Selection criteria for breast conservation in breast cancer

Breast conservation, comprising limited excision of the breast and axillary lymphadenectomy followed by irradiation, yields survival equal to mastectomy with the advantage of preservation of the breast for properly selected patients. When breast conservation therapy is competently done it achieves highly satisfactory cosmetic results and acceptably low rates of local recurrence. However, numerous controversies surround the selection criteria, the relative importance of some of them, and the treatment. Four critical elements in selecting patients for breast conservation therapy are: history and physical examination, careful mammographic evaluation, histological assessment of the resected specimen, and assessment of the patient's needs and expectations. Today, it is estimated that breast conservation can be recommended to 50%-75% of all women with operable breast cancer. However, this treatment is not widely used. In this article we review the generally accepted principles and controversies about the selection of patients for breast conservation.