Paradigm shift in the local treatment of breast cancer: mastectomy to breast conservation surgery

Abstract

There have been fundamental changes in the approach to breast cancer management over the last century but the primary objective of achieving oncological safety remains unchanged. This evolution is highlighted with a summary of the key evidences in support of the oncological safety of breast conserving surgery (BCS) in early breast cancer (EBC) management. We will also discuss the increasingly pivotal role that neoadjuvant chemotherapy (NACT) may play, in the local treatment of EBC and locally advanced breast cancer (LABC) and the long-term surgical and oncological outcomes.

Effect of pathologic stages on postmastectomy radiation therapy in breast cancer receiving neoadjuvant chemotherapy and total mastectomy: A Cancer Database Analysis

“…NACT results in long-term distant disease-free survival and overall survival (OS) comparable with those achieved with primary surgery followed by adjuvant systemic therapy [ 3 , 4 ]. However, the choice between breast conservation and total mastectomy (TM) after NACT is dependent on the pathologic response and patients’ breast size in relation to residual tumor size [ 5 , 6 ]. Therefore, the surgical approach to the primary tumor depends on the size of the tumor and breast [ 5 , 6 ].…”

“…However, the choice between breast conservation and total mastectomy (TM) after NACT is dependent on the pathologic response and patients’ breast size in relation to residual tumor size [ 5 , 6 ]. Therefore, the surgical approach to the primary tumor depends on the size of the tumor and breast [ 5 , 6 ]. Asian women have relatively smaller breasts compared with women in Western countries [ 7 ].…”

Comparison of breast cancer patients who underwent partial mastectomy (PM) with mini latissimus dorsi flap (MLDF) and subcutaneous mastectomy with implant (M + I) regarding quality of life (QOL), cosmetic outcome and survival rates

“…With the advances in BC treatment, the 10-year local recurrence rate following BCS is reduced from 10-15% down to 5% [41][42][43]. Factors such as surgical margin positivity, high histological grade, presence of lymphovascular invasion, axillary nodal involvement, multifocality, and poor molecular sub-types have been associated with increased local recurrence after BCS [41][42][43]. In our study, patients in PM + MLDF group had tumors with higher histologic grade, higher positivity rate for LVI, and luminal A molecular subtype rate was lower.…”

Future perspectives for breast conservation treatment: science & art

“…Several authors in this issue have offered insights into the science of BCT, its historical development and how it is applied in treatment today (11)(12)(13). However, the science continues to evolve as evidence is presented to allow best practice according © Gland Surgery.…”