How might systemic therapy practices impact on breast conservation?
As a consequence of studies demonstrating their efficacy in a wide range of indications, both chemotherapy and hormonal treatment are included in the initial treatment programme for an increasing proportion of breast cancer patients. In patients treated with conservation surgery and breast irradiation, the use of both postoperative chemotherapy and tamoxifen has clearly led to a decrease in local failure, and good local control can usually be obtained even in high-risk patients [31]. For example, microscopic excision margin status may have limited value in patients receiving both breast irradiation and chemoendocrine therapy [32]. Combined-modality treatment may negate the utility of the assessment of multiple `risk factors’ purportedly defining patients in whom BCT might be `unsafe’. Because the decision regarding systemic therapy can be based on clinical and biopsy data in most patients, there has been a tendency in recent years to favour administering chemo- or hormonal therapy prio
