title: Optimal surgical management for high-risk populations.
abstract: The recognition that breast cancer is a group of genetically distinct diseases with differing responses to treatment and varying patterns of both local and systemic failure has led to many questions regarding optimal therapy for those considered to be high risk. Young patients, patients with triple-negative breast cancer (TNBC), and those who harbor a deleterious mutation in BRCA1 or BRCA2 are frequently considered to be at highest risk of local failure, leading to speculation that more-aggressive surgical treatment is warranted in these patients. For both age and the triple-negative subtype, it appears that the intrinsic biology which imparts inferior outcomes is not overcome with mastectomy; therefore, a recommendation for more extensive surgical therapy among these higher-risk groups is not warranted. For those at inherited risk, a more-aggressive surgical approach may be preferable, however; patient age, ER status, stage of the index lesion, and individual patient preferences should all be considered in the surgical decision-making process.
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA. Electronic address: tking7@partners.org.
authors.forename: Tari A
authors.initials: TA
authors.lastname: King
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA. Electronic address: pilewskm@mskcc.org.
authors.forename: Melissa
authors.initials: M
authors.lastname: Pilewskie
authors.affiliation: Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, 300 East 66th Street, New York, NY 10065, USA. Electronic address: morrowm@mskcc.org.
authors.forename: Monica
authors.initials: M
authors.lastname: Morrow
mesh_terms: D000367:Age Factors; D001943:Breast Neoplasms / Q000235:genetics / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D058889:Molecular Typing; D009154:Mutation; D009364:Neoplasm Recurrence, Local / Q000737:chemistry / Q000235:genetics / Q000473:pathology; D009367:Neoplasm Staging; D057240:Patient Preference; D065286:Prophylactic Surgical Procedures; D011960:Receptors, Estrogen / Q000032:analysis; D064726:Triple Negative Breast Neoplasms / Q000601:surgery
chemical_list: D011960:Receptors, Estrogen
keywords: BRCA mutation; Breast cancer; Triple-negative subtype; Young age