Is breast conserving therapy better than mastectomy? Surgeons must speak out

Several population-based studies suggest that breast conserving surgery followed by radiotherapy (BCT) may provide longer overall survival than mastectomy. Better locoregional control after BCT due to improvements of preoperative imaging, oncoplastic surgery and radiotherapy, as well as the recent trend towards surgical de-escalation may be involved. Alternatively, modern radiotherapy may have such an improved benefit/risk ratio that its survival advantage now stands out more clearly. However, since the therapeutic equivalence of BCT and mastectomy was demonstrated by several randomised trials, this information cannot be disregarded, nor radiotherapy should be used to compensate for inadequate surgery. Both BCT and mastectomy are likely here to stay as clinical presentation of breast cancer is highly variable, and women desires may transcend a rational balance of pros and cons between the two surgical approaches. Our duty as surgeons is to lead the multidisciplinary board and accompany the patients along this difficult decision-making process.