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Breast conserving therapy

Author
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

INTRODUCTION

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".)

PATIENT SELECTION FOR BCT

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: Nov 2016. | This topic last updated: Mon Oct 31 00:00:00 GMT+00:00 2016.
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