Management of breast cancer: what do I tell the patient?

Controversies exist about management of breast cancer because different conclusions are drawn from the same sets of data. Evidence now shows that conservative methods of treatment give the same results as aggressive surgery, especially when combined with radiation, so the question is not which operation is best, but how this knowledge can be disseminated. The surgeon and patient should be fully aware of the options for reconstruction. The next big question concerns prophylactic radiotherapy, which awaits a convincing randomized controlled trial of its effectiveness. Long-term benefits of adjuvant chemotherapy are unknown, but costs (both physical and financial) are well known. Patients must be given access to data on risk factors for developing breast cancer, especially so-called 'precancerous' lesions. Screening of all women is still a debatable topic, although all women with risk factors should be screened. They should be frankly told that prognosis can only be based on statistical probability.