Contraindications to Breast Conserving Therapy
This section deals with breast cancers that are designated Stage
1 and 2. This system, recently revised by the American Joint
Committee on Cancer (www.cancerstaging.org) includes the size of the
cancer,
the regional lymph nodes, and the presence or absence of
distant metastases (ie, spread of the breast cancer to other parts
of the body). This
way, patients with similar cancers can be grouped together,
to better decide on appropriate treatment, and also to evaluate the
outcomes
of these treatments.
Cure rates for Stage 1 are over 90%. Indeed, throughout the
United States, the overall survival for all breast cancer patients
is at least 75% five years after treatment.
With the increased use of mammography and increased public
awareness, many breast cancers are now diagnosed at an early stage.
Stage 1 refers to breast cancers that are two centimeters (3/4 of
an inch) or less in size, and which have not spread to the regional
lymph nodes. Depending on the location of the cancer within the breast,
many are candidates for breast conservation and sentinel lymph node
biopsy. This allows the definitive surgical procedure to be performed
as an outpatient procedure, usually without overnight hospitalization.
For patients undergoing mastectomy, the sentinel node procedure
may be appropriate as well.
When evaluating a cancer, many additional factors are also
thought to influence outcome. These additional factors are evaluating
not size, but the biologic activity of the tumor. Thus, a breast cancer
is routinely tested for its sensitivity to the female hormones estrogen
and progesterone. These estrogen and progesterone receptor levels
tell us how aggressive the tumor is. They also predict whether a patient
is a candidate for hormonal therapy. Another commonly tested marker
is HER-2/neu, which is one of the oncogenes associated with breast
cancer. Amplification, or increased activity, of the oncogene can
be associated with a more aggressive breast cancer. However, its’ presence
also indicates that newer treatments including the use of monoclonal
antibodies such as Herceptin™ may be effective in cancer therapy.
Surgical therapy is the first-line of treatment in these
early breast cancers, and the various options will be discussed by
you and your surgeon. Depending on your mammograms, breast exam, as
well as prior history and family history, appropriate options including
breast conservation versus mastectomy, the role of sentinel node biopsy
versus axillary dissection, indications for radiation therapy and
the newer options (available at NYU) regarding the delivery of radiation
therapy, and the role of breast reconstruction. The table below includes
some of the situations in which breast conserving therapy may not
be the best option, even for an early cancer.
After surgery, you will be seen by your surgeon in post-operative
evaluation, to check on the progress of your healing, and to discuss
your pathology results. At that time, you will be referred to a medical
specialist to discuss additional therapies that may be indicated to
fully treat your cancer, and/or to discuss interventions to reduce
future breast cancer risks. You will be referred to Radiation Oncology
if you have had breast-conserving therapy, again to complete your
initial breast cancer treatment. In certain cases, even after mastectomy,
you may be referred to Radiation as well.
Contraindications to Breast Conserving Therapy
| Absolute contraindications |
| Prior radiation therapy to the involved
breast. First or second trimester of pregnancy. Two or more cancers that are in different quadrants of the breast. Diffuse suspicious microcalcifications involving more than 1 quadrant of the breast. |
| Relative contraindications |
| Large tumor-to-breast ratio, which results in a poor cosmetic
result. History of collagen vascular disease or underlying lung disease, which renders radiation dangerous to the lungs. |
