LOCAL RECURRENCE AFTER CONSERVATIVE BREAST SURGERY FOR BREAST CARCINOMA

Abstract

Breast cancer is the most common cancer in women in Developed western countries and is becoming even more significant in many developing countries. In Egypt, breast cancer is the most common cancer among women. Breast conserving therapy has become a standard treatment option for patients with early stage breast cancer with low rates of local recurrence and good cosmetic outcome. Over the past 40 years, there has been a major change in the treat-ment of patients with early breast cancer, with breast conservation coming to the forefront as a viable option. Breast-conserving surgery (BCS) was initially performed to reduce the physical and psycho¬logic morbidity of mastectomy. Many risk factors for local recurrence after breast conserving surgery have been studied widely .the most established risk factors are young age, positive resection margins, multicentric disease and vascular invasion. Extensive intraductal component has been much discussed as a risk factor, but seems to have little prognostic value if negative margins can be obtained. The majority of recurrences detected were true or marginal recurrences, which arise mostly in the first 4 years after BCT. The general approach to evaluation has become formalized as triple assessment, involving clinical examination, imaging (usually mammography and/or ultrasonography), and needle biopsy, but always perform this as part of a more general assessment beginning with clinical history. Clinical history, physical examination and breast imaging are the most effective means of follow up. Physical examination should be informed every three to six months for the first three years following surgery, and every six months in the years four and five. After five years, annual physical examination provides adequate follow up. Patients at exceptionally high risk of recurrence or development of a second primary tumour should be watched more closely. MR mammography is important for the early recognition of recurrence and should then be done at least annually.