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Breast cancer is a leading cause of cancer-related deaths among females in the world. The rapid growth of breast conservation therapy has significantly changed the management of early breast cancer, with outcomes shown to be equivalent to mastectomy when combined with radiation. This activity reviews the role of breast-conserving therapy in breast cancer treatment. It highlights the role of the interprofessional team in improving care for patients who undergo breast conservation therapy. Objectives: Identify Implthe indications for breast conservation therapy in the management of early-stage breast cancer. Determine the preoperative workup, operative steps, and post-operative follow-up for partial mastectomy with axillary lymph node mapping. Identify the most common adverse events following breast conservation therapy and associated risk factors. Implement interprofessional team strategies for improving care coordination and communication to advance breast-conserving therapy and improve outcomes. Access free multiple choice questions on this topic.

Breast cancer ranks among the leading causes of female cancer-related deaths in the world.[1] Surgical management remains the standard of care for noninvasive and localized invasive breast cancer, which may be combined with systemic endocrine therapy, chemotherapy, or radiation. With the publication of the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-06 trial, which showed equivalent disease-free survival, distant disease-free survival, and overall survival amongst women undergoing partial mastectomy with irradiation compared to radical mastectomy, breast conservation therapy (BCT) became standard of care for patients with tumors under 4 cm.[2] These results received confirmation in multiple studies, including a 20-year follow-up of the NSABP B-06 trial, where partial mastectomy followed by breast radiation continues to be appropriate in the management of smaller invasive breast cancer tumors.[3][4] Additionally, BCT, when combined with radiation, became the standard of care for localized intraductal breast cancers (eg, ductal carcinoma in situ [DCIS]). This development occurred after the NSABP B-17 trial, where the addition of radiation significantly decreased the recurrence rate of noninvasive and invasive breast cancers.[5] Identified advantages of BCT include reduced operative time, diminished psychological burden when compared with mastectomy, improved cosmetic outcomes, and limited side effects.[6][7] However, other studies have demonstrated no significant difference in depressive symptoms at one year post-operatively between women who underwent a total mastectomy, BCT, and breast reconstruction.[8] Proper staging is critical for determining the appropriate clinical treatment course and surgical planning. In 2018, the American Joint Committee on Cancer (AJCC) released the eighth edition of the Cancer Staging Manual for Breast Cancer. This staging includes the T (tumor), N (node), and M (metastases) staging, but incorporated biologic markers into the traditional staging system. Factors including estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2), tumor grade, and multigene assays were included to aid in determining prognosis and therapy as determined by a Clinical and Pathologic Prognostic Stage Group.[9]

Complications of breast cancer conservation therapy include: Seroma Hematoma Fat necrosis Infection with the development of cellulitis or abscess Altered sensation to the breast or nipple Close or positive margins Poor cosmetic outcome Lymphedema following sentinel lymph node biopsy Wound dehiscence, especially in oncoplastic technique; most commonly seen at the inverted T-junction in a wise incision pattern [22]

Interprofessional oncology teams incorporate a wide range of clinical specialists, including those in surgery, medical oncology, radiation oncology, genetics, pathology, specialist cancer nurses, and oncology pharmacists, to discuss the needs of patients with a confirmed cancer diagnosis. Globally, many healthcare systems address these needs at weekly interprofessional meetings.[33] Nursing is usually responsible for any medication administration accompanying breast-conserving surgery, and the oncology pharmacist will weigh in for checking dosing and agent selection options, working in conjunction with the oncologist and other clinicians. Retrospective studies have shown improved breast cancer survival rates when treated by an interprofessional team.[34] Moving forward, it is essential not only to continue utilizing interprofessional team meetings but also to optimize team dynamics and productivity to enhance patient-centered care and improve outcomes.

Nursing interventions for the patient undergoing BCT encompass the preoperative period, immediate postoperative, and long-term monitoring and surveillance of the patient. The most important preoperative action is to obtain arm measurements of the affected side; this provides the healthcare team with a baseline for lymphedema monitoring. Patients often fear lymphedema. Arm measurement is critical to providers but also reassures the patient that they receive close observation to ensure quick action if postoperative swelling does occur. This time also provides an opportunity to teach the patient a gentle range of motion exercises to prevent swelling. Secondly, it is crucial to provide thorough education surrounding the operation. Although surgeons do review the procedure and postoperative restrictions, many patients may be overwhelmed at that time. This stress may inhibit the patient, and their family, from thoroughly comprehending the information. A personal, one-on-one conversation can ensure the patient understands the operation. Reviewing the wire or wireless localization is necessary as many patients have a biopsy marker and may not understand why the area needs to be localized. The clinician should also review the purpose of sentinel lymph node biopsy, as many patients misconstrue this, assuming cancer has spread to the lymph nodes. In the immediate postoperative period, the nurse can address pain control. Education on the dosage of prescription and over-the-counter medication ensures patient safety. If a patient underwent oncoplastic surgery, she must understand that she must refrain from the use of ice on her breast for pain management, as this may compromise wound healing. During the balance of the patient’s postoperative period, education remains essential. Patients are anxious and eager about the "next step." This patient counsel provides time to review the cadence of treatment and the role of other specialties. The clinician should also take arm measurements beginning at 3 months postoperatively through 5 years to monitor for signs of lymphedema.

Clinicians must monitor patients undergoing BCT postoperatively for possible adverse reactions, both immediate and long-term. Immediate monitoring focuses primarily on incision assessment. Clinicians must watch for possible signs of infection, including warmth, erythema, fever, and purulent drainage. They should monitor for swelling as it may indicate a hematoma. Patients should receive instructions to call the office if they develop any of these symptoms. Long-term monitoring includes assessment for signs and symptoms of lymphedema through visual observation and performing arm circumference measurements.