Breast Conserving Surgery

Many studies have compared the recurrence and survival rates between women who have undergone mastectomy and those who had breast-conserving surgery (BCS) and radiation therapy. The findings have all confirmed that aside from a small chance of local recurrence with BCS, the outcomes were equal.

BCS is known by many names: lumpectomy, segmentectomy, quadrantectomy, wide local excision, and tylectomy. Each of these names refer to the amount of breast tissue that is removed during surgery.

The lump or tumor is removed with some amount of tissue surrounding the lump. The tissue surrounding the lump is then assessed for malignant cells. If no further malignant cells exist, then the margins are considered clear. The majority of the breast tissue is left intact and depending on the amount of tissue spared, cosmetic results are usually satisfactory. For those results that are not satisfactory, partial prostheses can replace the missing tissue.

Before BCS can be recommended, the surgeon must know the extent and nature of the tumor. This is done by staging the cancer to determine the extent of tissue involved. The earlier the diagnosis is made, the better chances are that BCS will be an appropriate choice of treatment. Women who have a small breast and a large tumor would usually not be considered for BCS due to possible poor cosmetic outcome. The best BCS surgery candidates usually those with the following conditions:

• Ductal carcinoma in-situ (DCIS)
• Other diagnoses determined to be at Stage I to III
• Single localized tumor
• Tumor smaller than 2 inches in size
• No contraindications to radiation therapy

During the procedure, a separate incision may be required to access axillary lymph nodes. The surgeon may perform a sentinel node biopsy. Other procedures to remove and assess the spread of cancer cells to the lymph nodes may include an axillary node sampling or an axillary node dissection.

BCS is commonly followed with systemic and local adjuvant therapy. Local adjuvant therapy usually consists of six weeks of radiation therapy. The ability to tolerate the physical and geographical requirements of radiation therapy can influence a patient's choice between BCS and mastectomy. Radiation therapy is usually given five days a week for six weeks. This can be a burden for those women who do not live near a radiation therapy facility or those who must depend on others for transportation. Studies are being done on the efficacy of shorter treatment plans but no recommendations to decrease the number of radiation therapy treatments have been made at this time.

"Many studies have compared the recurrence and survival rates between women who have undergone mastectomy and those who had breast-conserving surgery (BCS) and radiation therapy. The findings have all confirmed that aside from a small chance of local recurrence with BCS, the outcomes were equal."

Contraindications to radiation therapy:

Physical conditions preventing the woman from lying flat or raising her arm so that her hand lies on her forehead.

• Pregnancy
• Previous radiation therapy in the breast area
• Connective tissue diseases such as scleroderma or systemic lupus erythematosis

Systemic adjuvant therapy would include chemotherapy taken intravenously or by mouth. This category would include hormone therapies such as tamoxifen or a combination of different drug therapies. Studies have shown that the use of adjuvant and systemic therapies following BCS provides very adequate long term local control.

BCS offers women a choice in the treatment of their breast cancer. Studies have shown that women involved in the decision making process of their treatment plan experience less depression from their diagnosis.