Description

Breast cancer has a long natural history with a predisposition towards early onset systemic disease. Breast conservation surgery with radiotherapy is widely accepted as standard surgical treatment for many stage I and II cancers, limiting the indications for mastectomy to large tumours relative to breast size, multifocal disease and those with an extensive intraduct component. Most oncologists would recommend mastectomy when local breast recurrence occurs despite optimum primary treatment. The introduction of breast screening programmes has resulted in the increased detection of ductal carcinoma in-situ (DCIS). The risk of long term recurrence in DCIS after breast conservation may be as high as 50%, with 25% of recurrent cases containing invasive disease. Patients with extensive DCIS may thus choose to have mastectomy even when breast conservation is a reasonable option. Advances in cancer genetics and the means to identify affected individuals enable informed decisions to be made on prophylactic mastectomy. Immediate breast reconstruction should be an option available to women who require total mastectomy.