Surgical treatment of breast cancer in young women

Abstract

Surgical treatment is a fundamental aspect in the proper management of breast cancer. It is not only the mainstay of loco-regional treatment, but it also allows disease staging and optimization of adjuvant chemotherapy through histopathological and immunohistochemical analysis of the biopsied tissue. From a strict oncologic point of view, surgical treatment of breast cancer in young women does not differ greatly from that in older women, but the physical consequences of large breast resections can have a major impact on self image, and can result in significant emotional and psychosocial distress in younger women [1]. Moreover, the fact that the majority of women in this age group are of childbearing age calls for the need to consider distinct aspects of surgical treatment [2, 3]. When choosing between a conservative or a more radical surgical approach, it is also important to bear in mind that breast tumors in younger patients tend to be strongly associated with a family history of breast cancer, and therefore patients have an increased risk for carrying BRCA1 or BRCA2 (BRCA1/2) mutations [4]. In confirmed cases of BRCA1/2 mutations, risk-reducing salpingooophorectomy has been demonstrated to be the best strategy [5]. In patients with these mutations and established disease, radical mastectomy (RM), instead of breast-conserving surgery (BCS), is the most sensible approach [6]. Surgical treatment in localized disease