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Breast conserving therapy

Michael S Sabel, MD
Section Editors
Anees B Chagpar, MD, MSc, MA, MPH, MBA, FACS, FRCS(C)
Daniel F Hayes, MD
Deputy Editor
Wenliang Chen, MD, PhD


Breast conserving therapy (BCT) refers to breast conserving surgery (BCS) followed by moderate-dose radiation therapy (RT) to eradicate any microscopic residual disease. The goals of BCT are to provide the survival equivalent of mastectomy, a cosmetically acceptable breast, and a low rate of recurrence in the treated breast.

While modern surgical techniques are less morbid than radical mastectomy, a mastectomy still requires the loss of the breast. For this reason, the question arose as to whether the breast could be preserved without compromising survival. Six modern, prospective, randomized clinical trials directly comparing BCT with mastectomy [1-9] and an overview of all completed trials [10] have shown equivalent survival between the two treatment approaches. The success of BCT is contingent upon moderate-dose RT in eliminating subclinical foci of disease in the ipsilateral breast. (See "Adjuvant radiation therapy for women with newly diagnosed, non-metastatic breast cancer".)

The major issues related to breast conservation techniques for surgical treatment of breast cancer will be reviewed here. The diagnosis and management of breast cancer is discussed elsewhere. (See "Overview of the treatment of newly diagnosed, non-metastatic breast cancer".)


The selection of appropriate patients is crucial to the success of breast conserving therapy (BCT). Although BCT provides an acceptable alternative to mastectomy for the treatment of invasive breast cancer, it is not applicable to all patients. Mastectomy is mandatory for tumor control for some subgroups of patients with breast cancer, and it may provide more satisfactory outcomes in others. (See "Mastectomy: Indications, types, and concurrent axillary lymph node management".)

The American College of Surgeons, the American College of Radiology, the College of American Pathologists, and the Society of Surgical Oncology have developed consensus standards of care for BCT [11]. Similar recommendations have been made by the Canadian Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer [12]. The following issues are emphasized in the appropriate selection of patients for BCT:

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Literature review current through: Oct 2017. | This topic last updated: May 03, 2017.
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  1. Fisher B, Anderson S, Redmond CK, et al. Reanalysis and results after 12 years of follow-up in a randomized clinical trial comparing total mastectomy with lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 1995; 333:1456.
  2. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347:1233.
  3. Veronesi U, Salvadori B, Luini A, et al. Breast conservation is a safe method in patients with small cancer of the breast. Long-term results of three randomised trials on 1,973 patients. Eur J Cancer 1995; 31A:1574.
  4. Veronesi U, Cascinelli N, Mariani L, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347:1227.
  5. van Dongen JA, Voogd AC, Fentiman IS, et al. Long-term results of a randomized trial comparing breast-conserving therapy with mastectomy: European Organization for Research and Treatment of Cancer 10801 trial. J Natl Cancer Inst 2000; 92:1143.
  6. Jacobson JA, Danforth DN, Cowan KH, et al. Ten-year results of a comparison of conservation with mastectomy in the treatment of stage I and II breast cancer. N Engl J Med 1995; 332:907.
  7. Poggi MM, Danforth DN, Sciuto LC, et al. Eighteen-year results in the treatment of early breast carcinoma with mastectomy versus breast conservation therapy: the National Cancer Institute Randomized Trial. Cancer 2003; 98:697.
  8. Arriagada R, Lê MG, Rochard F, Contesso G. Conservative treatment versus mastectomy in early breast cancer: patterns of failure with 15 years of follow-up data. Institut Gustave-Roussy Breast Cancer Group. J Clin Oncol 1996; 14:1558.
  9. Blichert-Toft M, Rose C, Andersen JA, et al. Danish randomized trial comparing breast conservation therapy with mastectomy: six years of life-table analysis. Danish Breast Cancer Cooperative Group. J Natl Cancer Inst Monogr 1992; :19.
  10. Clarke M, Collins R, Darby S, et al. Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 366:2087.
  11. Morrow M, Strom EA, Bassett LW, et al. Standard for breast conservation therapy in the management of invasive breast carcinoma. CA Cancer J Clin 2002; 52:277.
  12. Scarth H, Cantin J, Levine M, Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer. Clinical practice guidelines for the care and treatment of breast cancer: mastectomy or lumpectomy? The choice of operation for clinical stages I and II breast cancer (summary of the 2002 update). CMAJ 2002; 167:154.
  13. Roughton MC, Shenaq D, Jaskowiak N, et al. Optimizing delivery of breast conservation therapy: a multidisciplinary approach to oncoplastic surgery. Ann Plast Surg 2012; 69:250.
  14. Halsted WS. I. The Results of Radical Operations for the Cure of Carcinoma of the Breast. Ann Surg 1907; 46:1.
  15. Adair F, Berg J, Joubert L, Robbins GF. Long-term followup of breast cancer patients: the 30-year report. Cancer 1974; 33:1145.
  16. TURNER-WARWICK RT. The lymphatics of the breast. Br J Surg 1959; 46:574.
  17. Veronesi U, Valagussa P. Inefficacy of internal mammary nodes dissection in breast cancer surgery. Cancer 1981; 47:170.
  18. Kapoor NS, Eaton A, King TA, et al. Should breast density influence patient selection for breast-conserving surgery? Ann Surg Oncol 2013; 20:600.
  19. Fleck R, McNeese MD, Ellerbroek NA, et al. Consequences of breast irradiation in patients with pre-existing collagen vascular diseases. Int J Radiat Oncol Biol Phys 1989; 17:829.
  20. Morris MM, Powell SN. Irradiation in the setting of collagen vascular disease: acute and late complications. J Clin Oncol 1997; 15:2728.
  21. Ross JG, Hussey DH, Mayr NA, Davis CS. Acute and late reactions to radiation therapy in patients with collagen vascular diseases. Cancer 1993; 71:3744.
  22. Chen AM, Obedian E, Haffty BG. Breast-conserving therapy in the setting of collagen vascular disease. Cancer J 2001; 7:480.
  23. Phan C, Mindrum M, Silverman C, et al. Matched-control retrospective study of the acute and late complications in patients with collagen vascular diseases treated with radiation therapy. Cancer J 2003; 9:461.
  24. Wo J, Taghian A. Radiotherapy in setting of collagen vascular disease. Int J Radiat Oncol Biol Phys 2007; 69:1347.
  25. Alm El-Din MA, Taghian AG. Breast conservation therapy for patients with locally advanced breast cancer. Semin Radiat Oncol 2009; 19:229.
  26. Coopey S, Smith BL, Hanson S, et al. The safety of multiple re-excisions after lumpectomy for breast cancer. Ann Surg Oncol 2011; 18:3797.
  27. Leaper DJ, Melling AG. Antibiotic prophylaxis in clean surgery: clean non-implant wounds. J Chemother 2001; 13 Spec No 1:96.
  28. Gagliardi AR, Fenech D, Eskicioglu C, et al. Factors influencing antibiotic prophylaxis for surgical site infection prevention in general surgery: a review of the literature. Can J Surg 2009; 52:481.
  29. Throckmorton AD, Boughey JC, Boostrom SY, et al. Postoperative prophylactic antibiotics and surgical site infection rates in breast surgery patients. Ann Surg Oncol 2009; 16:2464.
  30. Fry DE. Surgical site infections and the surgical care improvement project (SCIP): evolution of national quality measures. Surg Infect (Larchmt) 2008; 9:579.
  31. Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup, et al. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 2004; 38:1706.
  32. Braxton CC, Gerstenberger PA, Cox GG. Improving antibiotic stewardship: order set implementation to improve prophylactic antimicrobial prescribing in the outpatient surgical setting. J Ambul Care Manage 2010; 33:131.
  33. Tejirian T, DiFronzo LA, Haigh PI. Antibiotic prophylaxis for preventing wound infection after breast surgery: a systematic review and metaanalysis. J Am Coll Surg 2006; 203:729.
  34. Gage I, Schnitt SJ, Nixon AJ, et al. Pathologic margin involvement and the risk of recurrence in patients treated with breast-conserving therapy. Cancer 1996; 78:1921.
  35. Fisher ER, Sass R, Fisher B, et al. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). II. Relation of local breast recurrence to multicentricity. Cancer 1986; 57:1717.
  36. Park CC, Mitsumori M, Nixon A, et al. Outcome at 8 years after breast-conserving surgery and radiation therapy for invasive breast cancer: influence of margin status and systemic therapy on local recurrence. J Clin Oncol 2000; 18:1668.
  37. Smitt MC, Nowels KW, Zdeblick MJ, et al. The importance of the lumpectomy surgical margin status in long-term results of breast conservation. Cancer 1995; 76:259.
  38. Anscher MS, Jones P, Prosnitz LR, et al. Local failure and margin status in early-stage breast carcinoma treated with conservation surgery and radiation therapy. Ann Surg 1993; 218:22.
  39. Borger J, Kemperman H, Hart A, et al. Risk factors in breast-conservation therapy. J Clin Oncol 1994; 12:653.
  40. Dewar JA, Arriagada R, Benhamou S, et al. Local relapse and contralateral tumor rates in patients with breast cancer treated with conservative surgery and radiotherapy (Institut Gustave Roussy 1970-1982). IGR Breast Cancer Group. Cancer 1995; 76:2260.
  41. Freedman G, Fowble B, Hanlon A, et al. Patients with early stage invasive cancer with close or positive margins treated with conservative surgery and radiation have an increased risk of breast recurrence that is delayed by adjuvant systemic therapy. Int J Radiat Oncol Biol Phys 1999; 44:1005.
  42. Peterson ME, Schultz DJ, Reynolds C, Solin LJ. Outcomes in breast cancer patients relative to margin status after treatment with breast-conserving surgery and radiation therapy: the University of Pennsylvania experience. Int J Radiat Oncol Biol Phys 1999; 43:1029.
  43. Wazer DE, Schmidt-Ullrich RK, Ruthazer R, et al. Factors determining outcome for breast-conserving irradiation with margin-directed dose escalation to the tumor bed. Int J Radiat Oncol Biol Phys 1998; 40:851.
  44. Pittinger TP, Maronian NC, Poulter CA, Peacock JL. Importance of margin status in outcome of breast-conserving surgery for carcinoma. Surgery 1994; 116:605.
  45. Cowen D, Houvenaeghel G, Bardou V, et al. Local and distant failures after limited surgery with positive margins and radiotherapy for node-negative breast cancer. Int J Radiat Oncol Biol Phys 2000; 47:305.
  46. van Dongen JA, Bartelink H, Fentiman IS, et al. Factors influencing local relapse and survival and results of salvage treatment after breast-conserving therapy in operable breast cancer: EORTC trial 10801, breast conservation compared with mastectomy in TNM stage I and II breast cancer. Eur J Cancer 1992; 28A:801.
  47. Singletary SE. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg 2002; 184:383.
  48. Bodilsen A, Bjerre K, Offersen BV, et al. Importance of margin width in breast-conserving treatment of early breast cancer. J Surg Oncol 2016; 113:609.
  49. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. J Clin Oncol 2014; 32:1507.
  50. Houssami N, Macaskill P, Marinovich ML, Morrow M. The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 2014; 21:717.
  51. Buchholz TA, Somerfield MR, Griggs JJ, et al. Margins for breast-conserving surgery with whole-breast irradiation in stage I and II invasive breast cancer: American Society of Clinical Oncology endorsement of the Society of Surgical Oncology/American Society for Radiation Oncology consensus guideline. J Clin Oncol 2014; 32:1502.
  52. Hosseini A, Chandrasekaran B, Aft R, Blair S. Optimal margin width in breast conservation therapy: a review of the current guidelines and literature. Current breast cancer reports 2015; 7:48.
  53. Jagsi R, Smith BD, Sabel M, Pierce L. Individualized, patient-centered application of consensus guidelines to improve the quality of breast cancer care. Int J Radiat Oncol Biol Phys 2014; 88:535.
  54. Hunt KK, Sahin AA. Too much, too little, or just right? Tumor margins in women undergoing breast-conserving surgery. J Clin Oncol 2014; 32:1401.
  55. Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology-American Society for Radiation Oncology-American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery with Whole-Breast Irradiation in Ductal Carcinoma In Situ. Ann Surg Oncol 2016; 23:3801.
  56. Marinovich ML, Azizi L, Macaskill P, et al. The Association of Surgical Margins and Local Recurrence in Women with Ductal Carcinoma In Situ Treated with Breast-Conserving Therapy: A Meta-Analysis. Ann Surg Oncol 2016; 23:3811.
  57. Wapnir IL, Dignam JJ, Fisher B, et al. Long-term outcomes of invasive ipsilateral breast tumor recurrences after lumpectomy in NSABP B-17 and B-24 randomized clinical trials for DCIS. J Natl Cancer Inst 2011; 103:478.
  58. Van Zee KJ, Subhedar P, Olcese C, et al. Relationship Between Margin Width and Recurrence of Ductal Carcinoma In Situ: Analysis of 2996 Women Treated With Breast-conserving Surgery for 30 Years. Ann Surg 2015; 262:623.
  59. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Ann Surg Oncol 2014; 21:704.
  60. Veronesi U, Luini A, Galimberti V, Zurrida S. Conservation approaches for the management of stage I/II carcinoma of the breast: Milan Cancer Institute trials. World J Surg 1994; 18:70.
  61. Schnitt SJ, Connolly JL, Khettry U, et al. Pathologic findings on re-excision of the primary site in breast cancer patients considered for treatment by primary radiation therapy. Cancer 1987; 59:675.
  62. Vicini FA, Eberlein TJ, Connolly JL, et al. The optimal extent of resection for patients with stages I or II breast cancer treated with conservative surgery and radiotherapy. Ann Surg 1991; 214:200.
  63. Morrow M, Keeney K, Scholtens D, et al. Selecting patients for breast-conserving therapy: the importance of lobular histology. Cancer 2006; 106:2563.
  64. Peiro G, Bornstein BA, Connolly JL, et al. The influence of infiltrating lobular carcinoma on the outcome of patients treated with breast-conserving surgery and radiation therapy. Breast Cancer Res Treat 2000; 59:49.
  65. Clarke DH, Martinez AA. Identification of patients who are at high risk for locoregional breast cancer recurrence after conservative surgery and radiotherapy: a review article for surgeons, pathologists, and radiation and medical oncologists. J Clin Oncol 1992; 10:474.
  66. Silverstein MJ, Larson L, Soni R, et al. Breast biopsy and oncoplastic surgery for the patient with ductal carcinoma in situ: surgical, pathologic, and radiologic issues. In: Ductal carcinoma in situ of the breast, 2nd edition, Silverstein, MJ (Eds), Lippincott Williams and Wilkins, Philadelphia 2002. p.185.
  67. Langhans L, Jensen MB, Talman MM, et al. Reoperation Rates in Ductal Carcinoma In Situ vs Invasive Breast Cancer After Wire-Guided Breast-Conserving Surgery. JAMA Surg 2017; 152:378.
  68. Janssen NN, Nijkamp J, Alderliesten T, et al. Radioactive seed localization in breast cancer treatment. Br J Surg 2016; 103:70.
  69. Chan BK, Wiseberg-Firtell JA, Jois RH, et al. Localization techniques for guided surgical excision of non-palpable breast lesions. Cochrane Database Syst Rev 2015; :CD009206.
  70. Cox CE, Garcia-Henriquez N, Glancy MJ, et al. Pilot Study of a New Nonradioactive Surgical Guidance Technology for Locating Nonpalpable Breast Lesions. Ann Surg Oncol 2016; 23:1824.
  71. Cabioglu N, Hunt KK, Sahin AA, et al. Role for intraoperative margin assessment in patients undergoing breast-conserving surgery. Ann Surg Oncol 2007; 14:1458.
  72. Gibson GR, Lesnikoski BA, Yoo J, et al. A comparison of ink-directed and traditional whole-cavity re-excision for breast lumpectomy specimens with positive margins. Ann Surg Oncol 2001; 8:693.
  73. Ciccarelli G, Di Virgilio MR, Menna S, et al. Radiography of the surgical specimen in early stage breast lesions: diagnostic reliability in the analysis of the resection margins. Radiol Med 2007; 112:366.
  74. Riedl O, Fitzal F, Mader N, et al. Intraoperative frozen section analysis for breast-conserving therapy in 1016 patients with breast cancer. Eur J Surg Oncol 2009; 35:264.
  75. Olson TP, Harter J, Muñoz A, et al. Frozen section analysis for intraoperative margin assessment during breast-conserving surgery results in low rates of re-excision and local recurrence. Ann Surg Oncol 2007; 14:2953.
  76. Fukamachi K, Ishida T, Usami S, et al. Total-circumference intraoperative frozen section analysis reduces margin-positive rate in breast-conservation surgery. Jpn J Clin Oncol 2010; 40:513.
  77. Sabel MS, Jorns JM, Wu A, et al. Development of an intraoperative pathology consultation service at a free-standing ambulatory surgical center: clinical and economic impact for patients undergoing breast cancer surgery. Am J Surg 2012; 204:66.
  78. Jorns JM, Visscher D, Sabel M, et al. Intraoperative frozen section analysis of margins in breast conserving surgery significantly decreases reoperative rates: one-year experience at an ambulatory surgical center. Am J Clin Pathol 2012; 138:657.
  79. Klimberg VS, Westbrook KC, Korourian S. Use of touch preps for diagnosis and evaluation of surgical margins in breast cancer. Ann Surg Oncol 1998; 5:220.
  80. Klimberg VS, Harms S, Korourian S. Assessing margin status. Surg Oncol 1999; 8:77.
  81. Cox CE, Hyacinthe M, Gonzalez RJ, et al. Cytologic evaluation of lumpectomy margins in patients with ductal carcinoma in situ: clinical outcome. Ann Surg Oncol 1997; 4:644.
  82. Cox CE, Pendas S, Ku NN, et al. Local recurrence of breast cancer after cytological evaluation of lumpectomy margins. Am Surg 1998; 64:533.
  83. Creager AJ, Shaw JA, Young PR, Geisinger KR. Intraoperative evaluation of lumpectomy margins by imprint cytology with histologic correlation: a community hospital experience. Arch Pathol Lab Med 2002; 126:846.
  84. D'Halluin F, Tas P, Rouquette S, et al. Intra-operative touch preparation cytology following lumpectomy for breast cancer: a series of 400 procedures. Breast 2009; 18:248.
  85. Camp ER, McAuliffe PF, Gilroy JS, et al. Minimizing local recurrence after breast conserving therapy using intraoperative shaved margins to determine pathologic tumor clearance. J Am Coll Surg 2005; 201:855.
  86. Sebastian M, Akbari S, Anglin B, et al. The impact of use of an intraoperative margin assessment device on re-excision rates. Springerplus 2015; 4:198.
  87. Blair SL, Thompson K, Rococco J, et al. Attaining negative margins in breast-conservation operations: is there a consensus among breast surgeons? J Am Coll Surg 2009; 209:608.
  88. Hewes JC, Imkampe A, Haji A, Bates T. Importance of routine cavity sampling in breast conservation surgery. Br J Surg 2009; 96:47.
  89. Rizzo M, Iyengar R, Gabram SG, et al. The effects of additional tumor cavity sampling at the time of breast-conserving surgery on final margin status, volume of resection, and pathologist workload. Ann Surg Oncol 2010; 17:228.
  90. Tengher-Barna I, Hequet D, Reboul-Marty J, et al. Prevalence and predictive factors for the detection of carcinoma in cavity margin performed at the time of breast lumpectomy. Mod Pathol 2009; 22:299.
  91. Janes SE, Stankhe M, Singh S, Isgar B. Systematic cavity shaves reduces close margins and re-excision rates in breast conserving surgery. Breast 2006; 15:326.
  92. Jacobson AF, Asad J, Boolbol SK, et al. Do additional shaved margins at the time of lumpectomy eliminate the need for re-excision? Am J Surg 2008; 196:556.
  93. Chagpar AB, Killelea BK, Tsangaris TN, et al. A Randomized, Controlled Trial of Cavity Shave Margins in Breast Cancer. N Engl J Med 2015; 373:503.
  94. Fitzal F, Mittlboeck M, Trischler H, et al. Breast-conserving therapy for centrally located breast cancer. Ann Surg 2008; 247:470.
  95. Morrow M, Harris JR.. Local management of invasive breast cancer. In: Diseases of the Breast, Harris JR, Lippman ME, Morrow M, Osborne CK (Eds), Lippincott, Williams & Wilkins, Philadelphia 2000.
  96. de la Rochefordière A, Abner AL, Silver B, et al. Are cosmetic results following conservative surgery and radiation therapy for early breast cancer dependent on technique? Int J Radiat Oncol Biol Phys 1992; 23:925.
  97. Winchester DP, Cox JD. Standards for diagnosis and management of invasive breast carcinoma. American College of Radiology. American College of Surgeons. College of American Pathologists. Society of Surgical Oncology. CA Cancer J Clin 1998; 48:83.
  98. Harris JR, Levene MB, Svensson G, Hellman S. Analysis of cosmetic results following primary radiation therapy for stages I and II carcinoma of the breast. Int J Radiat Oncol Biol Phys 1979; 5:257.
  99. Wazer DE, DiPetrillo T, Schmidt-Ullrich R, et al. Factors influencing cosmetic outcome and complication risk after conservative surgery and radiotherapy for early-stage breast carcinoma. J Clin Oncol 1992; 10:356.
  100. Mills JM, Schultz DJ, Solin LJ. Preservation of cosmesis with low complication risk after conservative surgery and radiotherapy for ductal carcinoma in situ of the breast. Int J Radiat Oncol Biol Phys 1997; 39:637.
  101. Beadle GF, Silver B, Botnick L, et al. Cosmetic results following primary radiation therapy for early breast cancer. Cancer 1984; 54:2911.
  102. van Bemmel AJ, van de Velde CJ, Schmitz RF, Liefers GJ. Prevention of seroma formation after axillary dissection in breast cancer: a systematic review. Eur J Surg Oncol 2011; 37:829.
  103. Boostrom SY, Throckmorton AD, Boughey JC, et al. Incidence of clinically significant seroma after breast and axillary surgery. J Am Coll Surg 2009; 208:148.
  104. Say CC, Donegan W. A biostatistical evaluation of complications from mastectomy. Surg Gynecol Obstet 1974; 138:370.
  105. Aitken DR, Minton JP. Complications associated with mastectomy. Surg Clin North Am 1983; 63:1331.
  106. Budd DC, Cochran RC, Sturtz DL, Fouty WJ Jr. Surgical morbidity after mastectomy operations. Am J Surg 1978; 135:218.
  107. Mertz KR, Baddour LM, Bell JL, Gwin JL. Breast cellulitis following breast conservation therapy: a novel complication of medical progress. Clin Infect Dis 1998; 26:481.
  108. Rescigno J, McCormick B, Brown AE, Myskowski PL. Breast cellulitis after conservative surgery and radiotherapy. Int J Radiat Oncol Biol Phys 1994; 29:163.
  109. Brewer VH, Hahn KA, Rohrbach BW, et al. Risk factor analysis for breast cellulitis complicating breast conservation therapy. Clin Infect Dis 2000; 31:654.
  110. Keidan RD, Hoffman JP, Weese JL, et al. Delayed breast abscesses after lumpectomy and radiation therapy. Am Surg 1990; 56:440.
  111. de Glas NA, Kiderlen M, Bastiaannet E, et al. Postoperative complications and survival of elderly breast cancer patients: a FOCUS study analysis. Breast Cancer Res Treat 2013; 138:561.
  112. Miles RC, Gullerud RE, Lohse CM, et al. Local recurrence after breast-conserving surgery: multivariable analysis of risk factors and the impact of young age. Ann Surg Oncol 2012; 19:1153.
  113. Fourquet A, Campana F, Zafrani B, et al. Prognostic factors of breast recurrence in the conservative management of early breast cancer: a 25-year follow-up. Int J Radiat Oncol Biol Phys 1989; 17:719.
  114. Kurtz JM, Amalric R, Brandone H, et al. Local recurrence after breast-conserving surgery and radiotherapy. Frequency, time course, and prognosis. Cancer 1989; 63:1912.
  115. Gage I, Recht A, Gelman R, et al. Long-term outcome following breast-conserving surgery and radiation therapy. Int J Radiat Oncol Biol Phys 1995; 33:245.
  116. Gelman R, Gelber R, Henderson IC, et al. Improved methodology for analyzing local and distant recurrence. J Clin Oncol 1990; 8:548.
  117. Voogd AC, Peterse JL, Crommelin MA, et al. Histological determinants for different types of local recurrence after breast-conserving therapy of invasive breast cancer. Dutch Study Group on local Recurrence after Breast Conservation (BORST). Eur J Cancer 1999; 35:1828.
  118. Nixon AJ, Neuberg D, Hayes DF, et al. Relationship of patient age to pathologic features of the tumor and prognosis for patients with stage I or II breast cancer. J Clin Oncol 1994; 12:888.
  119. de la Rochefordiere, Mouret-Fourme E, de Ricke Y, et al. Local and distant relapses in relation to age following breast-conserving surgery and irradiation in premenopausal patients with breast cancer (abstract). Int J Radiat Oncol Biol Phys 1998; 42:180.
  120. Kurtz JM, Jacquemier J, Amalric R, et al. Why are local recurrences after breast-conserving therapy more frequent in younger patients? J Clin Oncol 1990; 8:591.
  121. Vrieling C, Collette L, Fourquet A, et al. Can patient-, treatment- and pathology-related characteristics explain the high local recurrence rate following breast-conserving therapy in young patients? Eur J Cancer 2003; 39:932.
  122. Matthews RH, McNeese MD, Montague ED, Oswald MJ. Prognostic implications of age in breast cancer patients treated with tumorectomy and irradiation or with mastectomy. Int J Radiat Oncol Biol Phys 1988; 14:659.
  123. Chan A, Pintilie M, Vallis K, et al. Breast cancer in women < or = 35 years: review of 1002 cases from a single institution. Ann Oncol 2000; 11:1255.
  124. de Bock GH, van der Hage JA, Putter H, et al. Isolated loco-regional recurrence of breast cancer is more common in young patients and following breast conserving therapy: long-term results of European Organisation for Research and Treatment of Cancer studies. Eur J Cancer 2006; 42:351.
  125. Jeon YW, Choi JE, Park HK, et al. Impact of local surgical treatment on survival in young women with T1 breast cancer: long-term results of a population-based cohort. Breast Cancer Res Treat 2013; 138:475.
  126. Donegan WL, Perez-Mesa CM, Watson FR. A biostatistical study of locally recurrent breast carcinoma. Surg Gynecol Obstet 1966; 122:529.
  127. de la Rochefordiere A, Asselain B, Campana F, et al. Age as prognostic factor in premenopausal breast carcinoma. Lancet 1993; 341:1039.
  128. Harris JR. Breast-conserving therapy as a model for creating new knowledge in clinical oncology. Int J Radiat Oncol Biol Phys 1996; 35:641.
  129. Holland R, Connolly JL, Gelman R, et al. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol 1990; 8:113.
  130. Healey EA, Osteen RT, Schnitt SJ, et al. Can the clinical and mammographic findings at presentation predict the presence of an extensive intraductal component in early stage breast cancer? Int J Radiat Oncol Biol Phys 1989; 17:1217.
  131. Sasson AR, Fowble B, Hanlon AL, et al. Lobular carcinoma in situ increases the risk of local recurrence in selected patients with stages I and II breast carcinoma treated with conservative surgery and radiation. Cancer 2001; 91:1862.
  132. Jolly S, Kestin LL, Goldstein NS, Vicini FA. The impact of lobular carcinoma in situ in association with invasive breast cancer on the rate of local recurrence in patients with early-stage breast cancer treated with breast-conserving therapy. Int J Radiat Oncol Biol Phys 2006; 66:365.
  133. Abner AL, Connolly JL, Recht A, et al. The relation between the presence and extent of lobular carcinoma in situ and the risk of local recurrence for patients with infiltrating carcinoma of the breast treated with conservative surgery and radiation therapy. Cancer 2000; 88:1072.
  134. Ciocca RM, Li T, Freedman GM, Morrow M. Presence of lobular carcinoma in situ does not increase local recurrence in patients treated with breast-conserving therapy. Ann Surg Oncol 2008; 15:2263.
  135. Ben-David MA, Kleer CG, Paramagul C, et al. Is lobular carcinoma in situ as a component of breast carcinoma a risk factor for local failure after breast-conserving therapy? Results of a matched pair analysis. Cancer 2006; 106:28.
  136. Stolier AJ, Barre G, Bolton JS, et al. Breast conservation therapy for invasive lobular carcinoma: the impact of lobular carcinoma in situ in the surgical specimen on local recurrence and axillary node status. Am Surg 2004; 70:818.
  137. Chabner E, Nixon A, Gelman R, et al. Family history and treatment outcome in young women after breast-conserving surgery and radiation therapy for early-stage breast cancer. J Clin Oncol 1998; 16:2045.
  138. Verhoog LC, Brekelmans CT, Seynaeve C, et al. Survival and tumour characteristics of breast-cancer patients with germline mutations of BRCA1. Lancet 1998; 351:316.
  139. Ford D, Easton DF, Bishop DT, et al. Risks of cancer in BRCA1-mutation carriers. Breast Cancer Linkage Consortium. Lancet 1994; 343:692.
  140. Pierce LJ, Strawderman M, Narod SA, et al. Effect of radiotherapy after breast-conserving treatment in women with breast cancer and germline BRCA1/2 mutations. J Clin Oncol 2000; 18:3360.
  141. Haffty BG, Harrold E, Khan AJ, et al. Outcome of conservatively managed early-onset breast cancer by BRCA1/2 status. Lancet 2002; 359:1471.
  142. Pierce LJ, Levin AM, Rebbeck TR, et al. Ten-year multi-institutional results of breast-conserving surgery and radiotherapy in BRCA1/2-associated stage I/II breast cancer. J Clin Oncol 2006; 24:2437.
  143. Smith TE, Lee D, Turner BC, et al. True recurrence vs. new primary ipsilateral breast tumor relapse: an analysis of clinical and pathologic differences and their implications in natural history, prognoses, and therapeutic management. Int J Radiat Oncol Biol Phys 2000; 48:1281.
  144. Robson M, Levin D, Federici M, et al. Breast conservation therapy for invasive breast cancer in Ashkenazi women with BRCA gene founder mutations. J Natl Cancer Inst 1999; 91:2112.
  145. Pierce LJ, Phillips KA, Griffith KA, et al. Local therapy in BRCA1 and BRCA2 mutation carriers with operable breast cancer: comparison of breast conservation and mastectomy. Breast Cancer Res Treat 2010; 121:389.
  146. NIH Consensus Development Conference statement on the treatment of early-stage breast cancer. Oncology (Williston Park) 1991; 5:120.
  147. Guadagnoli E, Weeks JC, Shapiro CL, et al. Use of breast-conserving surgery for treatment of stage I and stage II breast cancer. J Clin Oncol 1998; 16:101.
  148. Nattinger AB, Gottlieb MS, Veum J, et al. Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med 1992; 326:1102.
  149. Farrow DC, Hunt WC, Samet JM. Geographic variation in the treatment of localized breast cancer. N Engl J Med 1992; 326:1097.
  150. Riley GF, Potosky AL, Klabunde CN, et al. Stage at diagnosis and treatment patterns among older women with breast cancer: an HMO and fee-for-service comparison. JAMA 1999; 281:720.
  151. Temple WJ, Russell ML, Parsons LL, et al. Conservation surgery for breast cancer as the preferred choice: a prospective analysis. J Clin Oncol 2006; 24:3367.
  152. Gregorio DI, Kulldorff M, Barry L, et al. Geographical differences in primary therapy for early-stage breast cancer. Ann Surg Oncol 2001; 8:844.
  153. Hiotis K, Ye W, Sposto R, Skinner KA. Predictors of breast conservation therapy: size is not all that matters. Cancer 2005; 103:892.
  154. Chagpar AB, Studts JL, Scoggins CR, et al. Factors associated with surgical options for breast carcinoma. Cancer 2006; 106:1462.
  155. Morrow M, Bucci C, Rademaker A. Medical contraindications are not a major factor in the underutilization of breast conserving therapy. J Am Coll Surg 1998; 186:269.
  156. Foster RS Jr, Farwell ME, Costanza MC. Breast-conserving surgery for breast cancer: patterns of care in a geographic region and estimation of potential applicability. Ann Surg Oncol 1995; 2:275.
  157. Morrow M, Schmidt R, Hassett C. Patient selection for breast conservation therapy with magnification mammography. Surgery 1995; 118:621.
  158. Morrow M, White J, Moughan J, et al. Factors predicting the use of breast-conserving therapy in stage I and II breast carcinoma. J Clin Oncol 2001; 19:2254.
  159. Cyran EM, Crane LA, Palmer L. Physician sex and other factors associated with type of breast cancer surgery in older women. Arch Surg 2001; 136:185.
  160. Katz SJ, Lantz PM, Janz NK, et al. Patient involvement in surgery treatment decisions for breast cancer. J Clin Oncol 2005; 23:5526.
  161. Morrow M, Jagsi R, Alderman AK, et al. Surgeon recommendations and receipt of mastectomy for treatment of breast cancer. JAMA 2009; 302:1551.
  162. Keating NL, Guadagnoli E, Landrum MB, et al. Treatment decision making in early-stage breast cancer: should surgeons match patients' desired level of involvement? J Clin Oncol 2002; 20:1473.
  163. Waljee JF, Rogers MA, Alderman AK. Decision aids and breast cancer: do they influence choice for surgery and knowledge of treatment options? J Clin Oncol 2007; 25:1067.