Factors Contributing to Local Recurrence after Conservative Breast Surgery for Early Breast Cancer

Abstract

Breast cancer is one of the most common malignancies in women and a principle cause of death from cancer among women globally. It has become a major health issue in the world over the past 50 years, and its incidence has increased in the recent years. Early detection of breast cancer is the most effective way to reduce mortality, and currently a screening program based on mammography is considered the best method for early detection of breast cancer The general approach for evaluation has becomes formalized as triple assessment, involving history taking and clinical examination, imaging (usually mammography and/or ultrasonography) and tissue biopsy. In patients with early-stage breast cancer, the standard local treatment is conservative surgery in the form of lumpectomy or wide local excision and axillary dissection, followed by radiotherapy to the whole breast. Postoperative RT significantly reduces the risk of local relapse and mortality by treating residual microscopic disease that may have spread beyond the margin of surgical resection. Breast conserving surgery followed by radiotherapy has been shown to give the same survival benefit as mastectomy for women with localised tumours. Nonetheless, a minority of patients treated conservatively will develop a local recurrence, which remains one of the greatest concerns in breast conserving surgery. Adjuvant chemotherapy and hormonal treatment have substantially reduced the risks of relapse and death that threaten breast cancer patients. Selection of chemotherapy and/or hormone therapy is based on several factors, including a patients’ age and tumor characteristics, such as nodal status, the presence of estrogen receptors and the Her-2/neu status. Local recurrence is a marker of tumor aggressiveness and has been linked to an increased risk of distant metastases and death. This raised the attention on the need to identify more robust pathologic and molecular predictors of local recurrence and more effective treatment strategies that could decrease the risk of local failure after breast-conserving therapy. It was reported that early detection of local recurrence might have a favourable impact on the prognosis of patients followed after primary treatment for breast cancer because a difference in survival was recorded in favour of cases detected in the asymptomatic state. The treatment options for loco- regional recurrences are limited. Chemotherapy might not be effective in pre-irradiated tissue because a decreased perfusion can be expected due to radiation-induced fibrosis. Mastectomy or local excision and reconstructive surgery are, thus, the preferred therapies. However, in the recent years, evidence accumulates that a