Management of Early Breast Cancer Summary

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, or those who fail lymphatic mapping
References
- National Comprehensive Cancer Network. Breast Cancer. 2023; https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf.
- 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.