Local Management of Invasive Breast Cancer. By Steven Jones, MD. Connecting with the patient is the best part of medicine. We ’ re artists, not engineers. Epidemiology of Breast Cancer. 232,340 American women diagnosed each year. 39,620 die each year from the disease
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Local Management of Invasive Breast Cancer
By Steven Jones, MD
Connecting with the patient is the best part of medicine.
We’re artists, not engineers
With adjuvant therapy local failure low – 6%
Too many mastectomies
Some data demonstrate no difference in local failure rates
aClose relatives of individuals with the history mentioned in the table are appropriate candidates for genetic counseling. It is optimal to initiate testing in an individual with breast or ovarian cancer prior to testing at-risk relatives.
bCriteria modiﬁed from NCCN (109)
“Cancer of the breast spreads centrifugally.
It disseminates to bone by way of the lymphatics, not by blood vessels.”
Halsted, WS. The results of radical operations for the cure of carcinoma of the breast. Ann Surg 1907; 66:1
More extensive surgical procedures did not reduce risk of distant metastasis
Identification of small breast cancer by mammography
Started in 1971, 1665 patients enrolled, 25 year follow up
No difference in disease free or overall survival
Holland R, Veling S, Mravunac M, et al. Histologic multifocality of Tis, T1-2 breast carcinomas: implications for clinical trials of breast-conserving treatment. Cancer 1985; 56: 979
ER, estrogen receptor; PR, progesterone receptor
Includes areolar (nipple sparing controversial)
Excise biopsy incision
Radiate positive margins
2. Regional Control
In clinically negative axilla, axillary dissection reduces local occurrence from 20% to 3%
3. Small survival advantage (3-5%)
Preoperative Systemic Therapy
Tulane surgery:“ tough as the marines except the marines get to eat”