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.

Keywords: Mastectomy; breast conservation surgery (BCS); neoadjuvant chemotherapy (NACT); oncological safety.

Figure 1

Sick lobe theory (5). (A) Pictorial description of the pathogenesis of genetic alterations leading to breast cancer within a single lobe; (B) cellular level changes from normal to abnormal ductal cells; (C) these genetic alterations proven with immunostaining.

Figure 2

NASABP B-06 20 years follow-up results: cumulative Incidence of a first recurrence of cancer in the Ipsilateral in women treated with lumpectomy alone (n=570) and lumpectomy + breast radiation (n=567). The data are for women whose specimens had tumour-free margins (8).

Figure 3

NASABP B-06 results. Disease-free survival (A), distant-disease-free survival (B), and overall survival (C) among 589 women treated with total mastectomy, 634 treated with lumpectomy alone, and 628 treated with lumpectomy plus irradiation. In each panel, the P value above the curves is for the three-way comparing among the treatment groups; the P values below the curves are for the two-way comparisons lumpectomy alone or with irradiation and total mastectomy (8).