[The trend of surgery for breast cancer in USA]

Breast cancer continues to increase in incidence among the American women, and an increasingly larger proportion of patients are found to have earlier cancers. For the past decade, the modified mastectomy prevailed as the standard surgical procedure. As the smaller cancers are diagnosed more frequently, they are also treated with breast-conserving surgery. The proportion of patients treated by breast conservation has been reported to be 20 to 50 percent of all operable breast cancer patients. Selection for lumpectomy or breast conservation is based upon tumor size, tumor location in the breast and type of tumor; but more frequently, patient's desire for breast conservation is the deciding factor. Interestingly, in the patients without axillary nodal metastasis, adjuvant systemic treatment has demonstrated its effective role. In this decision making for adjuvant therapy in women without nodaL metastasis, some of the prognostic factors such as tumor size, pathologic grades, nuclear grades, DNA flow cytometry, receptor status are weighted. Here again, each patient has the deciding voice after discussion of available treatment options.