ASO Author Reflections: Bilateral Mastectomy After Neoadjuvant Therapy: An Ever-Increasing Trend?

Excerpt

Neoadjuvant chemotherapy was initially used in the context of large tumors and locally advanced disease. The early randomized trials of neoadjuvant chemotherapy (National Surgical Adjuvant Breast and Bowel Project [NSABP] B-18 and B-27) demonstrated an increase in patients eligible for breast-conserving surgery after neoadjuvant chemotherapy.1 During the past decade, neoadjuvant therapy has been used increasingly for earlier-stage disease2 such as node-positive, hormone receptor-negative, or human epidermal growth factor receptor 2 (HER2)neu-positive disease to learn more about the biology and tumor response to therapy, which has been linked to prognostic indicators such as disease-free and overall survival. During the same period, a trend of increasing rates for bilateral mastectomy have been observed.3 The authors were interested in seeing whether the trend of increasing bilateral mastectomy for breast cancer was being replicated for patients undergoing neoadjuvant therapy, particularly patients with a tumor complete response to neoadjuvant therapy who in the past would have undergone breast-conserving surgery. …