LAUSR

Not all is darkness amid the current global coronavirus disease 2019 (COVID-19) pandemic. This August 15, 2020, special issue of Cancer contains 7 solid articles from China indicating progress in breast cancer research, and this is further evidence of the growing momentum in this area in the most populous nation in the world. The articles are diverse but of generally good quality and were carefully critiqued by our outstanding breast cancer reviewers. An article on clinical trials in breast cancer by Fan and Xu from the Chinese Academy of Medical Sciences reviews the time trends of the changing landscape of clinical drug development in China over the last decade from 2009 to 2018. The results show that the number of clinical trials specific to breast cancer being conducted in China has increased in a span of 10 years from 36 trials in 2009 to 113 in 2018, and this has been accompanied by the number of publications increasing from 13 in 2009 to 52 in 2015. Unfortunately, the article fails to explore and contextualize the changing regulatory and pharmaceutical landscape in China; this approach would have made the review more informative and valuable. Also included is the broad-based “Chinese Expert Consensus on the Clinical Diagnosis and Treatment of Advanced Breast Cancer (2018)” led by Xu et al, a standard, solid consensus paper that sees international standards increasingly brought to bear. The articles are diverse in style impact and focus, with the common thread being diseases of the breast. Guo et al from Fudan University in Shanghai developed a nomogram for predicting an axillary pathologic complete response to neoadjuvant chemotherapy in hormone receptor–positive breast cancer with cytologically proven lymph node metastasis. This is an important unmet clinical need for optimum axillary lymph node management. The study was well conducted, and the article is well written and clear and should prove to be a valuable addition to the literature. Another multiinstitutional study led by Tang et al from the Chinese Academy of Medical Sciences and Peking Union Medical College developed a nomogram predicting overall survival for women with pT1-2N1 breast cancer after mastectomy. This nomogram may help to select a subgroup of patients with a good prognosis and spare those who will not benefit from postmastectomy radiotherapy. Others used high volumes to arrive at generally supportable conclusions based on retrospective data. Pan et al from the First Affiliated Hospital of Nanjing Medical University studied more than 2700 men with male breast cancer and concluded that chemotherapy should be considered for men with progesterone receptor–negative, nonmetastatic breast cancer and progesterone receptor–positive, stage II/III breast cancer. This article is more moderate in quality, and its utility is more incremental. Another retrospective study from An et al at Sun Yat-Sen University showed a survival benefit from adjuvant chemotherapy only for T1cN0 triple-negative breast cancer (TNBC). However, the accompanying meta-analysis showed adjuvant chemotherapy to be beneficial also for T1bN0 TNBC. For patients with T1cN0M0 TNBC, less intensive chemotherapy regimens appeared to achieve excellent survival outcomes similar to those achieved with intensive anthracycline and taxane combination chemotherapy. By far the most interesting, futuristic, and possibly controversial article is the one led by Yang et al from Peking University entitled “Use of High-Resolution Full-Field Optical Coherence Tomography and Dynamic Cell Imaging for Rapid Intraoperative Diagnosis During Breast Cancer Surgery.” In this study, full-field optical coherence tomography and dynamic cell imaging were applied to normal and cancerous breast tissue, benign breast lesions, and resected axillary lymph nodes; 314 samples were obtained from 158 patients during breast surgery for prospective imaging evaluations. We actually agree with the authors’ conclusion that, if validated independently in larger, better controlled trials, these timely and tissue-sparing optical imaging techniques could ultimately prove highly accurate in diagnosing breast cancer and nodal metastasis, comparing favorably in this study with routine histologic sections and demonstrating their promise in this setting. Perhaps because this is the most interesting article, the one with the most potential to affect diagnosis and care, it deserves the deepest review, the most