How to decide if breast conserving surgery is right for you?
Breast Conserving Surgery (BCS), wondering what this is? This breast surgery is a standard procedure considered for early detected breast cancers. BCS involves removal of the cancerous lump in the breast along with some surrounding healthy tissue and lymph nodes, with an aim to save as much healthy breast tissue as possible. A number of studies have revealed that patients treated with BCS have similar survival rates as that of patients treated with mastectomy (removal of entire breast). Although BCS is a safe procedure, there are a number deciding factors associated with BCS as a treatment option.
So how exactly do we decide if we are eligible for BCS? Let us understand a little more about the following influencing factors:
Size of the tumour
Generally, small tumours less than 5cm are good candidates for BCS, however it is the breast to tumour ratio that guides in decision making. As the main goal of BCS is to conserve maximum amount of healthy breast tissue and prevent local recurrence, tumours comparatively smaller than the breast size may provide favorable outcomes.
Breast to tumour ratio
The decision of performing BCS is made based on the probability of favourable cosmetic outcomes and expectations of the patient.
Early detection
Early detection would allow for removal of only the affected breast area, conserving cosmetically acceptable amount of breast as the cancer does not involve the complete breast at early stages.
Stage of the tumour
BCS is used as a standard therapeutic procedure in stage I and stage II tumours. BCS may help to provide a comparatively better cosmetic effect at early stages.
Age and comorbidities
Age plays an important role in the outcome of BCS. Elderly women may often present with increased risk of comorbidities when compared to younger women and this may influence the outcome of their treatment for breast cancer (BCS). Additionally, studies have shown to increase the risk of postoperative complications in patients who are 65 years and older. Therefore, risk vs benefit ratio is necessary to gauge.
Type and location of tumour within the breast
Breast tumours with a single centre are considered to have better outcomes with BCS. Multicentric tumours are comprised of two or more tumours within different quadrants of the breast, therefore the extent of breast tissue removal cannot be defined, leading to poor cosmetic outcomes of BCS.
It is important that the tumours are present within the same quadrant of the breast in order to achieve precise excision and conserve a satisfactory amount of breast volume from the cosmetic point of view. However, using Oncoplastic techniques, a trained surgeon maybe able to provide good cosmetic results even in multicentric tumours.
Breast tumours on the outer side generally tend to have better cosmetic outcomes rather than on the inner side (cleavage area). With advances in oncoplastic surgery, reconstruction can be possible for tumours within the inner aspects of the breasts as well.
Previous radiation therapy
Patients with a history of radiation therapy including the affected breast portion may compromise the cosmetic outcome of BCS. This may also result in excessive doses of radiations to the chest wall as BCS is often followed by radiation therapy. Studies have shown that patients with specific types of tumours like invasive lobular carcinoma are at a higher risk of in-breast recurrence following BCS after radiation therapy.
Genetic factors
Inherited risk of breast cancer is associated with BCRCA1 and BCRCA2 gene mutations in some women. Younger women with a family history of breast cancer have a higher risk of these mutations. Though these patients can be potential candidates for BCS, the chances of developing secondary cancers in the opposite breasts are much higher. The decision to perform BCS in women with these mutations must be made by consulting experienced breast surgeons and genetic counsellors. Options of surveillance versus risk reducing mastectomy should be explained.
Keeping the above mentioned factors in mind, patients diagnosed with breast cancer must undergo thorough screening, evaluation, and coordinated patient care involving the concerned oncologists, radiologists, and reconstructive surgeons to achieve successful outcomes of BCS
References:
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Accessed on 1 July, 2021. - Nair NS. Paradigm shift in surgery for breast cancer: The Indian reality. Indian Journal of Cancer (2011); 48; 389-390.
Accessed on 1 July, 2021. - Smith L, Dayal S, Murray J, Lannigan A. Attitudes towards breast conservation in patients aged over 70 with breast cancer. Springerplus. (2016);5(1).
Accessed on 1 July, 2021. - Lagendijk M, Vos E, Koning A et al. TUmor-volume to breast-volume RAtio for improving COSmetic results in breast cancer patients (TURACOS); a randomized controlled trial. BMC Cancer. (2017); 17(1).
Accessed on 9, July, 2021.
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