Controversies in Breast Cancer Surgery

Surg Clin North Am. 2021 Dec;101(6):1033-1044. doi: 10.1016/j.suc.2021.06.002. Epub 2021 Aug 25.

Abstract

Breast surgical oncology is a rapidly evolving field with significant advances shaped by practice-changing research. Three areas of ongoing controversy are (1) high rates of contralateral prophylactic mastectomy (CPM) in the United States despite uncertain benefit, (2) indications for and use of neoadjuvant chemotherapy (NACT) and endocrine therapy (NET), and (3) staging and treatment of the axilla, particularly after neoadjuvant systemic therapy. We discuss the patient populations for whom CPM may or may not be beneficial, indications for NACT and NET, and the trend toward de-escalation of locoregional axillary treatment.

Keywords: Axilla; Breast cancer; Chemotherapy; Contralateral prophylactic mastectomy; Endocrine therapy; Neoadjuvant.

Publication types

  • Review

MeSH terms

  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Agents, Hormonal / therapeutic use
  • Axilla
  • Breast Neoplasms / drug therapy
  • Breast Neoplasms / surgery*
  • Breast Neoplasms / therapy
  • Combined Modality Therapy
  • Female
  • Humans
  • Lymph Node Excision
  • Mammaplasty
  • Mastectomy
  • Neoadjuvant Therapy
  • Neoplasm Staging
  • Prophylactic Mastectomy

Substances

  • Antineoplastic Agents
  • Antineoplastic Agents, Hormonal