Lisa A. Newman, MD, MPH

Breast-conserving surgery and mastectomy are equivalent treatments for invasive breast cancer patients in terms of overall survival. For the majority of patients, successful breast conservation requires a margin-negative lumpectomy and access to WBRT. CPM yields no definitive survival advantage.

This article will detail current management approaches to achieving breast conservation in patients with invasive breast cancer, including cases of bulky tumors and/or multiple tumors.

The progress that has been made by the surgical breast oncology community is a well-deserved source of pride. This is not to say, however, that our work is complete.

Ductal lavage is a procedure that can improve the stratification ofwomen with clinical evidence of increased breast cancer risk by thecytologic detection of atypia. The relative risk of future breast cancerin women harboring atypia is approximately 3 to 5, as demonstrated instudies of women harboring atypia within direct nipple aspirates, fineneedleaspiration biopsies, and histopathology from surgical specimens.It is intuitively reasonable and biologically plausible that atypia detectedin ductal lavage specimens would be associated with a comparablemeasure of association; however, documentation of this assumptionawaits maturation of prospectively accumulated data. The technologyof the ductal lavage procedure is also a promising translational researchtool, because of the relatively substantial yield of ductal cellularmaterial for analysis via a minimally invasive technique.