Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, United States.
Breast. 2017 Aug;34 Suppl 1:S1-S4. doi: 10.1016/j.breast.2017.06.018. Epub 2017 Jun 30.
In the setting of increased awareness regarding the need to address potential overtreatment in the management of breast cancer patients with favorable-prognosis disease, this article reviews three relevant instances in which the extent of surgery has been safely decreased: margin width in patients with ductal carcinoma in situ; axillary management in clinically node-negative women undergoing primary breast-conserving surgery; and the use of neoadjuvant chemotherapy followed by sentinel node biopsy for patients presenting with node-positive breast cancer. The management of the axillary nodes over the past decade highlights the potential to de-escalate surgery in the era of multimodality therapy. Similar opportunities exist for the use of radiotherapy. To fully realize the potential of de-escalating surgery, new communication strategies must be developed to convince patients that bigger is not necessarily better.
在提高认识的背景下，需要解决乳腺癌患者治疗中潜在的过度治疗问题，本文回顾了三种手术范围可安全缩小的情况：导管原位癌患者的切缘宽度；临床淋巴结阴性行保乳手术的女性的腋窝管理；以及新辅助化疗后前哨淋巴结活检在淋巴结阳性乳腺癌患者中的应用。过去十年中腋窝淋巴结的处理强调了在多模式治疗时代降低手术风险的潜力。放疗也有类似的机会。为了充分发挥降低手术风险的潜力，必须制定新的沟通策略，让患者相信更大不一定更好。
