Key points
- The course of treatment for breast cancer will be decided at a multidisciplinary meeting (MDM).
- Recommended option will depend on several factors, including breast cancer subtype, lymph node involvement and tumour size.
Content:
A breast cancer MDM will normally comprise surgeons, radiologists, pathologists, and medical and radiation oncologists, as well as breast care nurses and radiographers.
Around 70% of DCIS patients have breast-conserving surgery; the remainder undergo mastectomy. Omitting surgery for DCIS is currently only recommended in the context of clinical trials. The Management of Early Breast Cancer - Evidence-based Best Practice Guidelines recommends the below factors in determining whether patients undergo mastectomy or breast-conserving surgery:
- Ratio of the size of the tumour to the size of the breast and tumour location in terms of acceptable cosmesis
- The presence of multifocal/multicentric disease or extensive malignant microcalcification on mammogram which cannot be adequately cleared with an acceptable cosmetic result with breast-conserving surgery.
- Potential contraindications to local radiotherapy (e.g. previous radiotherapy at this site, connective tissue disease, severe heart and lung disease, pregnancy.)
- Fitness for surgery.
- Patient choice.
Treatment is considered complete after mastectomy; breast conserving surgery is followed by radiotherapy to reduce risk of recurrence.
