Inappropriate lumpectomy in early breast cancer: Experience from a Tertiary Care Centre in India.

Abstract

77 Background: In India the incidence of breast cancer has shown an increasing trend over the past few decades and the majority of patients present with early breast cancer in the cities. A disturbing trend in the present setting is that a substantial proportion of patients are referred for the management of early breast cancer after inappropriate excision as diagnostic procedure in the primary care setup. Methods: The medical records of all patients who underwent surgery for early breast cancer post-lumpectomy status from September 2010 to December 2014 were reviewed retrospectively. The patterns of incision for lumpectomy, the margins of excision, the T stage, pre-operative imaging, the type of surgery and adjuvant therapy, the lapses in lumpectomy and various challenges it poses for further management and how it was combated were scrutinized in detail. Results: About one hundred and fifteen women were found eligible for the study. The mean age of onset was 47.33 years [Range 28-78]. The ratio of Left : Right were 57 : 58. The Margins and T status were known only in seventeen patients. Imaging ruled out any residual disease in breast in twenty eight patients. Twenty-seven patients underwent breast conservation with reconstruction, 82 underwent modified radical mastectomy and six of them underwent only axillary dissection. Only 41 patients had no residual primary disease on final histopathological evaluation. All patients underwent adjuvant therapy based on the approximate T staging. 12 patients were lost to follow up at one month.103 patients are alive and 101 disease free at an average follow up of 13.6 months. Conclusions: In early breast cancer, inappropriate lumpectomy for diagnostic purpose alters the course of surgical and adjuvant management. Hence it should be discouraged and not advocated as standard of care.