Breast cancer management isn’t “mastectomy vs lumpectomy.” It’s risk → imaging → tissue diagnosis → staging → locoregional control → systemic therapy, all tailored to tumor biology and patient goals.

In this episode, we walk through the modern evidence base that moved us from Halsted-era radical surgery to breast-conserving therapy + targeted systemic therapy, while keeping oncologic safety front and center.

Key takeaways:

• Screening: Average risk = annual mammography starting at 40; high-risk patients may add MRI starting ~30.

• Pathology framework: DCIS (basement membrane) vs LCIS (risk marker) vs invasive (ductal most common; lobular often occult on mammo).

• Breast conservation: Lumpectomy with negative margins + RT achieves survival comparable to mastectomy; RT dramatically improves local control.

• Axilla: SLNB is standard staging in early disease with lower morbidity; many patients avoid completion ALND depending on criteria + adjuvant RT.

• Systemic therapy: Endocrine therapy and targeted agents reduce recurrence risk—selection is tumor-marker driven.

Disclaimer: This content is for educational purposes only and is not medical advice.

#BreastCancer #BreastSurgery #PlasticSurgery #GeneralSurgery #Oncoplastic #SurgicalOncology #Residency #SLNB #DCIS #Mastectomy

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Citations (AMA):

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3. Clarke M, Collins R, Darby S, et al. Lancet. 2005;366(9503):2087-2106. doi:10.1016/S0140-6736(05)67887-7. PMID:16360786.

4. Giuliano AE, Hunt KK, Ballman KV, et al. JAMA. 2011;305(6):569-575. doi:10.1001/jama.2011.90. PMID:21304082.

5. Fisher B, Costantino J, Redmond C, et al. N Engl J Med. 1993;328(22):1581-1586. doi:10.1056/NEJM199306033282201. PMID:8292119.

6. Fisher B, Dignam J, Wolmark N, et al. Lancet. 1999;353(9169):1993-2000. doi:10.1016/S0140-6736(99)05036-9. PMID:10376613.