Breast conservation: predictors and treatment of local recurrence

Breast conservation therapy has become the preferred treatment for many Stage I and II breast cancers as the "Halstedian" theory of sequential spread has been replaced by the belief that breast cancer is a systemic disease and that local-regional therapy has little impact on overall survival. Local recurrence after conservation therapy is reportedly dependent upon a number of pathological, clinical, and treatment factors. This review examines the complex relationships among these factors, their ability to predict for residual disease within the breast, and its correlation with risk for local recurrence. A local recurrence does not appear to affect overall survival, and salvage therapy provides excellent local control in the majority of cases. The proper salvage therapy is evolving, with mastectomy the current standard. However, repeat wide-excision surgery may offer good local control in a select group of patients.