title: Utility of neoadjuvant chemotherapy in the treatment of operable breast cancer.
abstract: Neoadjuvant chemotherapy (NAC) is a legitimate alternative to first-line surgical therapy for the treatment of breast cancer patients, as level one evidence shows the effect on overall survival is equivalent to that of adjuvant chemotherapy. In the treatment of women with operable breast cancer, NAC provides a number of potential advantages including: improving the chance of achieving breast-conserving surgery, improving cosmesis after breast-conserving surgery, downstaging the breast and axilla, allowing time to fully consider surgical options, time for genetic testing and facilitating breast reconstruction in otherwise high-risk patients. However, in Australia, NAC is poorly utilized with less than 3% of women with operable breast cancer receiving NAC. This review discusses the potential harms and benefits of NAC, discusses areas of controversy in the use of NAC and describes how we have used NAC in our own practice. We conclude that if it is obviously necessary for the newly presenting breast cancer patient to have chemotherapy as part of the treatment, it is worth considering NAC. In many patients, the potential benefits of NAC outweigh the harms. However, maximizing these benefits is closely aligned with appropriate patient selection and timely multidisciplinary team communication.
authors.affiliation: Breast and Surgical Oncology, Poche Centre, North Sydney, New South Wales, Australia; Department of Surgery, Royal North Shore Hospital, St Leonards, New South Wales, Australia.
authors.forename: Rebecca L
authors.initials: RL
authors.lastname: Read
authors.forename: Kathy
authors.initials: K
authors.lastname: Flitcroft
authors.forename: Kylie L
authors.initials: KL
authors.lastname: Snook
authors.forename: Frances M
authors.initials: FM
authors.lastname: Boyle
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Spillane
mesh_terms: D000970:Antineoplastic Agents / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001315:Australia; D001943:Breast Neoplasms / Q000188:drug therapy* / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D005260:Female; D006801:Humans; D015412:Mastectomy, Segmental; D020360:Neoadjuvant Therapy; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents
keywords: breast cancer; neoadjuvant chemotherapy