Abstract
Since ancient times, breast cancer treatment has crucially relied on surgeons and clinicians making great efforts to find increasingly conservative approaches to cure the tumor. In the Halstedian era (mid-late 19th century), the predominant practice consisted of the radical and disfiguring removal of the breast, much to the detriment of women’s psycho-physical well-being. Thanks to enlightened scientists such as Professor Umberto Veronesi, breast cancer surgery has since impressively progressed and adopted a much more conservative approach. Over the last three decades, a better understanding of tumor biology and of its significant biomarkers has made the assessment of genetic and molecular profiles increasingly important. At the same time, neo-adjuvant treatments have been introduced, and great improvements in genetics, imaging technologies and in both oncological and reconstructive surgical techniques have been made. The future of breast cancer management must now rest on an ever more precise and targeted type of surgery that, through an increasingly multidisciplinary and personalized approach, can ensure oncological radicality while offering the best possible quality of life.
Highlights
It is known that mastectomy has been the treatment of choice for breast cancer (BC)since the times of the Byzantine Empire [1,2]
The growing importance of early diagnosis and the gradual introduction of mammography as its main tool, alongside the hypothesis that breast cancer has a systemic biological potential, inspired six widely known, large trials, which came to the same game-changing conclusion: in women with stage I and II breast cancer, breast-conserving surgery (BCS) followed by post-operative radiotherapy (RT), despite being associated with higher rates of local recurrence, does not affect the overall and the disease-free survival rates seen with mastectomy
Long-term follow-up results of these key trials [19,20,21,22,23,24] have confirmed that BCS with postoperative RT has, compared to mastectomy, similar effects on mortality even if it is associated with an increased risk of locoregional recurrence
Summary
It is known that mastectomy has been the treatment of choice for breast cancer (BC). since the times of the Byzantine Empire [1,2]. By completely removing the axillary nodes while leaving both pectoral muscles in place, this modified radical mastectomy represented a less disfiguring procedure with still reduced post-operative morbidity rate [10] It became more and more frequently used and, emerged as the standard of care for breast cancer patients [6]. The growing importance of early diagnosis and the gradual introduction of mammography as its main tool, alongside the hypothesis that breast cancer has a systemic biological potential, inspired six widely known, large trials, which came to the same game-changing conclusion: in women with stage I and II breast cancer, breast-conserving surgery (BCS) followed by post-operative radiotherapy (RT), despite being associated with higher rates of local recurrence, does not affect the overall and the disease-free survival rates seen with mastectomy. 10-year local recurrence rate among patients treated with breast-conserving surgery ranged from 3.5% to 6.5% instead [33]
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