[Recent changes in breast cancer surgery]

Area of Science:

• Oncology
• Surgical Oncology
• Breast Cancer Research

Context:

• Shift from radical mastectomy towards breast-conserving surgery.
• Growing evidence on the impact of surgical margins and intraductal components on local recurrence.
• Exploration of de-escalation strategies in breast cancer treatment, including reduced irradiation and axillary dissection.

Purpose:

• To review current trends in breast cancer surgery, emphasizing the principle of necessary minimum intervention.
• To discuss the role of surgical margins, intraductal components, and axillary lymph node status in local recurrence.
• To evaluate novel approaches like intraoperative lymph node mapping and the prognostic significance of hepatocyte growth factor.
• To investigate the potential survival benefits of timing breast cancer surgery to the menstrual cycle.

Summary:

• Modern breast cancer surgery prioritizes minimal intervention, moving away from radical procedures.
• Local recurrence is linked to intact surgical margins and the extent of intraductal components.
• Less aggressive treatment strategies include omitting irradiation in select cases and reconsidering routine axillary dissection.
• Intraoperative lymph node mapping shows promise for assessing tumor involvement, potentially replacing the prognostic role of dissection.
• Hepatocyte growth factor may serve as an alternative prognostic marker.
• Operating during the luteal phase of the menstrual cycle appears to improve survival rates.

Impact:

• Potential for reduced morbidity and improved quality of life for breast cancer patients.
• Advancements in surgical decision-making regarding extent of resection and axillary staging.
• Development of more personalized and effective breast cancer treatment protocols.
• Identification of novel biomarkers for prognostication and treatment guidance.