How to reduce risk of local recurrence after conservative treatment of breast cancer.

If for invasive breast carcinomas or DCIS, global survival is thesame after association of conservative surgical treatment and radiotherapyor total mammectomy, risk of local recurrence remainsmore important after conservative treatment (1%/year).Reduction of this risk, while obtaining a satisfactory cosmetic result,constitutes a major challenge to the management of breast cancer.Indeed, most of the local failures after conservative treatment arecurrently treated by total mammectomy, often in association withmedical treatment such as hormonotherapy or chemotherapy. Managementof breast cancer could be improved and risk of local recurrencecould be reduced by giving particular attention to the surgicalmargins status. If surgical margins have to be healthy, quadrantectomyconcerning cosmetic results not always recommended, relativeignorance of the evolution of the residual hearths despite radiotherapy,the variability of the studies concerning the influence ofthe quality of the margins on the risks of residual lesions and localfailures, lead however to the absence of consensus. Thus, the rate of“true” local recurrence could be reduced.It appears very probable that local “failures” in the future will infact be new neoplasic localisations, that radiotherapy would nothave avoided and whose recognition at the time of the initial tumourwould have necessitated a total mammectomy. The eventualityof a new cancer justifies lifelong surveillance and the risk ofnew neoplasic localisations mustn’t reduce the practice of conservativetreatment.