Breast cancer: In what cases can the breast be preserved?

This is an automatically translated article.

The article was professionally consulted by Specialist Doctor II Do Tuong Huan - Oncologist - Oncology Center - Vinmec Central Park International General Hospital.
For patients with breast cancer, there are currently 2 surgical methods to treat the disease: complete removal of the breast or preserving the breast. Breast-conserving surgery is mainly indicated for cases where the disease is detected at an early stage, when cancer cells have not spread widely.

1. Overview of 2 breast cancer surgery methods

Breast cancer is a malignancy of the mammary glands. In Vietnam, breast cancer and cervical cancer are the two most common cancers in women. The rate of breast cancer accounts for 7 - 10% of all malignant tumors in the body and the common age is 40 - 60.
Breast cancer treatment options depend on many factors such as stage of disease, size tumor size, nature, invasion of tumor, tumor location, status of axillary lymph nodes, histopathology of tumor, epithelial growth factor, hormone receptor,... In addition, other factors such as age, family history, co-morbid conditions, health status of the patient, ... also affect the choice of treatment.
Usually, there are 2 breast cancer surgery options indicated for breast cancer patients: total mastectomy or breast-conserving surgery.

Mastectomy: A surgical removal of the entire mammary gland, areola, and nipple, leaving only the muscle and skin of the chest wall. The advantage of this method is that the excisional area is wide, creating peace of mind for the patient, and after surgery, radiation therapy may not be required. However, this is a complicated surgery, with a long intervention time, many complications and a long hospital stay. In particular, removal of the entire mammary gland severely affects the aesthetics and psychology of the patient due to the loss of one breast. Patients who have a need for beautification will often undergo breast reconstruction surgery afterwards; Breast-conserving surgery (lumpectomy): A method of removing only the tumor and a part of the breast parenchyma surrounding the tumor (about 1-2cm away from the tumor), enough to no longer have cancer cells at the surgical site. Therefore, the mammary gland is still kept to an almost normal size. This treatment method ensures aesthetics, especially for young, unmarried patients. At the same time, as a minimally invasive method, breast cancer surgery in the direction of preserving the breast has a fast healing time. The limitation of this method is that it is not applicable in case of late detection of breast cancer, tumors located in the center, near the nipple, large breast tumors in women with small mammary glands,... in addition. After surgery, patients also have to have adjuvant radiation therapy after surgery to destroy the remaining cancer cells, reducing the risk of breast cancer recurrence.

The recurrence rate and 5-year survival rate of patients undergoing breast cancer surgery in the direction of total mastectomy and breast-conserving surgery with radiation therapy as indicated are similar.

2. In which cases may or may not preserve the mammary gland

Breast-conserving surgery is indicated for patients diagnosed with breast cancer based on clinical examination, mammogram, and cytology. The patient has a confirmed diagnosis by histopathology, tumor size < 3cm, has a lesion, regional lymph nodes have not metastasized or metastasized in small number, no distant metastases, localized calcification on radiographs. X-ray of the breast. Young women are also encouraged to have breast-conserving surgery to ensure aesthetics and confidence.
Breast-conserving surgery is absolutely contraindicated for cases with multiple tumors (multifocal), diffuse calcification on mammograms or pregnant women (cannot receive radiotherapy while pregnant). ). This method is relatively contraindicated for large breast tumors in women with small mammary glands, who have a history of collagen vascular disease because of possible complications of fibrosis and tissue necrosis after surgery.
Breast-conserving surgery is a method that brings many aesthetic and psychological benefits to patients. However, this method is only indicated for patients with early breast cancer detection. Therefore, women should periodically go for breast cancer screening to be detected early and have timely and effective treatment. Early detection increases the likelihood of breast preservation, preserving the aesthetic beauty of a woman. At the same time, the treatment of the disease at an early stage is also more effective, with fewer complications, and prevents cancer from progressing, metastasizing or recurring.

Vinmec International General Hospital is currently implementing a breast cancer screening package, providing 8 breast cancer screening packages for all customers. Breast cancer screening and screening at Vinmec, customers will be examined and consulted by experienced and highly specialized doctors; supported by the most modern medical equipment to ensure high accurate diagnosis efficiency and appropriate treatment regimen when unfortunately detected disease.
Summary of breast cancer screening packages at Vinmec Hospital:
Basic package: Customers under 40 years old, no breast changes, Gail 5-year risk model < 1.7% ; Standard package 1: Customers aged 40 years or older, no changes in breast are felt, Gail model 5-year risk < 1.7%; Standard package 2: Physician-determined age, client with no breast changes, Gail 5-year risk model from 1.7% or lifetime risk > 20% or Tyrer-Cuzick risk model lifetime > 20%; Standard package 3: Physician-determined age, client with no breast changes, Gail 5-year risk model from 1.7% or lifetime risk > 20% or Tyrer-Cuzick risk model lifetime > 20%; Advanced package 1: Customers aged 25 - 29 years old, have relatives with breast cancer, ovarian cancer, prostate cancer, pancreatic cancer who have not been tested for genes; Advanced package 2: Customers aged 30 years or older who have relatives with breast cancer, ovarian cancer, prostate cancer, pancreatic cancer who have not been tested for genes; Intensive package 1: Customers from 25 to 29 years old, whose relatives have breast cancer, ovarian cancer, prostate cancer, pancreatic cancer have been tested positive for genes; Intensive package 2: Customers aged 30 years or older, whose relatives have breast cancer, ovarian cancer, prostate cancer, pancreatic cancer have had a positive gene test. Specialist II Do Tuong Huan has 20 years of experience in the examination, diagnosis, and surgical treatment and chemotherapy of cancer pathologies. Dr. Huan worked for a long time at Ho Chi Minh City Oncology Hospital from 1999 to 2017 and now works at Vinmec Central Park International General Hospital from March 2017

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