Breast-conserving therapy for mammary carcinoma: psychosocial aspects, indications and limitations

Breast-conserving therapy (BCT) for invasive cancer comprises complete tumour excision and axillary dissection, followed by irradiation. The object is to perform local treatment and determine the stage of disease on lines similar to those of mastectomy. In selected series of patients the efficacy of BCT has been equivalent to that of mastectomy with a view to distant relapse and survival. On the other hand, it has not been proved whether local relapse pattern is comparable to that of mastectomy, especially in high-risk patients. The advantage of BCT is of psychological nature, since preserving the configuration of the body maintains the sensation of female identity and body image to a better extent than that seen after mastectomy. BCT does not, however, reduce the high frequency of anxiety phenomena, mental instability, and depression. The selection of patients for BCT is based primarily upon a clinical-technical assessment, patient's preference and surgeon's preference, rather than eligibility based on biological risk factors. Demands on surgical technique, radicality of operation, and irradiation are important issues regarding local control. The relation between local recurrence rate and distant relapse will be discussed. The conclusion is that BCT is a method eligible for selected patients and that the increased used of mammography is going to extend the intake of patients for the method. However, it must be an obligation to keep following up the therapeutic results, in order not to lose the advantage of an early diagnosis by altered treatment.(ABSTRACT TRUNCATED AT 250 WORDS)