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Invited Commentary
May 5, 2021

Safety of Breast-Conserving Surgery in Breast Cancer and Risk of Overtreatment vs Undertreatment

Author Affiliations
  • 1Department of Surgery, Weill Cornell Medicine, New York, New York
JAMA Surg. 2021;156(7):638. doi:10.1001/jamasurg.2021.1450

The oncology community has advocated in favor of breast-conserving surgery (BCS) as an alternative to mastectomy in appropriately selected patients with breast cancer for several decades.1 This recommendation is supported by multiple prospective randomized clinical trials demonstrating overall survival equivalence for both operative approaches and is aligned with the paradigm shift in oncology to de-escalate all components of multidisciplinary care. Medical breast oncologists use less chemotherapy as a consequence of improved risk stratification by gene expression profiling and surgical breast oncology has also evolved. Today, the radical mastectomy is largely of historic significance; patients with early-stage breast cancer are routinely offered lumpectomy with sentinel node biopsy and radiation. Recent years have also witnessed efforts to de-escalate radiation therapy. The National Surgical Adjuvant Breast and Bowel Project B-06 trial2 established the landmark finding that several weeks of breast radiation after lumpectomy is necessary for local control but does not contribute to survival. However, since that time, efforts to minimize the cost, inconvenience, and cosmetic sequelae of radiation have resulted in widespread implementation of accelerated hypofractionated schedules, partial breast irradiation, and ongoing studies designed to identify lumpectomy patients that can omit radiation completely.3

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