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
    • 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.

#Arrangoiz #CancerSurgeon #BreastSurgeon #SurgicalOncologist #Miami #CASO #CenterforAdvancedSurgicalOncology

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