Surgical Treatment

1. Several long-term studies show that conservative therapy and radiation result in at least as good a prognosis as radical mastectomy. Skin-sparing mastectomy involves removing all the breast tissue, the nipple, and the areolar complex. The remainder of the surface skin tissue remains intact. Reconstruction is then completed with a natural-appearing breast. This procedure is considered for those women with ductal carcinoma in situ or T1 or T2 invasive carcinomas. Because a mastectomy leaves 3.5% of the breast tissue behind, the recurrence rate for this procedure is comparable with a modified radical mastectomy.

2. Local excision of the tumor mass (lumpectomy) followed by lymph node staging and subsequent adjuvant hormone therapy, chemotherapy, or radiation therapy is an accepted treatment. Long-term studies have found that recurrence rates are similar when lumpectomy was compared with radiation therapy and mastectomy. One study showed no recurrence if 1-cm margins were obtained followed by the use of radiation therapy.

C. Radiation Therapy. External beam radiation therapy has proven effective in preventing recurrence of breast cancer and for palliation of pain. The risk of relapse after radiation therapy ranges from 4% to 10%. Lumpectomy can now be performed followed by implantation of high-dose brachytherapy catheters.

D. Anti-Hormonal Therapy. Hormonal therapy is indicated for those tumors that test positive for hormone receptors. Tamoxifen has both estro-genic and anti-estrogenic effects. In women who are older than 50 years with breast cancers that test positive for hormone receptors, tamoxifen use produces a 20% increase in 5-year survival rates. The response rate in advanced cases increases to 35%.

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