Breast conservation in breast cancer: surgical and adjuvant considerations

Breast-conserving surgery is accepted as an alternative to mastectomy for the treatment of early breast cancer. This paper reviews the recent contributions to the literature, with special emphasis on breast-conserving surgery in the management of invasive breast cancer.

Long-term follow-up of randomized trials confirms that in women with early stage breast cancer, breast-conserving surgery achieves similar survival compared with mastectomy. Increase in early breast cancer detection, and efforts in patient and physician education are likely to enhance breast-conserving surgery use. Patients with locally advanced tumors may also become eligible for breast-conserving surgery after tumor downsizing with preoperative chemotherapy, with acceptable rates of ipsilateral breast tumor recurrence. Efforts should be made to minimize the risk of ipsilateral breast tumor recurrences after breast-conserving surgery as they have been associated with worse distant-disease-free and breast cancer-specific survival rates. One of the most effective strategies to minimize ipsilateral breast tumor recurrence risk is to ensure negative surgical margins. This necessitates careful surgical planning, tumor localization, precise surgical technique and careful pathological processing. Radiation therapy is also a critical therapeutic tool to minimize the risk. Although the standard of care has been whole-breast irradiation, preliminary results with accelerated partial breast irradiation are promising. Adjuvant systemic therapy can further reduce the risk of ipsilateral breast tumor recurrence, but it cannot replace adequate surgery and radiation therapy for achieving local control after breast-conserving surgery.

Breast-conserving surgery is confirmed to be appropriate therapy for patients with early stage breast cancer. Increasing numbers of patients are likely to be eligible for surgery in the future. Strategies to minimize the risk of ipsilateral breast tumor recurrence while enhancing the convenience of breast-conserving surgery need to be pursued.