Breast Cancer Surgery: New Issues

Abstract

Since ancient times, breast cancer treatment has crucially relied on surgeons and clinicians making great efforts to find increasingly conservative approaches to cure the tumor. In the Halstedian era (mid-late 19th century), the predominant practice consisted of the radical and disfiguring removal of the breast, much to the detriment of women’s psycho-physical well-being. Thanks to enlightened scientists such as Professor Umberto Veronesi, breast cancer surgery has since impressively progressed and adopted a much more conservative approach. Over the last three decades, a better understanding of tumor biology and of its significant biomarkers has made the assessment of genetic and molecular profiles increasingly important. At the same time, neo-adjuvant treatments have been introduced, and great improvements in genetics, imaging technologies and in both oncological and reconstructive surgical techniques have been made. The future of breast cancer management must now rest on an ever more precise and targeted type of surgery that, through an increasingly multidisciplinary and personalized approach, can ensure oncological radicality while offering the best possible quality of life.

Spiritual needs and their associated psychosocial factors among women with breast cancer: A cross‐sectional study

“…Breast cancer not only harms women's physical bodies, but their mental and psychological health as well, thereby reducing their quality of life (Zamanian et al, 2015). There have been a variety of treatments for the disease, such as surgery and other adjuvant treatments, including radiotherapy and chemotherapy (Magnoni et al, 2021). The prognosis and 5‐year survival rate have improved to some extent (Mkuu et al, 2021).…”

Surgical Management of Inherited Breast Cancer: Role of Breast-Conserving Surgery

“…Risk-reducing surgery is currently witnessing a growing impulse towards the inclusion of breast-conserving therapy (BCT), defined as breast-conserving surgery (BCS) combined with radiotherapy (RT), in the personalized and multidisciplinary approach to managing BC high-risk patients [64]. Indeed, the debate on what the optimal local therapy for women with BRCA-associated BC should be is still ongoing.…”

“…Indeed, the choice of treatment for sporadic BC is influenced by factors that include tumor location, breast size, and patient preference [77]. In reference to sporadic BC, multiple prospective randomized trials have found equivalent patient survival rates after BCS and after mastectomy [64]. In particular, Veronesi et al [78] and other authors [79][80][81] found that the 20-year overall survival rate did not differ in a statistically significant way (p = 0.1) between patients who had undergone BCS (58.3%) and those who had undergone mastectomy (58.8%).…”

“…Scientific studies are currently comparing survival, risk of ipsilateral BC recurrence, and new primary BCs between BRCA mutation carriers that received BCT and those that underwent a mastectomy, with special attention to patients who also had prophylactic bilateral salpingo-oophorectomy and adjuvant systemic therapy [64].…”

Progress in breast cancer surgical management

“…Moreover, the management of hereditary breast cancer is including BCS as a possible treatment option to offer and discuss in a multidisciplinary fashion with both high and moderate penetrance genes mutated breast cancer patients, if clinically appropriate (Corso and Magnoni, 2021; Yip and Newman, 2021). Recent studies have also reported an association between CDH1 germline mutations and lobular breast cancer: NSM is acquiring an interesting preponderance as a prophylactic tool for breast cancer patients with CDH1 mutation and a significant family history for breast cancer aggregation (Magnoni et al 2021).…”