrexate and 5-fluorouracil in the late 1980s, whereas today up to 18% have no viable tumour cell detected at histological examination when taxane-containing regimens, for example adriamycin/cyclophosphamide followed by docetaxel or docetaxel/adriamycin/cyclophosphamide, are being used. This improvement has implications on current treatment recommendations and should be considered when this approach gains a broader use in routine practice.