Fibroadenomas are most common benign tumour of the breast, usually affecting pre-menopausal women. The traditional treatment aimed at symptomatic relief and confirmation of the lesion's benign nature through open surgical excision and biopsy. The rise of ‘triple assessment’ in recent years has meant that a definitive benign diagnosis is now generally possible without recourse to open biopsy. But patients would still face undergoing open surgical excision for relief of symptoms. A third option is now available – that of percutaneous vacuum-assisted excision under local anaesthetic. Performed in a similar fashion to conventional percutaneous needle biopsy, the procedure can normally be completed within 15 min and offers quicker recovery times and better cosmetic outcome than traditional excision.

The role of estradiol and the estrogen receptor (ER-α) in the etiology of breast cancer have long been appreciated. This understanding has been complicated by two discoveries in the 1990s: (1) a second estrogen receptor (ER-β) whose expression pattern and activity overlap with but are distinct from those of ER-α; and (2) a pool of ERs located at the plasma membrane. This plasma membrane-localized ER constitutes a distinct pool of receptors whose protein interactions, signaling mechanisms, and cellular functions are not the same as that of the cytoplasmic- and nuclear-localized ER and are not as well understood. Here, we will consider the structure and function of the membrane-localized ER protein. We will then discuss what is known about the role of the membrane ER in the development and its implications for breast cancer treatment.

The use of three-dimensional conformal external beam accelerated partial breast irradiation (3D conformal APBI) to deliver hypofractionated adjuvant radiation treatment to the region of the breast at highest risk for developing a local recurrence after lumpectomy is reviewed. Potential advantages of a 3D conformal radiation therapy approach for APBI compared to brachytherapy include improved dose homogeneity within the target volume and a non-invasive method for treatment delivery. Data from several early studies using 3D conformal APBI from New York University, William Beaumont Hospital, RTOG 0319, and Massachusetts General Hospital demonstrate technical feasibility, satisfactory early cosmetic outcome, and acceptable recurrence rates. To determine whether APBI provides equivalent local tumour control in the breast compared to conventional whole breast irradiation in the local management of early stage breast cancer, the first phase III randomized study of conventional whole breast irradiation vs. partial breast irradiation was opened conjointly by the NSABP and RTOG in March 2005. The results of this study will determine future directions in the treatment of early stage breast cancer, and, will help to define the role of APBI in breast conservation therapy.