title: The oncologic safety and practicality of breast conservation surgery in large breast tumors 5 centimeters or more.
abstract: BACKGROUND
  Surgery remains a therapeutic strategy for women with breast cancer, and long-term outcomes for breast conservation surgery (BCS) and radiotherapy are equivalent to those for mastectomy. To date, there are few published data assessing the oncologic safety and practicality of BCS in women with large breast cancers ≥ 5 cm. The current study compares survival outcomes for women with breast cancer ≥ 5 cm undergoing BCS or mastectomy.
  
  
  METHODS
  All women undergoing surgery for breast cancer ≥ 5 cm between January 2004 and December 2011 were included in this study. Kaplan-Meier survival curves statistically compared the overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS) in the BCS and mastectomy groups. Statistical analysis involved chi-square analysis and t test. The mean length of follow-up was 55.25 months (range, 6-115 months).
  
  
  RESULTS
  A total of 217 women had surgery for tumors ≥ 5 cm (BCS in 51, mastectomy in 166). There was no statistical difference in the OS, DFS, and LRFS between groups (P = .439; 95% confidence interval, 0.114-0.347). The re-excision rate of women undergoing BCS was 45.1%, with 65.2% of women undergoing a completion mastectomy. Extensive ductal carcinoma in situ represented the only significant risk factor associated with inadequate margins (P = .021). Larger tumor size was associated with a greater risk of local recurrence (P = .039).
  
  
  CONCLUSIONS
  This study is one of the largest studies to date to report BCS + radiotherapy as a safe oncologic treatment option for women with large breast cancers. However, the higher re-excision rate advocates a need to investigate ways to improve patient selection.
authors: Department of Surgery, Galway University Hospital, Galway, Ireland. Electronic address: conormsugrue@rcsi.ie.
authors: Conor M
authors: CM
authors: Sugrue
authors: Department of Surgery, Galway University Hospital, Galway, Ireland.
authors: Peadar S
authors: PS
authors: Waters
authors: Department of Surgery, Galway University Hospital, Galway, Ireland.
authors: Karl J
authors: KJ
authors: Sweeney
authors: Department of Surgery, Galway University Hospital, Galway, Ireland.
authors: Carmel
authors: C
authors: Malone
authors: Department of Surgery, Galway University Hospital, Galway, Ireland.
authors: Kevin
authors: K
authors: Barry
authors: Department of Surgery, Galway University Hospital, Galway, Ireland.
authors: Michael J
authors: MJ
authors: Kerin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D008408:Mastectomy; D015412:Mastectomy, Segmental / Q000009:adverse effects / Q000379:methods; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D016019:Survival Analysis; D047368:Tumor Burden; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents
keywords: Breast cancer; Breast conservation surgery; Disease-free survival; Ductal carcinoma in situ; Local recurrence