With advanced detection methods now allowing cancers to be found at earlier and earlier stages, new treatment methods to deal with these early stage cancers are also emerging. Radioguided occult lesion localisation (ROLL), a technique pioneered in 1996, is a useful method for localisation of impalpable breast tumours with results superior to those obtained by wire localisation and comparable to those achieved by surgery of palpable lesions. ROLL allows for the precise localisation necessary to optimise the cosmetic outcome in breast conserving surgery without jeopardising sufficient free tissue margins. ROLL can also be used in conjunction with sentinel node biopsy (SNB) using either the same or different radioactive tracer. For all these reasons, ROLL is an important development in breast cancer treatment.

Historical assumptions concerning the optimal fractionation schedules for women with breast cancer are being challenged by the early results of randomised clinical trials. Multiple small fractions of 2.0 Gy or less are optimal for squamous cell carcinomas, which are clearly less sensitive to fraction size than the surrounding dose-limiting normal tissues. Breast cancer may be different in showing comparable sensitivity to fraction size as the healthy tissues of the breast and underlying ribcage. If this is confirmed, it means that fewer, larger fractions confer the same benefit as standard 2.0 Gy schedules, provided appropriate downward corrections are made to the total dose. The approach also lends itself to tests of acceleration, shorter treatment times being of obvious interest to patients and possibly of therapeutic benefit in their own right.