Management of Early Breast Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • 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 positive 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. 2014; https://www.nccn.org/professionals/physician_gls/pdf/breast.pdf. Accessed 8/28/2024, 2024
    • 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.
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Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

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