Special Issues in Breast Cancer Outcome and Prognostic Factors in the Conservative Treatment of Breast Cancer

With the implementation of early screening more women are diagnosed with early stage breast cancer; the curative therapy remains however an important challenge. For years, radical mastectomy was the only treatment option for breast cancer. The concept of conservative treatment was initially developed in Europe during the years 1960-1970. It consisted of breast conserving surgery followed by radiation. The principle goals being the equivalence in terms of survival compared with mastectomy, a good local control and esthetic outcome. Conservative treatment has been established for early stages breast cancer. In fact, six randomized controlled trials comparing mastectomy to conservative management reported identical outcomes in terms of survival [1-6]. Knowing that overall survival of the patients is quite identical in these trials, local control is far better with the addition of radiotherapy to breast conserving surgery. Overall survival with conservative treatment varies between 70 and 80% and local recurrence between 4 and 18%. Local recurrence after mastectomy varies between 2 and 9% [1-6]. On the individual setting, local recurrence compromises the possibility of breast conservation and is responsible of the systemic dissemination and ultimately to the decrease of the overall survival. Analysis of clinical and pathological prognostic factors predict local control and select patients that are candidates for a conservative treatment with a good cosmetic outcome in the majority of patients with stage I and II breast cancer [7-9]. We present in this retrospective study the outcome of conservative treatment in 100 patients treated for early breast cancer. All patients were treated with breast conserving surgery followed by radiotherapy. The primary goals of the study were outcome and the impact of the different prognostic factors in this population.