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Mastectomy rates among women with early breast cancer in Asia have traditionally been high. This study assessed trends in the surgical management of young women with early-stage breast cancer in Asian settings. Survival in women treated with breast-conserving surgery (BCS; lumpectomy with adjuvant radiotherapy) and those undergoing mastectomy was compared. Young women (aged less than 50 years) newly diagnosed with stage I or II (T1-2 N0-1 M0) breast cancer in four hospitals in Malaysia, Singapore and Hong Kong in 1990-2012 were included. Overall survival (OS) was compared for patients treated by BCS and those who had a mastectomy. Propensity score analysis was used to account for differences in demographic, tumour and treatment characteristics between the groups. Some 63·5 per cent of 3536 women underwent mastectomy. Over a 15-year period, only a modest increase in rates of BCS was observed. Although BCS was significantly associated with favourable prognostic features, OS was not significantly different for BCS and mastectomy; the 5-year OS rate was 94·9 (95 per cent c.i. 93·5 to 96·3) and 92·9 (91·7 to 94·1) per cent respectively. Inferences remained unchanged following propensity score analysis (hazard ratio for BCS mastectomy: 0·81, 95 per cent c.i. 0·64 to 1·03). The prevalence of young women with breast cancer treated by mastectomy remains high in Asian countries. Patients treated with BCS appear to survive as well as those undergoing mastectomy.

Background Malignant/borderline phyllodes tumors (PTs) are rare, and little is known about their long-term prognosis. This study sought to evaluate recurrence rates and identify factors associated with local and distant failure. Methods From 1957 to 2017, we identified 124 patients with 125 PTs (86 malignant and 39 borderline). Recurrence rates and survival were assessed using the Kaplan–Meier method, and correlated with clinicopathologic factors using the log-rank test. Results The median age of the patients was 44 years, and the median tumor size was 5 cm. Breast-conserving surgery was performed for 57% of the patients. At a median follow-up of 7.1 years, 14 patients experienced a locoregional recurrence (LRR), with a 10-year cumulative LRR incidence of 12%. On univariable analysis, age younger than 40 years ( p  = 0.02) and close/positive margins ( p  = 0.001) were associated with increased risk of LRR. Seven patients developed distant disease, all occurring in malignant PTs. The 10-year distant recurrence-free survival was 94%. Uniformly poor pathologic features consisting of marked stromal cellularity, stromal overgrowth, infiltrative borders, and 10 or more mitoses per 10 high-power fields (hpf) were identified in 25 PTs (20%), and all distant recurrences occurred in this group. For the patients who did not have uniformly poor features, the 10-year disease-specific survival was 100%, and the overall survival was 94% compared with 66% and 57%, respectively, among those with poor features. Conclusion Malignant/borderline PTs without uniformly poor histologic features have an excellent prognosis after surgical resection, with a 10-year disease-specific survival of 100%. The presence of uniformly poor pathologic features predicts a poor prognosis. Efforts should be directed toward new treatment approaches for these tumors.

Multifocal multicentric breast cancer has traditionally been considered a contraindication to breast conserving surgery because of concerns regarding locoregional control and risk of disease recurrence. However, the evidence supporting this practice is limited. Increasingly, many breast surgeons are advocating breast conservation in selected cases. This short narrative review summarises current evidence on the role of surgery in multifocal multicentric breast cancer and shows that when technically feasible the option of breast conservation is oncologically safe.

The most prevalent malignancy among women is breast cancer; hence, treatment approaches are needed in consideration of tumor characteristics and disease stage but also patient preference. Two surgical options, Mastectomy and Breast Conserving Surgery (BCS), share the same survival outcomes, clinical or molecular factors; and explainable Machine Learning (ML) techniques like SHapley Additive exPlanations (SHAP) offer further insights. To compare the overall survival status of breast cancer patients undergoing Mastectomy versus BCS using ML models and SHAP values, identifying key predictors for survival. This study used the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) dataset, which contains 2509 patients with clinical and molecular features. The preprocessing steps included imputation of missing values, class balancing using Synthetic Minority Over-sampling Technique (SMOTE), and feature selection. Gradient Boosting was identified as the best model, considering metrics such as accuracy, precision, and Area Under the Receiver Operating Characteristic Curve (ROC-AUC). SHAP values were used for feature importance, detailing the contribution of predictors to survival outcomes in both surgical groups. Gradient Boosting achieved a training accuracy of 95.4% and test accuracy of 86.4% for Mastectomy, and 94.6% and 82.8% respectively for BCS. Strong predictors included Relapse Free Status, Nottingham Prognostic Index and Age at Diagnosis. SHAP analysis indicated that the Relapse Free Status was an important predictor across both surgeries though there were specific influences of Age and Menopausal State. Younger patients benefited more with BCS while older ones faced higher risks from Mastectomy. The performance for BCS was significantly higher-3.73 than the performance of Mastectomy-1.21. The SHAP-driven insights pointed toward a more personalized approach to treatment, depending on both clinical and molecular predictors. This will justify tailored surgical and adjuvant therapies in achieving optimized survival.

Introduction Recent studies have reported increases in the rate of mastectomy and contralateral prophylactic mastectomy (CPM). We hypothesized that there would be different reasons for choosing mastectomy for women aged <50 compared with those aged ≥50 years. Methods A questionnaire was administered to 332 patients who underwent unilateral or bilateral mastectomy for breast cancer from 2006 to 2010. The survey queried on demographics, surgical choices, and rationale for those choices. A retrospective chart review was performed to determine tumor characteristics. Responses and clinical characteristics were described by contingency tables and compared using Fisher exact test or χ 2 test, as appropriate. Results Of 332 patients surveyed, 310 were evaluable. Median age was 55 years, including 88 patients <50 (28 %) and 222 patients ≥50 (72 %) at time of diagnosis. Forty-four percent of women <50 and 41 % of women ≥50 were given the option of breast conservation and chose mastectomy ( p  > 0.63). The two groups did not differ in their reason for choosing mastectomy, with lower recurrence risk and improved survival cited as the two most common reasons. Younger patients were more likely to undergo reconstruction and CPM ( p  < 0.0001) as well as have estrogen receptor-negative tumors, undergo neoadjuvant chemotherapy, and have higher magnetic resonance imaging utilization ( p  < 0.05). Conclusions Choosing mastectomy and the reasons for doing so were the same for women aged <50 and ≥50 years. Prospective studies are needed to determine whether patient education regarding perceived versus actual recurrence risk and survival would alter this decision-making process.

PurposeMetaplastic breast cancer (MBC) is a rare, aggressive form of breast cancer with limited data to guide management. This study of a large, contemporary US database described national practice patterns and addressed the impact of radiotherapy (RT) on survival.MethodsThe National Cancer Data Base was queried (2004–2013) for women with non-metastatic MBC. Multivariable logistic regression ascertained factors associated with RT administration. Kaplan–Meier analysis evaluated overall survival (OS) between patients treated with either lumpectomy or mastectomy with or without RT, while substratifying patients into pT1–2N0 and pT3–4/N+ subcohorts. Cox proportional hazards modeling determined variables associated with OS.ResultsOf 5211 total patients, 447 (9%) had lumpectomy alone, 1831 (35%) had post-lumpectomy RT, 2020 (39%) had mastectomy alone, and 913 (18%) had post-mastectomy RT (PMRT). Most patients underwent chemotherapy (79%), and mastectomy was the most common surgical approach (56%). RT delivery was impacted by many factors, including higher nodal disease (p < 0.001), but not T classification or estrogen receptor status (p > 0.05 for both). Post-lumpectomy RT was associated with higher OS in both the pT1–2N0 and pT3–4/N+ subsets (p < 0.001 for both), while PMRT was associated with OS benefits in pT3–4/N+ cases (p < 0.001), but not in pT1–2N0 cases (p = 0.259).ConclusionsIn the largest study to date evaluating MBC, practice patterns of surgery, systemic therapy, and RT are described. The addition of RT in the post-lumpectomy setting was associated with higher OS, in addition to pT3–4/N+ in the post-mastectomy setting. Although not implying causation, further work is required to corroborate the conclusions herein.

Background and objective Nipple-sparing mastectomy (NSM) and skin-sparing mastectomy (SSM) are recognized for their aesthetic benefits in breast cancer patients. However, detailed evaluations with large samples of their long-term oncological effectiveness are limited. This study aims to compare the long-term oncologic outcomes of NSM/SSM and traditional mastectomy (TM) in patients with stage I-III breast cancer and to identify influential preoperative factors. Methods Among the 12,802 breast cancer patients who underwent surgery from 2009 to 2022 in West China Hospital of Sichuan University, 295 NSM/SSM patients and 584 TM patients were selected after propensity score matching adjusted for variables. Survival outcomes were analyzed using Kaplan-Meier estimates, Fisher’s exact test, and log-rank tests, with Cox regression identifying survival predictors. Results The median follow-up period was 97.93 months. Local recurrence (LR) was 5.76 ± 1.36% for NSM/SSM compared to 3.25 ± 0.73% for TM ( p  = 0.076). Overall survival (OS) was comparable ( p  = 0.601), while disease-free survival (DFS) showed a trend toward significance ( p  = 0.066). However, there was a significant difference in distant metastasis-free survival (DMFS) ( p  = 0.029). The 5-year OS rates between the matched groups were similar (98.11% vs. 98.09%, p  = 1.000), while the TM group exhibited higher 5-year DFS(95.14% vs. 92.03%, p  = 0.335). Following the univariate analysis, multivariate analysis identified significant DFS predictors: stage (HR = 2.701, p  = 0.031), radiotherapy (HR = 1.928, p  = 0.018), and targeted therapy (HR = 5.584, p  < 0.001). For OS, significant predictors included stage (HR = 8.309, p  = 0.021) and PR status (HR = 0.35, p  = 0.010). Conclusions NSM/SSM demonstrated comparable OS and DFS to TM, though with lower DMFS. Preoperative ultrasound parameters showed no significant impact on long-term outcomes, confirming the oncologic safety of NSM/SSM. Tailored adjuvant therapies and appropriate follow-up may further optimize patient prognoses.

Background Current treatment guidelines for male breast cancer are predominantly guided by female-only clinical trials. With scarce research, it is unclear whether breast-conserving therapy (BCT) is equivalent to mastectomy in men. We sought to compare overall survival (OS) among male breast cancer patients who underwent BCT versus mastectomy. Methods We performed a retrospective analysis of 8445 stage I–II (T1–2 N0–1 M0) male breast cancer patients from the National Cancer Database (2004–2014). Patients were grouped according to surgical and radiation therapy (RT). BCT was defined as partial mastectomy followed by RT. Multivariable and inverse probability of treatment-weighted (IPTW) Cox proportional hazards models were used to compare OS between treatment groups, controlling for demographic and clinicopathologic characteristics. Results Most patients underwent total mastectomy (61.2%), whereas 18.2% underwent BCT, 12.4% underwent total mastectomy with RT, and 8.2% underwent partial mastectomy alone. In multivariable and IPTW models, partial mastectomy alone, total mastectomy alone, and total mastectomy with RT were associated with worse OS compared with BCT ( p  < 0.001 all). Ten-year OS was 73.8% for BCT and 56.3, 58.0 and 56.3% for other treatment approaches. Older age, higher T/N stage, histological grade, and triple-negative receptor status were associated with poorer OS ( p  < 0.05). Subgroup analysis by stage demonstrated similar results. Conclusions In this national sample of male breast cancer patients, BCT was associated with greater survival. The underlying mechanisms of this association warrant further study, because more routine adoption of BCT in male breast cancer appears to translate into clinically meaningful improvements in survival.

Background The study investigates the prognostic differences between breast-conserving surgery (BCS) and mastectomy in patients with invasive ductal carcinoma of the breast who achieve a complete response (CR) after neoadjuvant chemotherapy. Methods This study analyzed data from 9,411 patients diagnosed with invasive ductal carcinoma of the breast who achieved complete response following neoadjuvant chemotherapy, using data from the SEER database between 2010 and 2019, comprising 4,219 patients in the BCS group and 5,192 in the mastectomy group. Propensity score matching (PSM) was employed to control for confounding variables, and univariate and multivariate analyses were performed to identify variables associated with overall survival (OS) and cancer-specific survival (CSS). Kaplan-Meier survival curves were used to evaluate the prognosis of patients in the two groups. Results The multivariate Cox regression analysis demonstrated that histological subtype, T stage, N stage, surgical method, and radiotherapy were risk factors for CSS, while age, histological subtype, T stage, and N stage were associated with OS ( p  < 0.05). Following matching, the Kaplan-Meier survival analysis curve suggested that the BCS group had higher CSS than the mastectomy group ( p  < 0.05), although there was no statistically significant difference in OS between the two groups ( p  = 0.16). Subgroup analysis revealed that, among patients aged ≤ 50, of White ethnicity, with grade 3 tumors, and HR+/HER-2- subtype, the BCS group exhibited superior CSS compared to the mastectomy group ( p  < 0.05). Conclusion Patients with invasive ductal carcinoma of the breast who achieve complete response following neoadjuvant chemotherapy experience better CSS benefits with BCS compared to undergoing mastectomy.

Sentinel-lymph-node (SLN) surgery was designed to minimise the side-effects of lymph-node surgery but still offer outcomes equivalent to axillary-lymph-node dissection (ALND). The aims of National Surgical Adjuvant Breast and Bowel Project (NSABP) trial B-32 were to establish whether SLN resection in patients with breast cancer achieves the same survival and regional control as ALND, but with fewer side-effects. NSABP B-32 was a randomised controlled phase 3 trial done at 80 centres in Canada and the USA between May 1, 1999, and Feb 29, 2004. Women with invasive breast cancer were randomly assigned to either SLN resection plus ALND (group 1) or to SLN resection alone with ALND only if the SLNs were positive (group 2). Random assignment was done at the NSABP Biostatistical Center (Pittsburgh, PA, USA) with a biased coin minimisation approach in an allocation ratio of 1:1. Stratification variables were age at entry (≤49 years, ≥50 years), clinical tumour size (≤2·0 cm, 2·1–4·0 cm, ≥4·1 cm), and surgical plan (lumpectomy, mastectomy). SLN resection was done with a blue dye and radioactive tracer. Outcome analyses were done in patients who were assessed as having pathologically negative sentinel nodes and for whom follow-up data were available. The primary endpoint was overall survival. Analyses were done on an intention-to-treat basis. All deaths, irrespective of cause, were included. The mean time on study for the SLN-negative patients with follow-up information was 95·6 months (range 70·1–126·7). This study is registered with ClinicalTrials.gov, number NCT00003830. 5611 women were randomly assigned to the treatment groups, 3989 had pathologically negative SLN. 309 deaths were reported in the 3986 SLN-negative patients with follow-up information: 140 of 1975 patients in group 1 and 169 of 2011 in group 2. Log-rank comparison of overall survival in groups 1 and 2 yielded an unadjusted hazard ratio (HR) of 1·20 (95% CI 0·96–1·50; p=0·12). 8-year Kaplan-Meier estimates for overall survival were 91·8% (95% CI 90·4–93·3) in group 1 and 90·3% (88·8–91·8) in group 2. Treatment comparisons for disease-free survival yielded an unadjusted HR of 1·05 (95% CI 0·90–1·22; p=0·54). 8-year Kaplan-Meier estimates for disease-free survival were 82·4% (80·5–84·4) in group 1 and 81·5% (79·6–83·4) in group 2. There were eight regional-node recurrences as first events in group 1 and 14 in group 2 (p=0·22). Patients are continuing follow-up for longer-term assessment of survival and regional control. The most common adverse events were allergic reactions, mostly related to the administration of the blue dye. Overall survival, disease-free survival, and regional control were statistically equivalent between groups. When the SLN is negative, SLN surgery alone with no further ALND is an appropriate, safe, and effective therapy for breast cancer patients with clinically negative lymph nodes. US Public Health Service, National Cancer Institute, and Department of Health and Human Services.