Surgical Treatment of Minimal Breast Cancer

Abstract

The surgical approach to minimal breast cancer is still under discussion. In fact by the term « minimal » three lesions are meant, namely « lobular carcinoma in situ », « intraductal carcinoma » and invasive « microcarcinoma ». It is really difficult to indicate appropriate treatment for these tumors, also because the series reported in the literature are few and represented by a small number of cases. The present paper is a critical review of the literature on the subject. According to the most recent view lobular carcinoma in situ and intraductal carcinoma demand for radical surgery (total mastectomy) due to the high percentage of multicentricity and bilaterality of these lesions. More particularly with regard to lobular carcinoma in situ recent reports claim for a « wait and see » policy which is gaining favour, on the ground that the risk of developing invasive cancer in women with lobular carcinoma in situ is not so high and that the period of time between diagnosis of the lobular carcinoma and the development of the invasive cancer is usually very long. On the other side, for intraductal carcinoma, axillary dissection seems to be pleonastic due to the low percentage of secondary deposits in axillary lymph-nodes (1-3 %) in women operated on for intraductal carcinoma. Invasive microcarcinomas, less than 5 mm in diameter, should be considered as T₁N₀ tumors; actually there is no reason to treat them by a more conservative surgery than is done for T₁N₀ cancers, as they present the same involvement of the axillary lymph-nodes. In a small series of 38 microcarcinoma observed at the Milan Cancer Institut N⁺ cases were 27 %.