Breast conserving surgery for early cancer: who, when, where, and how?

Breast-conserving surgery combined with postoperative radiation therapy is a therapeutic option for the early stages of breast cancer that has been proven efficacious by multiple studies with long-term follow-up. The validity of this approach has been recently questioned following the discovery of erroneous data submitted by a single investigator to a study of the National Surgical Adjuvant Breast and Bowel Project. When this individual's contributed data was eliminated, and the residual data reexamined and reviewed by National Cancer Institute statisticians, the conclusions of the study were unchanged and supported other clinical investigations in affirming that breast-conserving therapy is an effective and appropriate treatment for early breast cancer. Marked geographical, institutional, and individual physician variation persists today regarding the acceptance of breast-conserving surgery in the treatment of breast carcinoma. Currently, the trend, however, is toward increased acceptance and utilization of this treatment option. A woman's choice of treatment can be remarkably enhanced if she is carefully provided the pros and cons of all treatment options and then allowed to choose.