Breast-Conserving Surgery for Breast Cancer -- American Family Physician

Conservative Breast Surgery Stage I and Stage II breast cancers are early cancers that are not fixed to the skin or muscle. If lymph nodes are involved, they are not fixed to each other or to underlying structures. Modified radical mastectomy continues to be appropriate for some patients, but breast conservation therapy is now regarded as the optimal treatment for most. Six prospective randomized trials have shown no difference in survival when mastectomy is compared with conservative surgery plus radiation for Stage I and Stage II breast cancer (Table 1). Local recurrence can happen after surgery. Following lumpectomy, local recurrence is usually at the surgical site and can be treated with mastectomy. After mastectomy, recurrence is on the chest wall. The resulting five-year survival rate is approximately 69 percent. Randomized trials also have compared breast conservation surgery alone with surgery plus radiation therapy. These trials have shown a higher recurrence rate in women who did not receive radiation. Standard breast conservation therapy should therefore include radiation therapy. A pproximately 192,200 women in the United States are diagnosed annually with invasive breast cancer. Conservative surgery followed by breast irradiation has replaced modified radical mastectomy as the preferred treatment for early-stage invasive breast cancer. Public education and proactive screening programs have contributed to the early detection of small tumors in a greater percentage of women. Studies have shown that women diagnosed at early stages of invasive breast cancer have equivalent outcomes when they are treated by lumpectomy and radiation therapy or modified radical mastectomy.