The goal of breast conserving therapy (BCT) for early breast cancer is to provide equivalent survival to more radical surgical treatments such as modified radical mastectomy while allowing patients to retain their own breast tissue. In 1985, Fisher et al. published the first report of an American randomized controlled trial comparing mastectomy, lumpectomy followed by radiation, and lumpectomy alone for early breast cancer (stage I and II). In 2002, Fisher reported 20 years of follow-up of NSABP B-06 confirming that BCT offered equivalent survival to mastectomy, but the women who received BCT had a higher rate of in-breast local recurrence. One thousand eight hundred and fifty-one women with invasive breast cancers less than 4 cm were randomized to axillary dissection and either mastectomy, lumpectomy alone, or lumpectomy followed by radiation therapy. The tumors were excised with negative margins. The in-breast recurrence after lumpectomy alone was 39.2%. For patients who had lumpectomy followed by radiation therapy, in-breast recurrence was 14.3% (P < 0.001). The risk of in-breast recurrence was lower for patients with tumor-free lymph nodes (negative nodes) than those with metastases to the nodes (positive nodes). Radiation therapy decreased the risk of in-breast recurrence in both groups. This chapter reviews breast conservation therapy as an option for women with newly diagnosed breast cancer.
KeywordsBreast Cancer Local Recurrence Dense Breast Inflammatory Breast Cancer Invasive Lobular Carcinoma