De-escalation towards omission is the tipping point of individualizing breast cancer surgery

Joerg Heil; André Pfob; Henry Mark Kuerer

doi:10.1016/j.ejso.2020.03.208

De-escalation towards omission is the tipping point of individualizing breast cancer surgery

Eur J Surg Oncol. 2020 Aug;46(8):1543-1545. doi: 10.1016/j.ejso.2020.03.208. Epub 2020 Mar 19.

Authors

Joerg Heil¹, André Pfob², Henry Mark Kuerer³

Affiliations

¹ Department of Gynecology/ Breast Unit, Heidelberg University, Heidelberg, Germany. Electronic address: Joerg.Heil@med.uni-heidelberg.de.
² Department of Gynecology/ Breast Unit, Heidelberg University, Heidelberg, Germany.
³ Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.

PMID: 32241595
DOI: 10.1016/j.ejso.2020.03.208

Abstract

Tailoring of breast cancer treatment to the individual has especially occurred in breast cancer surgery: paradigms have changed from Halsted's radical mastectomy in 1882, to simple mastectomy, to lumpectomy. Within the next decade, we might face another paradigm change of omitting breast cancer surgery at all in case of a complete response after neoadjuvant systemic treatment. In this article, we provide an overview of the reasoning for this new paradigm change, the criticism it has evoked, and under which conditions it might be incorporated into clinical practice. We also take a look at previous paradigm changes in breast cancer surgery and the insights they provide us in the current situation on a statistical but also on a psychological level.

Keywords: Individualized treatment; Neoadjuvant systemic treatment; Omission of breast cancer surgery; Pathologic complete response; Vacuum-assisted biopsy.

MeSH terms

Breast Neoplasms / mortality
Breast Neoplasms / pathology
Breast Neoplasms / surgery*
Female
Humans
Mastectomy