Nonpharmacologic Local Regional Therapy

The choice of surgical procedures has changed drastically over the past 50 years.

Q Current surgical management options for early invasive breast cancer include the modified radical mastectomy (also termed total mastectomy with ipsilateral axillary lymph node dissection) and breast conservation. In the modified radical mastectomy, the pectoralis minor muscle may be excised, divided, or left intact, and more important, there may be variation in the extent of axillary lymph node dissection, ranging from sampling to full dissection. It is important to note that in the elderly, patients with comorbid conditions, patients with particularly favorable tumors, or patients whose adjuvant therapy likely would not be affected by node status, axillary dissection can be considered optional. Breast conservation consists of lumpectomy, also referred to as segmental mastectomy, or partial mastectomy, and is defined as excision of the primary tumor and adjacent breast tissue, followed by radiation therapy to reduce the risk of local recurrence. Removal of level I/II axillary lymph nodes is recommended for completeness of staging and prognostic information. The National Institutes of Health (NIH) Consensus Conference on the Treatment of Early-Stage Breast Cancer addressed the roles of modified radical mastectomy versus breast conservation and concluded that primary therapy for breast cancer stages I and II should

be breast conservation. The reason given for favoring breast conservation therapy is that it achieved similar results to more extensive surgical procedures and had superior results cosmetically.

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