Surgery of early breast cancer

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Randomized trials of treatment have evaluated the role of radiotherapy after breast-preserving surgery for both in situ and invasive cancer. These trials provide treatment guidelines and identified “show biz” questions relating to both therapy and biology. A trial of systemic treatment of premenopausal women with node-positive disease provided compelling reasons to always determine estrogen receptor status before determining adjuvant systemic treatment. Additional data on pathology, needle biopsy, and surgical techniques provide important information for surgeons. New data on breast cancer biology in young women and data suggesting that mastectomy rates are still higher than necessary provide issues on which surgeons can reflect. Evidence that supports marrow biopsy for staging at the time of surgery is important for surgeons. Psychosocial data are partly reassuring in that mastectomy patients, if they choose the procedure themselves, may not be worse off. Finally, a sobering report of the devastating effects of late diagnosis came from Nigeria.

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