Approximately 192200 women in the U...

Approximately 192200 women in the United States are diagnosed annually with invasive breast cancer. (1) Conservative surgery followed at breast irradiation has replaced modified radical mastectomy as the preferr 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 issues when they are treated by way of lumpectomy and radiation therapy or modified radical mastectomy. (2-4)

Diagnosis

The diagnostic proces for a breast mass begins with assessment of risk based onward family history, personal history of breast question s and physical examination. Significant signs of cancer include an irregular hard mass, lymph node involvement, and skin changes. If none of these signs is current and the mass is asymptomatic, mammography (ultrasound for women 30 years of age or less) and needle biopsy should be performed. (5)

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 arrangements Modified radical mastectomy continues to be appropriate for an patients, but breast conservation therapy is now regarded as the optimal treatment for in the greatest degree 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) (6)

Local return can happen after surgery. Following lumpectomy, local return is usually at the surgical site and can be treated with mastectomy. After mastectomy, return is on the chest wall. The resulting five-year survival rate is approximately 69 percent (7)

Randomized trials also have compared breast conservation surgery alone with surgery plus radiation therapy. These trials have shown a higher the having recourse rate in women who did not receive radiation. (89) Standard breast conservation therapy should therefore include radiation therapy.

Patient Selection

A undiminished history and physical examination help determine which surgery is best for each individual patient. A family history of breast cancer is not a contraindication to breast-conserving surgery (10) Age alone should not be a determining factor in selecting surgical strategy, however somewhat old women may have comorbid conditions that ne to be considered. A woman who is likely to have difficulty with general anesthesia might benefit from a lumpectomy performed beneath local anesthesia. Conversely, a woman who has difficulty complying with six weeks of radiation treatments may be a better candidate for mastectomy.

Mammographic evaluation performed within the past three month is necessary to plan surgery The location, size, associated microcalcifications, and any other characteristics of the primary tumor must be determined. Bilateral mammography is also necessary to evaluate the air of other suspicious lesions in the breast tissue.

Patients with invasive ductal and lobular cancers are candidates for conservative therapy if the tumor is not diffuse and negative surgical margins can be achieved. (11) The air of positive axillary nodes is not a contraindication to breast conservation therapy. (12) Tumors located near the nipple areolar intricate web may require excision of the nipple, still this also is not a contraindication. (12)

The status of the margins of resection after lumpectomy is important when determining the optimal surgical treatment. When negative margins can be achieved with the preservation of adequate amounts of breast tissue, the patient is a candidate for conservative surgical therapy. If tumor remains at the margin after re-excision, modified radical mastectomy may be the treatment of choice. (1314)

The patient's wishes should always be considered when deciding treatment. For most numerous patients, mastectomy will not influence the likelihood of survival if it be not that may impact quality of life. Women whose breasts are preserv have fewer episodes of depression, anxiety, and insomnia. (15) A late study of patients with early-stage breast cancer erect women who undergo breast conservation therapy have improved corpse image, higher satisfaction with treatment, and no more fear of the having recourse compared with women treated with mastectomy. (16)

Contraindications to Conservative Surgery

ABSOLUTE

When sum of two units or more primary tumors are located in different quadrants of the breast or there are associated diffuse microcalcifications which appear malignant, breast-conserving therapy is not appropriate. A woman with previous breast irradiation is also not a candidate. (17) Breast irradiation cannot be given during pregnancy, however it may be possible to perform breast-conserving surgery in the third trimester and administer irradiation after delivery. (18) As mentioned above, positive surgical margins are also an absolute contraindication.