Breast conservation treatment for multifocal and multicentric breast cancers in women with small‐volume breast tissue
Breast conservation treatment (BCT) was established as an alternative to mastectomy for the treatment of breast cancer on the basis of equivalent survival outcomes,1 but recent data suggest BCT may be superior to mastectomy in terms of breast cancer‐specific survival and local control.3 An absolute benefit in breast cancer‐specific survival of 4% at 10 years was reported where 70% of patients underwent BCT,3 and it is estimated that for each percentage point rise mastectomy rates, seven‐year survival would be reduced by 0.1%.4 Hence, in a patient population with BCT rates below 30%, survival benefit may not be evident, and treated women may suffer poorer body image and quality of life outcomes.3 Many contemporary series from predominantly Chinese populations report BCT rates averaging 30%.8 The reasons cited for these low BCT rates include cultural factors, surgeon preferences and physical attributes.9 Chinese women have been shown to have smaller breast volume (SVB) tissue,13 posing challenges for good cosmetic outcomes with BCT.14
The presence of ipsilateral multifocal and multicentric breast cancers (MFMCBC) compounds these challenges. The lower initial parenchymal volume serves as a barrier for the provision of adequate retained tissue to achieve a reasonable postsurgical cosmetic outcome following multiple tumour excisions. As conventional contraindications to BCT reflect the clinical situations that would compromise either local control or cosmesis,15 MFMCBC could be viewed as a contraindication for BCT in women with SVB. While the oncologic principle of achieving clear margins should not be compromised, methods can be explored to allow such women the potential benefits of BCT. This study was therefore conducted to evaluate the feasibility of performing of BCT among women who were diagnosed to have MFMCBC in a predominantly Chinese community, where more women with SVB are expected.