by André Pfob,
Peter Dubsky
The Breast: Published: January 17, 2023
Abstract
Breast conserving therapy (BCT), consisting of breast
conserving surgery and subsequent radiotherapy, is an equivalent option to
mastectomy for women with early breast cancer. Although BCT after neoadjuvant
systemic treatment (NAST) has been routinely recommend by international
guidelines since many years, the rate of BCT worldwide varies largely and its
potential is still underused. While the rate of BCT in western countries has
increased over the past decades to currently about 70%, the rate of BCT is as low
as 10% in other countries. In this review, we will evaluate the underused
potential of breast conservation after NAST, identify causes, and discuss
possible solutions. We identified clinical and non-clinical causes for the
underuse of BCT after NAST including uncertainties within the community
regarding oncologic outcomes, the correct tumor localization after NAST, the
management of multifocal and multicentric tumors, margin assessment,
disparities of socio-economic aspects on a patient and national level, and
psychological biases affecting the shared decision-making process between
patients and clinicians. Possible solutions to mitigate the underuse of BCT
after NAST include interdisciplinary teams that keep the whole patient pathway
in mind, optimized treatment counseling and shared decision-making, and
targeted financial support to alleviate disparities.
