Background: Different types of acellular dermal, synthetic and biological matrices have been used in connection with immediate implant-based breast reconstruction. Patients & methods: A new long-term absorbable surgical matrix, TIGR® Matrix mesh was used in a total of 29 patients undergoing a total of 37 mastectomies and immediate reconstruction. Results: Early postoperative results showed no adverse reactions to the mesh and a good integration into the tissue. Conclusion: It may therefore constitute an alternative to acellular, dermal or other synthetic matrices currently available.

Survivorship care plans are comprehensive, individualized documents that are recommended for all cancer survivors by the Institute of Medicine, and soon to be required by the Commission on Cancer. Breast cancer survivors are in many ways an ideal population for provision of survivorship care plans due to prominence within the survivorship population, relatively well-understood risk for late effects, data supporting improved outcomes with aggressive survivorship management and general interest within the population. Care plans that are provided must be of excellent quality in order to provide benefit, and quality should be measured with regard to content accuracy and language, customized information, completeness, applicability to diverse user groups and feasibility.

Thromboembolic events are common in cancer patients and, apart from contributing to significant morbidity, are regarded as the second leading cause of death in this population. Breast cancer patients are considered low risk for venous thromboembolism; however, the presence of advanced disease and use of chemotherapy and/or other adjunct treatments significantly raises this risk by altering the balance of pro- and anti-coagulant proteins. Low molecular weight heparin is central to the management of venous thromboembolism in this context, whether for prophylaxis, acute management or prevention of recurrences. Risk stratification models need to be incorporated to guide decision making where available.

SUMMARY Breast cancer is a heterogeneous disease consisting of distinct biological subtypes with therapeutic and prognostic implications. Triple-negative breast cancer (TNBC) often follows a more aggressive disease course with poorer disease-specific survival compared with other breast cancer subtypes. Despite tremendous efforts to change the current treatment algorithm for women with TNBC, little has changed in over a decade. Encouraging results emerging from elegant preclinical studies to early-phase clinical trials demonstrate that platinum agents may have a role to play in the treatment of TNBC. In addition to germline BRCA1 and BRCA2 mutation status, other biomarkers with the ability to assess platinum responsiveness are emerging, including tissue-based assays that detect genomic 'scarring' caused by accumulated DNA damage and immunological biomarkers. Prospective evaluation of these biomarkers in a clinical setting is a high priority, as tailoring therapy with the incorporation of platinum agents based on biomarkers of response is an intriguing alternative to current standard of care.

David Brenner* speaks to Ruth Williamson, Commissioning Editor of Breast Cancer Management: David Brenner focuses on developing mechanistic models for the effects of ionizing radiation on living systems, dividing his research between the effects of high doses of ionizing radiation (relating to radiation therapy) and the effects of low doses of radiation (relating to medical, environmental and occupational exposures). In the field of medical imaging, he has focused on the risk–benefit balance of higher-dose imaging techniques; and in the field of radiotherapy, he has focused on optimizing fractionation schemes for different tumor types, to maximize tumor killing and minimize serious side effects. As well as being Director of the Center for Radiological Research (Columbia University, CO, USA), Brenner is the Director of the Radiological Research Accelerator Facility (Columbia University) and principal investigator of the Center for High-Throughput Minimally-Invasive Radiation Biodosimetry (Columbia University).

*Lissevenlaan 13 5582 KB Waalre, The Netherlands; Tel.: +31 40 221 3807; wimbreed@online.nl

SUMMARY As a consequence of breast cancer diagnosis and treatment side effects, many patients reduce their physical activity, resulting in physical deconditioning. However, it has been shown that both aerobic and resistance exercise are feasible and safe throughout the breast cancer continuum. Exercise can reduce fatigue, depression and anxiety, improve quality of life and self-esteem, as well as cardiorespiratory fitness, muscle strength, physical functioning and body composition. In addition, as early-stage breast cancer patients may be at higher risk for cardiac events owing to cardiotoxic therapy, exercise can mitigate cardiovascular impairments. There is increasing evidence that higher physical activity levels are associated with improved overall survival after breast cancer; therefore, patients should receive support and be encouraged to engage in exercise training during and after cancer treatment.

SUMMARY Despite progress with microarray-based gene expression profiling of multiple genes concurrently, solid biomarkers or molecular classification have not been established as a result of Phase III randomized trials. Conventional clinicopathological characteristics and single-gene defect-based molecular tools based on the old dogma of reductionist approaches and linear experimentation that have created our knowledge in biology over the past century, and still today represent the basis for the prevention, diagnosis and treatment of all diseases in clinical medicine, are saving the lives of tens of thousands of patients with breast cancer. Almost 5000 manuscripts have been published on next-generation technologies in MEDLINE in the last 3 years, with 100 of them regarding breast cancer. This review considers evidence published after 2010 and up until October 2013 of the latest studies published using high-throughput next-generation techniques in significant numbers of samples from patients with breast cancer and data from trials enrolled on ClinicalTrials.gov website. A perspective estimation of the potential and challenges of modern approaches are also explained in detail.

The 2013 American Society of Clinical Oncology (ASCO) Breast Cancer Symposium was held in San Francisco, CA, USA, on 7–9 September 2013. The meeting provided a number of provocative sessions, aimed at a multidisciplinary audience. The conference covered a range of important topics in breast cancer, including local/regional therapy, systemic therapy, prevention and screening, and survivorship/health policy.

The much awaited 10‐year follow‐up results of the UK START A and B trials have now been published in Lancet Oncology. The UK START trials were conducted to compare standard radiotherapy with hypo‐ fractionation schemes in over 4000 women with early‐stage breast cancer. The primary end points were locoregional control and normal tissue effects. The START A trial compared standard fractionation of 50 Gy in 25 fractions over 5 weeks with 41.6 or 39 Gy in 13 fractions over 5 weeks. Patients in START B were randomized to 50 Gy in 25 fractions in 5 weeks versus 40 Gy in 15 fractions over 3 weeks. The initial results from these studies that were previ‐ ously published were promising in favor of the hypofractionated regimens. At longer follow‐up, there continues to be a benefit to hypofractionation over stan‐ dard fractionation. Rates of locoregional failure and late tissue effects, including moderate/marked breast induration, tel‐ angiectasia and breast edema, were sig‐ nificantly lower in the hypofractionated arms. The rates of ischemic heart disease, symptomatic rib fracture and symptomatic lung fibrosis were low and similar among the different arms. Furthermore, the hypofractionated arm in START B had lower distant relapse rates, which resulted in higher rates of disease‐free survival and overall survival compared with the standard arm. In conclusion, the 10‐year follow‐up confirms that hypofractionation is both safe and effective in early‐stage breast cancer and has now been adopted as the standard of care by most UK centers.