Due to an increase in breast cancer awareness as well as improvements in technology, more women who are diagnosed with breast cancer are diagnosed with early-stage disease. Tumor size, along with the status of the lymph nodes and the biologic behavior of the individual cancer impacts the therapy and prognosis of the disease. Many advances have been made in the treatment of women with early-stage breast cancer.

The primary treatment for most breast cancer remains surgery. Up until the 1970’s, the Halsted radical mastectomy was the surgical procedure most commonly performed.  In addition to removal of the breast, it also involved removal of the pectoralis muscle off of the ribs and a large number of underarm lymph nodes. The result was a significant deformity of the chest, as well as difficulty with arm movement and a high rate of lymphedema, or permanent swelling of the arm. The modified radical mastectomy was developed which still involved removal of the breast, but the muscle was not removed, and fewer lymph nodes were removed from the underarm.

As screening mammography became more popular, breast cancers were detected at a much smaller size than in prior years. The need to remove the entire breast for these small tumors was questioned. Lumpectomy, which involves removal of the tumor and a small rim of surrounding breast tissue (called the “margin”) was compared to mastectomy, and it was found that there was no difference in long-term survival between the two procedures. If radiation treatment is not performed after lumpectomy, the risk of the cancer returning in the breast is quite high, so this is a necessary step for successful breast conservation. Currently, lumpectomy with radiation treatment is considered to be the standard of care in women with small breast cancers. Oncoplastic techniques (combining cancer surgery and plastic surgery) can result in an improved cosmetic outcome after breast-conserving surgery.

Removal and evaluation of the underarm lymph nodes has always been a part of breast cancer surgery. Despite our advances in imaging such as MRI and PET scans, removal of the lymph nodes and evaluation by the pathologist remains the most accurate way to tell if the cancer has spread into the lymph nodes.  This information is important as it helps to determine if a woman requires chemotherapy after surgery. As less than 20% of women with early-stage breast cancer have spread of the cancer to the lymph nodes, the sentinel lymph node mapping technique was developed so that the surgeon can identify the just the first one or more lymph nodes that drain the breast, and only those nodes are removed. The risk of lymphedema from a sentinel lymph node dissection is lower than after standard axillary node dissection, and discomfort and arm mobility problems are reduced.

Another advance has come in the radiation treatment given after lumpectomy. Standard radiation therapy after lumpectomy is given over the course of 6 weeks - the entire breast is treated, which may lead to skin thickening, scarring, and burns. Rarely, damage to the ribs, lungs and heart can occur. Accelerated partial breast irradiation (APBI) involves targeted radiation therapy which is delivered using a catheter directly to the area where the tumor was removed, known as the “lumpectomy bed”. Because the radiation is being delivered directly into the breast tissue, a higher dose can be used, reducing the treatment time from 6 weeks down to just 5 days. In addition, the potential for damage to the skin, ribs, lungs and heart is significantly reduced, and normal uninvolved breast tissue does not get treated.  Studies have demonstrated equivalent recurrence rates in women treated with whole-breast irradiation compared to partial breast irradiation.

Lumpectomy, sentinel lymph node biopsy, and accelerated partial breast irradiation are only possible in women who have small, early stage breast cancers. This reinforces the need and importance for early detection. Women should practice breast self-awareness, and should discuss with their physicians the appropriate imaging tests to improve their rate of early detection. In addition, maintaining a healthy diet and lifestyle will help reduce the risk of even developing a breast cancer, and much promising research is ongoing in the area of breast cancer prevention.