68 - Local Recurrence, the Augmented Breast, and the Contralateral Breast

Abstract

Over a quarter million women in the United States are diagnosed with breast cancer annually, with over 3.6 million women living with a personal history of breast cancer [National Cancer Institute. Surveillance, Epidemiology, and End Results Program. Female Breast Cancer—Cancer Stat Facts. https://seer.cancer.gov/statfacts/html/breast.html]. Multidisciplinary treatment continues to be the mainstay, with surgery, radiotherapy, and systemic therapy essential for cure; however, personalizing each treatment approach to each individual’s extent of disease, biology, and future breast cancer risk is paramount. Understanding risk for locoregional recurrence as well as future contralateral breast cancer is necessary. Treatment planning should focus on curative intent for the index breast cancer as well as avenues for future primary breast cancer prevention when indicated. As the number of women who undergo treatment for breast cancer increases, more patients will be at risk for locoregional recurrence or a second primary breast cancer. Disease recurrence can be local, regional, or distant, and treatment is based on extent of disease, past index cancer treatment, as well as risk for future breast cancer. Contralateral breast cancer is considered a second primary breast cancer, with risk dependent on age, family history, presence of pathogenic gene mutations, as well as index cancer biology and treatment. For locoregional recurrence, comprehensive multimodality therapy is the mainstay with surgery at the forefront along with individualized role for radiotherapy and systemic therapy. The role for risk-reducing surgery should also be individualized to each patient, with a clear discussion of true risk, indications for risk-reducing surgery, and complete risk-benefit analysis.