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Review |

Breast Cancer:  A Review for the General Surgeon

Cindy B. Matsen, MD1; Leigh A. Neumayer, MD, MS1,2
[+] Author Affiliations
1Department of General Surgery, University of Utah, Salt Lake City
2Department of Surgery, Huntsman Cancer Hospital, University of Utah, Salt Lake City
JAMA Surg. 2013;148(10):971-980. doi:10.1001/jamasurg.2013.3393.
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Breast cancer care is complex and requires a multidisciplinary approach. In this study, we provide an overview of current practices for the diagnosis and treatment of breast cancer for surgical practitioners who do not focus on this disease. We include studies published in high-impact, peer-reviewed journals that have informed or altered the standard of care, with preference given to large, multicenter, randomized clinical trials when available. Our study highlights that the surgical management of breast cancer has changed dramatically over the past decades. As our understanding of the disease process increases, practice guidelines will continue to evolve.

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Figure 1.
Simplified Algorithm for Surgical Management of Biopsy-Proved Breast Disease

ADH indicates atypical ductal hyperplasia; ALH, atypical lobular hyperplasia; DCIS, ductal carcinoma in situ; SLNB, sentinel lymph node biopsy; and XRT, radiation therapy.

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Figure 2.
Twenty-Year Follow-up of NSABP B-06 Survival Curves

Disease-free survival (A), distant disease–free survival (B), and overall survival (C) among 589 women treated with total mastectomy, 634 treated with lumpectomy alone, and 628 treated with lumpectomy plus irradiation. P values above the lines are for 3-way comparison among the groups. P values below the lines are for 2-way comparisons between lumpectomy alone or with irradiation and total mastectomy. NSABP B-06 indicates National Surgical Adjuvant Breast and Bowel Project B-06. Reproduced with permission from Fisher et al.72

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Figure 3.
Twenty-Year Follow-up of NSABP B-06 Ipsilateral Breast Recurrence in Lumpectomy and Lumpectomy Plus Irradiation Groups

Cumulative incidence of a first recurrence of cancer in the ipsilateral breast during 20 years of follow-up among 570 women treated with lumpectomy alone and 567 treated with lumpectomy plus breast irradiation. The data are for women whose specimens had tumor-free margins. NSABP B-06 indicates National Surgical Adjuvant Breast and Bowel Project B-06. Reproduced with permission from Fisher et al.72

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