What is breast conserving therapy (BCT)?
The attempt to preserve the breast without compromising survival brought up the use of Breast Conserving Therapy (BCT). This includes breast conserving surgery and breast radiotherapy. Although BCT and breast conserving surgery (BCS) are used interchangeably, strictly speaking BCT includes both BCS and breast radiotherapy.
What is breast-conserving surgery?
Breast-conserving surgery is sometimes called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. It’s often an option for a woman with early-stage cancer, and allows her to keep most of her breast.
Is breast-conserving treatment associated with noninferior outcome after mastectomy?
Noninferior outcome after breast-conserving treatment compared to mastectomy in breast cancer patients with four or more positive lymph nodes. Front Oncol. 2019;9:143. doi:10.3389/fonc.2019.00143 [PMC free article][PubMed] [CrossRef] [Google Scholar]
What is the primary goal in the treatment of breast cancer?
The primary goal in the treatment of breast cancer is to control the disease with the aim of achieving cure.
What is the goal of breast-conserving surgery?
Surgery Overview Breast-conserving surgery (lumpectomy) removes the cancer and just enough tissue to get all the cancer. The goal is to keep the breast looking as normal as possible after the surgery while reducing the chances of the cancer coming back.
What are the advantages of radiation therapy for breast cancer?
Why it's done. Radiation therapy kills cancer cells. It's often used after surgery to reduce the risk that the cancer will come back. It can also be used to provide relief from pain and other symptoms of advanced breast cancer.
What are the benefits of lumpectomy?
The main advantage of lumpectomy is that it can preserve much of the appearance and sensation of your breast. It is a less invasive surgery, so the recovery time is shorter and easier than with mastectomy.
Who is eligible for breast-conserving surgery?
BCS may be done as part of treatment for breast cancer. This surgery is an option for some women with a lump that is small and in 1 area. It's also an option for many women with early stage breast cancers. BCS removes a smaller part of your breast.
Why is radiation therapy recommended?
Radiation therapy kills cancer cells or slows their growth by damaging their DNA. Radiation therapy (also called radiotherapy) is a cancer treatment that uses high doses of radiation to kill cancer cells and shrink tumors.
What are the pros and cons of radiation treatment?
Preoperative radiation therapy:Advantages. lowers risk of local recurrence and distant metastases.Disadvantages. possibly obscures the extent of the tumor due to shrinkage and destruction of the margins of the tumor; this may impact the effectiveness of surgery. delay of surgery may cause anxiety in some patients.
Which is more effective lumpectomy or mastectomy?
Lumpectomy and mastectomy procedures are both effective treatments for breast cancer. Research shows there is no difference in survival rate from either procedure, though lumpectomy has a slightly higher risk of recurrent cancer.
When is a lumpectomy recommended?
Your doctor may recommend lumpectomy if a biopsy has shown that you have cancer and that the cancer is believed to be small and early stage. Lumpectomy may also be used to remove certain noncancerous or precancerous breast abnormalities.
Does breast tissue grow back after lumpectomy?
In a local recurrence, cancer reappears in the same area as your original cancer. If you've undergone a lumpectomy, the cancer could recur in the remaining breast tissue. If you've undergone a mastectomy, the cancer could recur in the tissue that lines the chest wall or in the skin.
Will fat necrosis in breast go away?
Fat necrosis usually doesn't need treatment and will go away on its own in time. If you have pain or tenderness around the lump, over-the-counter anti-inflammatory medications like ibuprofen (Advil, Motrin) can help. You can also try massaging the area or applying a warm compress.
How common is ductal carcinoma in situ?
About 1 in 5 new breast cancers will be ductal carcinoma in situ (DCIS). Nearly all women with this early stage of breast cancer can be cured. DCIS is also called intraductal carcinoma or stage 0 breast cancer.
How long does it take to recover from breast-conserving surgery?
Recovering from breast-conserving surgery Most women should be able to function after going home and can often return to their regular activities within 2 weeks. Some women may need help at home depending on how extensive their surgery was.
What is the success rate of radiation therapy for breast cancer?
Radiation therapy decreased the risk of dying from cancer by approximately 33%. The probability of surviving 10 years from treatment was increased from 54% to 64% and 45% to 54% in the two studies, respectively. No significant long-term side effects of radiation therapy were reported.
Is radiation therapy necessary for breast cancer?
Radiation therapy can be used to treat all stages of breast cancer. Pregnant women should not have radiation therapy because it can harm the unborn baby. Radiation therapy is recommended for most people who have lumpectomy to remove breast cancer. Lumpectomy is sometimes called breast-conserving surgery.
What are the long-term side effects of radiation for breast cancer?
Long-term side effects can include:Breast changes: The breasts may shrink or become more dense after radiation. ... Brachial plexopathy: Radiation to the breast or chest wall can sometimes damage the nerves that run through the arm, wrist, and hand. ... Lymphedema: Lymphedema is swelling of the arm, hand, or chest.
What is the success rate of radiation therapy?
“In fact, based on the literature reviewed, it appears that external-beam radiation therapy is a superior treatment in some cases. “When patients are treated with modern external-beam radiation therapy, the overall cure rate was 93.3% with a metastasis-free survival rate at 5 years of 96.9%.
Who Can Get Breast-Conserving Surgery?
Breast-conserving surgery (BCS) is a good option for many women with early-stage cancers. The main advantage is that a woman keeps most of her brea...
Recovering from Breast-Conserving Surgery: What to Expect After Surgery
This type of surgery is typically done in an outpatient surgery center, and an overnight stay in the hospital is usually not needed. Most women sho...
Side Effects of Breast-Conserving Surgery
Side effects of breast-conserving surgery can include: 1. Pain or tenderness or a "tugging" sensation in the breast 2. Temporary swelling 3. Hard s...
How Can The Doctors Be Sure All of The Cancer was removed?
During the surgery, the surgeon will try to remove all of the cancer, plus some surrounding normal tissue.After surgery is complete, a doctor, call...
Will I Need Breast Reconstruction Surgery After Breast-Conserving Surgery?
Before your surgery, talk to your breast surgeon about how breast-conserving surgery might change the look of your breast. The larger the portion o...
Will More Treatment Be Needed After Breast-Conserving Surgery?
Most women will need radiation therapy to the breast after breast-conserving surgery. Sometimes, to make it easier to aim the radiation, small meta...
What is breast-conserving surgery?
Breast-conserving surgery (BCS) may be used as part of a treatment plan for breast cancer. It is sometimes called a lumpectomy or a partial mastectomy.
What happens during breast-conserving surgery?
BCS may be done on an outpatient basis. This means you go home the same day. Or it may be done as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
What is the procedure to remove a breast tumor?
He or she will also remove some of the normal breast tissue around it. If the lymph nodes under your armpit are to be removed, a separate surgical cut may be made in or near the armpit.
What to do if you have a breast removed?
Breast tissue and any other tissues that are removed will be sent to the lab for exam. A drainage tube may be inserted into the affected area. The skin will be closed with stitches or adhesive strips. A sterile bandage or dressing will be placed over the site.
What is done during breast surgery?
The skin over the surgical site will be cleaned with a sterile solution. A small cut (incision) will be made over or near the breast tumor.
What do doctors do before surgery?
Your doctor will take your medical history. He or she will also give you a physical exam. This is to be sure you are in good health before the surgery. You may also have blood tests or other tests.
Can BCS be done for breast cancer?
BCS may be done as part of treatment for breast cancer. This surgery is an option for some women with a lump that is small and in 1 area. It’s also an option for many women with early stage breast cancers. BCS removes a smaller part of your breast. You may worry that this might make your cancer more likely to return.
Why is empathy important in breast cancer?
Empathy is equally important as it increases shared decision-making and lessens decision regret. In conclusion, both BCT and mastectomy are likely to be here to stay, as the clinical presentation of breast cancer encompasses a wide spectrum of situations, and also because breast anatomy is highly variable.
Is mastectomy flap thickness one size fits all?
Accordingly, mastectomy flap thickness is not “one size fits all” and should therefore not be used to guide surgical dissection as it is related to body mass index and breast size [ 16 ]. Above all, inadequate surgery should not be compared with optimal radiotherapy, nor radiotherapy should be used to compensate for it.
Does BCT improve survival?
There is no evidence indicating that BCT has improved overall survival over mastectomy as a result of better locoregional control [ 20 ]. The suggestion that in more recent years BCT may have provided better overall survival than mastectomy is thought-provoking, but data may be biased, and the causes remain unclear [ 3 ].
Is BCT better than mastectomy?
BCT is certainly preferable to mastectomy whenever it is oncologically safe as it provides a good cosmetic result and is well accepted. By contrast, there are many circumstances when a well performed conservative mastectomy with immediate reconstruction provides a clearly superior outcome. There is no evidence indicating that BCT has improved overall survival over mastectomy as a result of better locoregional control [ 20 ]. The suggestion that in more recent years BCT may have provided better overall survival than mastectomy is thought-provoking, but data may be biased, and the causes remain unclear [ 3 ]. Furthermore, cardiac or lung morbidity remains relevant even with modern radiotherapy, especially among smokers [ 4 ]. Therefore, based on the data reviewed, it has not yet been proven that BCT provides better survival than mastectomy, nor that a properly performed modern conservative mastectomy followed by immediate reconstruction is less protective than a traditional total mastectomy [ 16 ]. Finally, new techniques have improved the benefit/risk ratio of radiotherapy, but surgery remains a mainstay of breast cancer therapy in most clinical circumstances [ 23 ].
Does radiotherapy help with breast conservation?
Indeed, radiotherapy can compensate for less surgery after breast conservation in which case it is always delivered, yet this does not happen after mastectomy when it is frequently omitted. Furthermore, if surgery provides superior local control within resected tissues, radiotherapy exerts its antitumor effect on a greater body volume [ 3 ].
Is breast conserving surgery better than mastectomy?
Several population-based studies suggest that breast conserving surgery followed by radiotherapy (BCT) may provide longer overall survival than mastectomy. Better locoregional control after BCT due to improvements of preoperative imaging, oncoplastic surgery and radiotherapy, as well as the recent trend towards surgical de-escalation may be ...
What is the role of the funder/sponsor in a study?
Role of the Funder/Sponsor:The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.
Is breast cancer survival better after mastectomy?
Cohort studies show better survival after breast-conserving surgery (BCS) with postoperative radiotherapy (RT) than after mastectomy (Mx) without RT. It remains unclear whether this is an independent effect or a consequence of selection bias.
Does BCS affect survival?
While the previously mentioned studies deliver evidence encouraging the use of BCS, it remains unclear why such survival differences would exist.7,8,9,10Theories of a negative effect of larger surgery on recurrence rates and survival through the systemic release of growth factors and inflammatory effects have not been sufficiently corroborated, so Mx in itself may not be an independent factor for worse survival.13Selection mechanisms and unmeasured confounders must be suspected. For example, BCS is less common in women with a lower socioeconomic status,14which in turn is associated with multimorbidity,15a more advanced stage at presentation,16lower rates of adjuvant chemotherapy,17and worse survival.18,19,20Furthermore, comorbidity is associated with choice of systemic and locoregional treatment21,22,23and survival.21,24
Is BCS a good option for breast cancer patients?
Since the publication of key trials1,2confirming the oncological equivalence of breast-conserving surgery (BCS) followed by adjuvant radiotherapy (RT) and mastectomy (Mx), BCS is recommended for patients with early breast cancer. Additionally, in case of advanced lymph node involvement, Mx does not confer any survival benefit.3The same is true for the younger breast cancer population and in specific subtypes such as triple-negative breast cancer (TNBC).4,5,6Recently, population-based studies have reported improved overall survival after BCS with RT over Mx without RT.7,8,9,10Mastectomy has subsequently been questioned as an equally valid surgical alternative. However, there are important confounders that may have biased these results.
Is breast conservation a survival benefit?
Breast conservation seems to offer a survival benefit independent of measured confounders and should be given priority if both breast conservation and mastectomy are valid options.
Is BCS a locoregional treatment?
Locoregional treatment was categorized as BCS with RT (BCS+RT), Mx with RT (Mx+RT), or Mx without RT (Mx-RT). The use of reconstructive or oncoplastic procedures was not considered. Because the omission of whole-breast irradiation after BCS was not in accordance with Swedish guidelines, 2390 women treated with BCS but not receiving adjuvant RT were excluded, leaving 48 986 women for the final analysis (eFigure 1 in the Supplement).
