, Volume 16, Issue 9, pp 2656-2657
Date: 12 Jun 2009

Challenges in Personalizing Decisions on Whole, Partial or No Breast Irradiation and Extent of Surgery for Early Breast Cancer

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To the Editors:

Breast-conserving surgery (BCS), and adjuvant radiotherapy and systemic treatment is the standard of care for early breast cancer. Whole breast irradiation (WBI) of 50 Gy and systemic treatment consisting of empirical chemotherapeutic and targeted agents according to hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status is used in current clinical practice.

However, despite compliance with these guidelines, a substantial proportion of patients experiences local failures. To prevent these isolated, usually late, events including ipsilateral breast cancer (IBC) local recurrence and/or contralateral breast cancer (CBC) and to improve overall survival, a personalized approach is indicated in high-risk patients.1 Indeed, women carrying heritable mutations in either BRCA1 or BRCA2 (BRCA) face high risk of developing IBC/CBC. Currently, genetic testing guides decisions among patients with family history. Bilateral mastectomy should be offered in patien ...