Analysis of low-benefit subgroups in breast-conserving surgery: Implications for clinical decision-making (Review)

Breast-conserving surgery (BCS) with radiotherapy is a standard treatment for early-stage breast cancer, offering survival outcomes equivalent to mastectomy while preserving breast appearance and improving quality of life. However, BCS suitability and effectiveness vary notably among patients due to differences in age, comorbidities, tumor biology, breast anatomy and psychosocial factors. Through a systematic review, the present study identified six patient subgroups that may derive limited benefit from BCS followed by radiotherapy. These constituted the elderly with multiple comorbidities, those with ductal carcinoma in situ, premenopausal women with aggressive tumor subtypes, patients with cardiac contraindications to radiotherapy, individuals at high risk of poor cosmetic outcomes and those with socioeconomic constraints. For these patients, alternative procedures such as mastectomy with immediate reconstruction may provide improved oncologic or functional results. The present analysis highlights the importance of a personalized, risk-adapted approach to surgical decision-making in breast cancer. By integrating clinical, pathological and sociodemographic variables, the present study supports treatment strategies that are not only valid within oncology but also aligned with the functional needs and psychological well-being of patients.