Surgical Management of Early Stage Invasive Breast Cancer

National Comprehensive Cancer Network (NCCN) guidelines:
- Recommend surgical management for local control for women with early stage invasive breast cancer
Several studies have shown:
- An equivalence in overall and / or breast cancer-specific survival rates:
  - For breast conservation with radiation compared to mastectomy among early stage breast cancer patients
For patients with ER+ disease:
- Endocrine therapy with tamoxifen or aromatase inhibitors:
  - Is prescribed after surgery
A systematic review evaluated the efficacy of primary endocrine therapy alone versus surgery in women over 70 years old with operable tumors:
- The review reported similar survival between the two groups:
  - But women treated with surgery had lower rates of local failure when compared to endocrine therapy alone
  - The authors concluded that primary endocrine therapy:
    - Should be reserved for women who are unfit for surgery or decline surgery
Sentinel node biopsy:
- Has become the standard method for staging the axilla in women with early stage breast cancer who are clinically node negative
Axillary dissection:
- Is only performed in women with:
  - Documented nodal involvement
  - Inflammatory breast cancers
  - Those who fail lymphatic mapping
References
- National Comprehensive Cancer Network. Breast Cancer. 2018; https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 8/14/2018, 2018
- Fisher B, Anderson S, Bryant J, et al. Twenty-year followup of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New Engl J Med. 2002;347(16):1233-1241.
- Litiere S, Werutsky G, Fentiman IS, et al. Breast-conserving therapy versus mastectomy for stage I-II breast cancer: 20 year followup of the EORTC 10801 phase 3 randomized trial. Lancet Oncol. 2012;13(4):412-419.
- 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. New Engl J Med. 2002;347(16):1227-1232.
- Morgan J, Wyld L, Collins KA, Reed MW. Surgery versus primary endocrine therapy for operable primary breast cancer in elderly women (70 years plus). Cochrane Database Syst Rev. 2014(5). https://www.cochrane.org/CD004272/BREASTCA_surgery-versus-primary-endocrine-therapy-for-elderly-women-with-operable-primary-breast-cancer Accessed August 25, 2019.