The appropriate extent of surgery for early-stage breast cancer

Attitudes regarding the appropriate extent of surgery for breast cancer and the effect of surgery on breast cancer-specific survival have varied over time. Failure to maintain local control is associated with decreased survival, but the extent of surgery necessary for local control has decreased as other treatment modalities, such as radiotherapy and systemic therapy, have become more widely used. Both endocrine therapy and chemotherapy considerably reduce rates of local recurrence in the breast, as well as the incidence of contralateral breast cancer, and as efficacy in reducing metastatic disease increases, so does the benefit in reducing local recurrence. The excellent rates of local control in the ACOSOG Z11 trial after elimination of axillary dissection in patients with positive sentinel nodes receiving whole-breast irradiation and systemic therapy are a model for reducing surgical morbidity in the era of multimodality therapy.