ABSTRACT
Historically, breast cancer was treated with mastectomy and axillary clearance, but in recent decades surgical de-escalation has reduced the morbidity of breast cancer surgery. The process started with trials such as the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-06 trial showing that survival with breast-conserving surgery (BCS) (plus radiotherapy) gives equivalent survival rates to mastectomy, albeit with a higher rate of local recurrence. Since then, rates of local recurrence have progressively reduced due to improved surgery, radiotherapy and systemic therapy. This paper, and several similar articles, have re-evaluated survival rates according to type of breast surgery and suggest that survival may be better with BCS, although the observational nature of the data, despite adjusting for confounders, means it is not possible to make any definitive conclusions.
