Skip to main content
Log in

Conservation surgery for breast cancer: Selection criteria and technical considerations

  • Review Articles
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Patients with stage I or II breast cancer are candidates for either modified radical mastectomy or breast preservation therapy involving limited resection of the primary tumor, axillary dissection, and breast irradiation. The overall survival rates of both these approaches are comparable according to retrospective reviews and ongoing clinical trials, and long-term follow-up confirms the earlier findings. Thus, patients should be given the choice between these two options by surgeons, radiation therapists, and other physicians involved in their care. However, not all breast cancer patients will choose breast preservation surgery, and because of tumor-related and other factors not all patients are candidates. The patient selection criteria are discussed herein and the optimal surgical techniques are reviewed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Henderson IC, Harris JR, Kinne DW, Hellman S (1989) Cancer of the Breast. In: DeVita IV, Hellman S, Rosenberg SA (eds) Cancer principles and practice of oncology. Lippincott, Philadelphia, pp 1197–1268

    Google Scholar 

  2. NIH Consensus Conference (1991) Treatment of early-stage breast cancer. JAMA 265:391–395

    Google Scholar 

  3. Clinical Alert from the National Cancer Institute. May 18, 1988

  4. Liagos MD, Westdahl PR, Rose MP (1981) The concept and implications of multicentricity in breast carcinoma. Pathol Annu 16:83–102

    Google Scholar 

  5. Rosen PP, Fracchia AA, Urban JA, Schottenfeld D, Robbins GF (1975) “Residual” mammary carcinoma following simulated partial mastectomy. Cancer 35:739–747

    Google Scholar 

  6. Schwartz GF, Patchesky AS, Feig SA, Shaber GS, Schwartz AB (1980) Multicentricity of nonpalpable breast cancer. Cancer 45:2913–2916

    Google Scholar 

  7. Rosen PP, Braun DW, Kinne DW (1980) The clinical significance of preinvasive breast carcinoma. Cancer 46:919–925

    Google Scholar 

  8. Harris JR, Recht A, Schnitt S, Connolly J, Silva B, Come S, Handerson IC (1985) Current status of conservative surgery and radiotherapy as primary local treatment for early carcinoma of the breast. Breast Cancer Res Treat 5:245–255

    Google Scholar 

  9. Fisher B, Bauer M, Margolese R, Poisson R, Pilch Y, Redmond C, Fisher E, Wolmark N, Deutsch M, Montague E, Saffer E, Wickerham L, Lerner H, Glass A, Shibata H, Deckers P, Ketcham A, Oishi R, Russell I (1985) Five-year results of a randomized clinical trial comparing total mastectomy and segmental mastectomy with or without radiation in the treatment of breast cancer. N Engl J Med 312:665–673

    Google Scholar 

  10. Fisher B, Redmond C, Poisson R, Margolese R, Wolmark N, Wickerham L, Fisher E, Deutsch M, Caplan R, Pilch Y, Glass A, Shibata H, Lerner H, Terz J, Sidorovich L (1989) Eight-year results of a randomized clinical trial comparing total mastectomy and lumpectomy with or without irradiation in the treatment of breast cancer. N Engl J Med 320:822–828

    Google Scholar 

  11. Adair F, Berg J, Joubert L, Robbins GF (1974) Long-term follow-up of breast cancer patients: The 30-year report. Cancer 33:1145–1150

    Google Scholar 

  12. Fisher B, Slack NH (1970) Number of lymph nodes examined and the prognosis of breast carcinoma. Surg Gynecol Obstet 131:79–88

    Google Scholar 

  13. Rosen PP, Lesser ML, Kinne DW, Beattie EJ Jr (1983) Discontinuous or “skip” metastases in breast carcinoma. Ann Surg 197:276–283

    Google Scholar 

  14. Davies GC, Millis RR, Hayward JL (1980) Assessment of axillary lymph node status. Ann Surg 192:148–151

    Google Scholar 

  15. Pickren JW (1961) The significance of occult metastases: A study of breast cancer. Cancer 14:1266–1271

    Google Scholar 

  16. Wilkinson EJ, Hause LL, Hoffman RG, Kuzma JF, Rothwell DJ, Donegan WL, Clowry LJ, Almagro UA, Choi H, Rimm AA (1982) Occult axillary lymph node metastases in invasive breast carcinoma: Characteristics of primary tumor and significance of the metastases. Path Annu 17:67

    Google Scholar 

  17. Schottenfeld D, Nash A, Robbins GF, Beattie EJ Jr (1976) Ten-year results of the treatment of primary operable breast cancer. Cancer 38:100

    Google Scholar 

  18. Fisher B, Redmond C, Fisher ER, Bauer M, Wolmark N, Wickerham L, Deutsch M, Montague E, Margolese R, Foster R (1985) Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation. N Engl J Med 312:674–681

    Google Scholar 

  19. Kinne DW (1987) Primary treatment of breast cancer. In: Harris JR, Hellman S, Henderson IC, Kinne DW (eds) Breast diseases. Lippincott, Philadelphia, pp 259–284

    Google Scholar 

  20. Kinne DW (1984) Surgical management of clinically early breast cancer. Cancer 53:685–690

    Google Scholar 

  21. Haagensen CD, Bodian C (1984) A personal experience with Halsted's radical mastectomy. Ann Surg 188:143

    Google Scholar 

  22. Rosen PP, Groshen S, Saigo P, et al. (1989) A long-term follow-up study of survival in Stage I (T1N0M0) and Stage II (T1N1M0) breast carcinoma. J Clin Oncol 7:355–366

    Google Scholar 

  23. Harris JR, Hellman SH (1986) Observations on survival curve analysis with particular reference to breast cancer. Cancer 57:925–928

    Google Scholar 

  24. Kurtz J, Amalric R, Brandone H, Ayme Y, Jacquemier J, Pietra J-C, Hans D, Pollet J-F, Bressac C, Spitalier J-M (1989) Local recurrence after breast-conservation surgery and radiotherapy. Cancer 63:1912–1917

    Google Scholar 

  25. Recht A, Silen W, Schnitt SJ, Connolly JL, Gelman RS, Rose MA, Silver B, Harris JR (1988) Time-course of local recurrence following conservative surgery and radiotherapy for early stage breast cancer. Int J Radiat Oncol Biol Phys 15:255–261

    Google Scholar 

  26. Veronesi U, Zucali R, Luini A (1986) Local control and survival in early breast cancer: The Milan trial. Int J Radiat Oncol Biol Phys 12:717–720

    Google Scholar 

  27. Harris JR, Hellman S, Kinne DW (1985) Limited surgery and radiotherapy for early breast cancer. N Engl J Med 313:1365

    Google Scholar 

  28. Winchester DP, Cox JD (1992) Standards for breast-conservation treatment. Ca-Ca J Clin 42:134–162

    Google Scholar 

  29. Wolberg WH, Tanner MA, Romsaas EP, Trump DL, Malec JF (1987) Factors influencing options in primary breast cancer treatment. J Clin Oncol 5:68–74

    Google Scholar 

  30. Munoz E, Shamash F, Friedman M, Teicher I, Wise L (1986) Lumpectomy vs mastectomy. Arch Surg 121:1297–1301

    Google Scholar 

  31. Schain W, Edwards BK, Gorrell CR, de Moss EV, Lippman ME, Gerber H, Lichter AS (1983) Psychosocial and physical outcomes of primary breast cancer therapy: Mastectomy vs excisional biopsy and irradiation. Breast Cancer Res Treat 3:377–382

    Google Scholar 

  32. Kemeny MM, Wellisch DK, Schain WS (1988) Psychosocial outcome in a randomized surgical trial for treatment of primary cancer. Cancer 62:1231–1237

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kinne, D.W. Conservation surgery for breast cancer: Selection criteria and technical considerations. Surg Today 24, 767–771 (1994). https://doi.org/10.1007/BF01636303

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01636303

Key Words

Navigation