Breast-conserving surgery is an appropriate procedure for centrally located breast cancer

1. Patients with centrally located breast cancer (CLBC) had higher breast cancer-specific survival (BCSS) and overall survival (OS) rates.

2. There was no significant difference in BCSS and OS between CLBC and non-CLBC patients who underwent BCS.

Evidence Rating Level: 2 (Good)

CLBC refers to breast cancer localized in the nipple, areola, or central region of the breast. While breast-conserving treatment is the standard of care for early-stage breast cancer, literature on its efficacy and safety in CLBC patients is lacking. In this large retrospective cohort study, data from 210,409 patients (median age [interquartile range]: 56 [48-63] years) with stage T1-2 non-metastatic breast cancer as their first malignancy was extracted from the US Surveillance, Epidemiology, and End Results (SEER) database, to evaluate the overall and cancer-specific survival between BCS and mastectomy in CLBC patients, and between CLBC and non-CLBC patients treated with BCT. Among these patients, 7.14% were diagnosed with CLBC, while 92.86% had non-CLBC. CLBC patients with less aggressive characteristics (lower histological grade, smaller tumor size, none or limited lymph node metastasis, or positive ER or PR status) often underwent BCS. Over a median follow-up of 91 months, 11.73% of patients died, with 6.10% being due to breast cancer. Multivariable analysis showed better BCSS (HR = 0.67, 95%CI: 0.55–0.80, p < 0.001) and OS (HR = 0.78, 95%CI: 0.68–0.90, P=0.001) in patients who received BCS compared to those who received mastectomy. These results remained consistent after propensity score matching, although the improved OS was non-significant (HR = 0.82, 95%CI: 0.65–1.04, P=0.110). BCSS and OS were comparable between CLBC and non-CLBC patients opting for BCS. Overall, these findings support BCS as a preferable alternative to mastectomy for early-stage CLBC patients. 

Click to read the study in BMC Surgery

Image: PD

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