[Indications and counter-indications for non-mutilating treatment of breast cancer]

Progress achieved in understanding the biology of breast cancer, as well as the desire of patients to avoid major mutilation, have resulted in ever increasing indications for breast-conserving surgery. Such indications depend on two considerations: the medical consideration which seeks to achieve the same rate of control of loco-regional disease as mutilating surgery and the aesthetic consideration, permitting a satisfactory result on a functional plane. Nevertheless, a case of breast cancer appearing unifocal under clinical examination and radiology is frequently accompanied by tumoral intramammal dissemination, the evaluation of which after histological examination varies according to the author. Should the coexistence of cancer in situ and invasive cancer radically modify the choice of therapy? It seems absurd to accept non-mutilating surgery for invasive cancer and to choose mutilating treatment for certain cases of cancer in situ. Although there appears to be only relative counter-indication for conservatory treatment in cases of advanced cancer (T3N1b and above), it is not recommended in the presence of several types of histology and in certain specific circumstances when associated with cancer in situ. A review of the literature will enable us to cover in detail other risk factors and to enumerate indications and counter-indications for non-mutilating treatment of breast cancer.