title: Preoperative chemotherapy decreases the need for re-excision of breast cancers between 2 and 4 cm diameter.
abstract: BACKGROUND
  It is accepted that preoperative chemotherapy can result in increased breast preservation for breast cancers greater than 4 cm. The benefits of preoperative chemotherapy are less clear, however, for patients who present with smaller tumors and are already candidates for breast-preserving surgery. The goal of this study is to assess the effect of preoperative chemotherapy on breast cancers between 2 and 4 cm diameter.
  
  
  METHODS
  A retrospective chart review was conducted of patients diagnosed with new breast cancer at the Yale-New Haven Breast Center for the years 2002-2007. Patients were included in the study if their breast cancer was between 2 and 4 cm and their initial surgical treatment had been completed. Patients with distant metastases were excluded.
  
  
  RESULTS
  There were 156 new cancers that met study requirements. Forty-seven patients underwent preoperative chemotherapy, and 109 patients had their surgery first, usually followed by chemotherapy. Initial surgery was lumpectomy for 31 out of 47 patients (66%) in the preoperative chemotherapy group compared with 62 out of 109 patients (57%) in the surgery group. For patients with lumpectomies, 2 out of 31 patients (6%) in the preoperative group had positive margins and required re-excision compared with 20 out of 62 patients (37%) in the surgery-first group (P<0.01).
  
  
  CONCLUSIONS
  We conclude that, for tumors between 2 and 4 cm, preoperative chemotherapy is associated with a significantly decreased rate of re-excision following lumpectomy. This not only results in fewer mastectomies, but also avoids the morbidity and inferior cosmetic results associated with a re-excision lumpectomy.
authors.affiliation: Department of Surgery, Yale Cancer Center, Yale University School of Medicine, New Haven, CT 06520, USA. carlajchristy@yahoo.com
authors.forename: Carla J
authors.initials: CJ
authors.lastname: Christy
authors.forename: David
authors.initials: D
authors.lastname: Thorsteinsson
authors.forename: Baiba J
authors.initials: BJ
authors.lastname: Grube
authors.forename: Dalliah
authors.initials: D
authors.lastname: Black
authors.forename: Maysa
authors.initials: M
authors.lastname: Abu-Khalaf
authors.forename: Gina G
authors.initials: GG
authors.lastname: Chung
authors.forename: Michael P
authors.initials: MP
authors.lastname: DiGiovanna
authors.forename: Kenneth
authors.initials: K
authors.lastname: Miller
authors.forename: Susan A
authors.initials: SA
authors.lastname: Higgins
authors.forename: Joanne
authors.initials: J
authors.lastname: Weidhaas
authors.forename: Lyndsay
authors.initials: L
authors.lastname: Harris
authors.forename: Fattaneh A
authors.initials: FA
authors.lastname: Tavassoli
authors.forename: Donald R
authors.initials: DR
authors.lastname: Lannin
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D001952:Bridged-Ring Compounds / Q000008:administration & dosage; D018270:Carcinoma, Ductal, Breast / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D018275:Carcinoma, Lobular / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008207:Lymphatic Metastasis; D008408:Mastectomy; D015412:Mastectomy, Segmental; D008875:Middle Aged; D009367:Neoplasm Staging; D011300:Preoperative Care; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D018943:Anthracyclines; D001952:Bridged-Ring Compounds; D043823:Taxoids; C080625:taxane