Five decades of progress in surgical oncology: Breast Review
| Authors: | Downs-Canner, S.; Cody, H. S. 3rd |
| Review Title: | Five decades of progress in surgical oncology: Breast |
| Abstract: | Surgery remains the single most effective treatment for breast cancer but coincident with a deeper understanding of tumor biology and advances in multidisciplinary care (encompassing breast imaging, systemic adjuvant therapy, radiotherapy, and genomics) continues to de-escalate, supported by strong level I data. We have moved from mastectomy to breast conservation, and from routine axillary dissection to sentinel lymph node biopsy to selective omission of axillary node staging altogether. We have further de-escalated through consensus over margin width in breast conservation, through improvements in neoadjuvant therapy, and by demonstrating no benefit for upfront surgery in patients with stage IV disease. For patients with ipsilateral breast tumor recurrence, reconservation surgery and reirradiation are promising. Cell cycle and immune checkpoint inhibitors, when added to conventional systemic therapy, have now moved beyond stage IV disease to phase III trials in the adjuvant and neoadjuvant settings, promising even further de-escalation of surgery. Finally, with genomic profiling we are moving away from the primacy of axillary node status for prognostication and into a new era allowing prediction of response to therapy. © 2022 Wiley Periodicals LLC. |
| Keywords: | genetics; systemic therapy; cancer radiotherapy; neoadjuvant therapy; cancer staging; nuclear magnetic resonance imaging; positron emission tomography; lymph node metastasis; lymphatic metastasis; sentinel lymph node biopsy; cell cycle; breast cancer; breast; echomammography; mastectomy; pathology; breast neoplasms; breast reconstruction; cancer hormone therapy; adjuvant chemotherapy; breast tumor; fluorodeoxyglucose; axillary lymph node dissection; surgical margin; breast-conserving surgery; procedures; re-irradiation; surgical oncology; immune checkpoint inhibitor; humans; human; female; article; contrast enhanced digital mammography; simple mastectomy; genetic profile; breast cancer recurrence; ductal breast carcinoma in situ; surgical advances |
| Journal Title: | Journal of Surgical Oncology |
| Volume: | 126 |
| Issue: | 5 |
| ISSN: | 0022-4790 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2022-10-01 |
| Start Page: | 852 |
| End Page: | 859 |
| Language: | English |
| DOI: | 10.1002/jso.27035 |
| PUBMED: | 36087082 |
| PROVIDER: | scopus |
| PMCID: | PMC9472874 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 3 October 2022 -- Source: Scopus |
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