ASO Author Reflections: The Difficult Assessment of the Hard-Won Progress of Breast Cancer Care

Excerpt

In modern times, the extent of surgery for breast cancer treatment has followed a linear descending trajectory with almost no interruptions. The progressive de-escalation of surgery, both on the breast and axilla, has spared millions of women the permanent consequences of disfiguring and disabling operations of the past. Meanwhile, radiotherapy and systemic therapies have also evolved, and, albeit now certainly more precise and effective, have progressively substituted surgery as the main determinants of treatment-related morbidity. However, mastectomy rates unexpectedly started to rise in some countries around 15 years ago; paradoxically, at that time a few retrospective studies were beginning to suggest that breast-conserving therapy (BCT) could be associated with better survival than mastectomy1. Likely, the major drivers of such phenomenon were enhanced sensitivity of modern imaging for multifocal tumors, better outcome of reconstructive surgery after mastectomy, and increased awareness of genetic risk. More recently, the proportion of women undergoing repeated breast surgery (RBS) after a first suboptimal attempt of breast conservation was also deemed responsible for the increasing number of mastectomies performed. Indeed, in several series published over the last 20 years, the RBS rate exceeded 30%. Therefore, in order to decrease its frequency and variability among different surgeons and institutions, the RBS rate was proposed as a quality metric of breast cancer care.2 …