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Multiple Ipsilateral Breast Cancers: Current Strategies for Surgical Management

  • Local-Regional Evaluation and Therapy (KK Hunt, Section Editor)
  • Published:
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Abstract

Based on historic, retrospective data, most surgeons recommend mastectomy for women with multiple ipsilateral breast cancers (MIBC) due to a perceived prohibitively high risk of local recurrence. More recent retrospective studies, however, have documented acceptable local recurrence rates in women with MIBC who have undergone breast conservation with lumpectomy and radiation therapy. The recent data suggest that earlier detection, improved margin analysis, and increased use and efficacy of targeted therapies all contribute to the decreased risk of local recurrence when compared to rates historically documented in this MIBC population. Appropriate surgical management for MIBC is of growing importance. Pre-operative identification of MIBC has increased in the past decade due to the increased use of MRI and improved mammographic and sonographic sensitivity. Review of the current literature supports the use breast conservation with one or more partial mastectomies and sentinel node biopsy in appropriately selected patients with MIBC.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance, •• Of major importance

  1. Veronesi U, Cascinelli N, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227–32.

    Article  PubMed  Google Scholar 

  2. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of iInvasive breast cancer. NEJM. 2002;347:1233–41.

    Article  PubMed  Google Scholar 

  3. Fisher B, Costantino J, Redmond C, Fisher E, Margolese R, Dimitrov N, et al. Lumpectomy compared with lumpectomy and radiation therapy for the treatment of intraductal breast cancer. N Engl J Med. 1993;328:1581–6.

    Article  PubMed  CAS  Google Scholar 

  4. Coombs NJ, et al. Multifocal and multicentric breast cancer: does each focus matter? J Clin Oncol. 2005;23:7497–502.

    Article  PubMed  Google Scholar 

  5. Sardanelli F, et al. Sensitivity of MRI versus mammographcy for detecting foci of multifocal, multicentric breast cancer in fatty and dense breasts using the whole breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004;183:1149–57.

    PubMed  Google Scholar 

  6. Bendifallah S, Werkoff G, Borie-Moutafoff C, Antoine M, Chopier J, Gligorov J, Uzan S, Coutant C, Rouzier R. Multiple synchronous (multifocal and multicentric) breast cancer: clinical implications. Surg Oncol. 2010;19(4):e115–23.

    Article  PubMed  Google Scholar 

  7. Berg WA, Gilbreath PL. Multicentric and multifocal cancer: whole-breast US in preoperative evaluation. Radiology. 2000;214(1):59–66.

    PubMed  CAS  Google Scholar 

  8. Berg WA, Madsen KS, Schilling K, Tartar M, Pisano ED, Larsen LH, Narayanan D, Ozonoff A, Miller JP, Kalinyak JE. Breast cancer: comparative effectiveness of positron emission mammography and MR imaging in presurgical planning for the ipsilateral breast. Radiology. 2011;258(1):59–72.

    Article  PubMed  Google Scholar 

  9. Houssami N, Ciatto S, Macaskill P, Lord SJ, Warren RM, Dixon JM, Irwig L. Accuracy and surgical impact of magnetic resonance imaging in breast cancer staging: systematic review and meta-analysis in detection of multifocal and multicentric cancer. J Clin Oncol. 2008;26(19):3248–58.

    Article  PubMed  Google Scholar 

  10. Moon WK, Noh DY, Im JG. Multifocal, multicentric, and contralateral breast cancers: bilateral whole-breast US in the preoperative evaluation of patients. Radiology. 2002;224(2):569–76.

    Article  PubMed  Google Scholar 

  11. Wilkinson LS, Given-Wilson R, Hall T, Potts H, Sharma AK, Smith E. Increasing the diagnosis of multifocal primary breast cancer by the use of bilateral whole-breast ultrasound. Clin Radiol. 2005;60(5):573–8.

    Article  PubMed  CAS  Google Scholar 

  12. Arrington AK, Jarosek SL, Virnig BA, Habermann EB, Tuttle TM. Patient and surgeon characteristics associated with increased use of contralateral prophylactic mastectomy in patients with breast cancer. Ann Surg Oncol. 2009;16(10):2697–704.

    Article  PubMed  Google Scholar 

  13. Sorbero ME, Dick AW, Beckjord EB, Ahrendt G. Diagnostic breast magnetic resonance imaging and contralateral prophylactic mastectomy. Ann Surg Oncol. 2009;16(6):1597–605.

    Article  PubMed  Google Scholar 

  14. Wood, W. C. "Should the use of contralateral prophylactic mastectomy be increasing as it is?" Breast 2009 18 Suppl 3: S93-95. PMID: 19914552

  15. •• Fisher, B. “Role of Science in the Treatment of Breast Cancer When Tumor Multicentricity is Present.” J Natl Cancer Inst. 2011 103(17): 1292–1298. PMID: 21765010. This is a compelling editorial that advocates for breast conservation in the MIBC population. Fisher uses scientific evidence from early breast cancer trials, including NSABP B06, to document the oncologic safety of breast conservation in this patient population. It also addresses the regression to mastectomy in lieu of breast conservation.

  16. Leopold KA, Recht A, et al. Results of conservative surgery and radiation therapy or multiple synchronous cancers of one breast. Int J Radiat Oncol Biol Phys. 1989;16(1):11–6.

    Article  PubMed  CAS  Google Scholar 

  17. Kurtz JM, Jacquemier J, et al. Breast conserving therapy for macroscopically multiple cancer. Ann Surg. 1990;212:38–44.

    Article  PubMed  CAS  Google Scholar 

  18. Wilson LD, Beinfield M, et al. Conservative surgery and radiation in the treatment of synchronous ipsilateral breast cancers. Cancer. 1993;72(1):137–43.

    Article  PubMed  CAS  Google Scholar 

  19. Fowble B, Yeh I, et al. The role of mastectomy in patients with stage I-II breast cancer presenting with gross multifocal or multicentric disease or diffuse microcalcifications. Int J Radiat Oncol Biol Phys. 1993;27(3):567–73.

    Article  PubMed  CAS  Google Scholar 

  20. Singletary E. Surgical margins in patients with early-stage breast cancer treated with breast conservation therapy. Am J Surg. 2002;184(5):383–93.

    Article  PubMed  Google Scholar 

  21. Macdonald H. Margin width as the sole determinant of local recurrence after breast conservation surgery in patients with ductal carcinoma in situ of the breast. Am J Surg. 2006;192(4):420–2.

    Article  PubMed  Google Scholar 

  22. Smith R, Saslow D. American Cancer Society guidelines for breast cancer screening. Clin Canc J. 2003;53(3):141–69.

    Article  Google Scholar 

  23. Barth R. Detection of breast cancer on screening mammography allows patients to be treated with less toxic therapy. Am J Roentgenol. 2005;184(1):324–9.

    Google Scholar 

  24. Cho LC, Senzer N, et al. Conservative surgery and radiation therapy for macroscopically multiple ipsilateral invasive breast cancers. Am J Surg. 2002;183:650–4.

    Article  PubMed  Google Scholar 

  25. Giron G, et al. Breast conservation in patients with multiple ipsilateral synchronous breast cancers. J Am Coll Surg. 2003;187:726–9.

    Google Scholar 

  26. Lim W, Park E, et al. Breast conserving surgery for multifocal breast cancer. Ann Surg. 2009;249:87–90.

    Article  PubMed  Google Scholar 

  27. • Gentilini O, Rotteri E et al. Conservative surgery in patients with multifocal/multicentric breast cancer. Breast Cancer Res Treat. 2009:113(3): 577–83. This is one of the largest retrospective studies to examine if breast conservation is safe in women with MIBC. The follow-up is satisfactory at over 6 years. The study elucidates risk factors for increased LR including HER2-positive disease and ER/PR-negative disease. This study also emphasizes the need for appropriate adjuvant therapy.

  28. •• Yerushalmi, R, Tyldesley, S, Woods, R et al. Is breast-conserving therapy a safe option for patients with tumor multicentricity and multifocality? Ann Onc. 2011 Aug epub ahead of print. This article tracks the largest known series of MIBC over the longest median follow-up. The authors perform univariate and multivariate analyses to inform their conclusions that well-selected patients with MIBC are candidates for BCT, with equivalent oncologic outcomes in comparison to those who undergo mastectomy and those who undergo breast conservation for unifocal disease.

  29. Oh JL, Dryden MJ, Woodward WA, Yu TK, Tereffe W, Strom EA, Perkins GH, Middleton L, Hunt KK, Giordano SH, Oswald MJ, Domain D, Buchholz TA. Locoregional control of clinically diagnosed multifocal or multicentric breast cancer after neoadjuvant chemotherapy and locoregional therapy. J Clin Oncol. 2006;24(31):4971–5.

    Article  PubMed  Google Scholar 

  30. Veronesi U, Paganelli G, Galimberti V, et al. Sentinel node biopsy to avoid axillary dissection in breast cancer with clinically negative lymph-nodes. Lancet. 1997;349:1864–7.

    Article  PubMed  CAS  Google Scholar 

  31. Andea AA, et al. Pathologic analysis of tumor size and lymph node status in multifocal/multicentric breast cancer. Cancer. 2002;94:1383–90.

    Article  PubMed  Google Scholar 

  32. Schrenk P, Wayand W. Sentinel –node biopsy in axillary lymph-node staging for patients with multicentric breast cancer. Lancet. 2001;35:122.

    Article  Google Scholar 

  33. Kumar R, Jana S, Heiba S, et al. Retrospective analysis of sentinel node localization in multifocal, multicentric, palpale or nonpalpable breast cancer. J Nucl Med. 2002;44:7–10.

    Google Scholar 

  34. Lyman FH, et al. American Society of Clinical Oncology guideline recommendations for sentinel lymph node biopsy in early stage breast cancer. J Clin Oncol. 2005;23:7703–20.

    Article  PubMed  Google Scholar 

  35. Patini N, Carpenter R. Oncological and aesthetic considerations of conservational surgery for multifocal/multicentric breast cancer. Breast J. 2010;16(3):222–30.

    Article  Google Scholar 

  36. Cablioglu N, et al. Increased lymph node positivity in multifocal and multicentric breast cancer. J Am Coll Surg. 2009;208(1):67–74.

    Article  Google Scholar 

  37. Bevilacqua JL, Kattan MW. Doctor, what are my chances of having a positive sentinel node? A validated nomogram for risk estimation. J Clin Oncol. 2007;25(24):3670–9.

    Article  PubMed  Google Scholar 

  38. Chua B, Ung O, et al. Frequency and predictors of axillary lymph node metastases in invasive breast cancer. ANZ J Surg. 2001;71:723–8.

    Article  PubMed  CAS  Google Scholar 

  39. Van Zee KJ, Kattan MW. Validating a predictive model for presence of additional disease in the non-sentinel lymph nodes of a woman with sentinel node positive breast cancer. Ann Surg Oncol. 2007;14(8):2177–8.

    Article  PubMed  Google Scholar 

  40. Bauman L, et al. Breast conservation in women with multifocal-multicentric breast cancer: is it feasible? Ann Surg Oncol. 2010;17 Suppl 3:325–9.

    Article  PubMed  Google Scholar 

  41. Hartsell WF, Recine R, Griem KL, Cobleigh MA, Witt TR, Murthy AK. Should multicentric disease be an absolute contraindication to the use of breast conserving therapy. Int J Radiat Oncol Biol Phys 1994;30(1):49–53.

    Google Scholar 

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  1. Dartmouth Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA

    Kari Rosenkranz

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  1. Kari Rosenkranz
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Correspondence to Kari Rosenkranz.

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Rosenkranz, K. Multiple Ipsilateral Breast Cancers: Current Strategies for Surgical Management. Curr Breast Cancer Rep 4, 148–152 (2012). https://doi.org/10.1007/s12609-012-0075-7

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