ABSTRACT

Advances in breast cancer treatment have resulted in the concomitant rise in survivorship and a greater focus on quality of life after breast cancer. Patients are increasingly afforded the opportunity to live not only longer but better. Long gone are the days where the Halsted radical mastectomy was thought to be the only option to treat all stages of breast cancer. Therapy is now individualized to best meet the needs of the patient in a shared decisionmaking approach, creating opportunities to tailor treatment to patient preferences. Additionally, thanks to improvements in screening and breast imaging, breast cancer is being detected at a smaller size and earlier stage, allowing patients to have more surgical options.
Here, we explore both sides of the major branchpoint in the surgical pathway in the treatment of early-stage breast cancer—breast-conservation surgery (BCS) with radiotherapy versus mastectomy. Several early randomized controlled trials demonstrated no survival difference between these two surgical options for patients with earlystage breast cancer. Subsequent research has supported the notion that BCS with radiation provides adequate local control, improves quality of life, and perhaps even enhances
long-term survival, but does this evidence support that all eligible patients with early-stage breast cancer should be recommended BCS as the surgical treatment of choice? In what situations might a patient opt for a mastectomy instead?