The Surgical clinics of North America
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Surg. Clin. North Am. · Apr 2013
ReviewScreening, imaging, and image-guided biopsy techniques for breast cancer.
Mammography remains the primary modality for breast cancer diagnosis. Other imaging studies, most commonly ultrasonography and magnetic resonance imaging, are also used to characterize breast lesions, stage breast cancer, and aid in surgical planning. Although mammography is the only screening examination demonstrated to decrease breast cancer mortality in the general population, other imaging studies have been shown to be beneficial for screening high-risk patients. In the future, new technologies may also improve the sensitivity and specificity of breast cancer screening and detection.
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Apart from BRCA1, BRCA2, and TP53, more than a dozen breast cancer susceptibility genes have been identified. Recognizing affected individuals depends on evaluation of cancer family history and recognition of certain phenotypic markers on physical examination. ⋯ Mutation carriers have several options for managing risk, including lifestyle alterations, enhanced surveillance, chemoprevention, and prophylactic surgery. Genetic counseling and testing should be considered in the initial evaluation of patients with newly diagnosed breast cancer because this information contributes to surgical decisions, radiation therapy options, and systemic therapy choices.
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Surg. Clin. North Am. · Apr 2013
ReviewSurgical management of the breast: breast conservation therapy and mastectomy.
The twentieth century has witnessed dramatic changes in the surgical management of breast cancer. Herein we focus on the evolution of breast conservation surgery and current surgical trends of lumpectomy, mastectomy and contralateral prophylactic mastectomy. ⋯ Despite these advances, mastectomy remains a popular choice for many women and the use of nipple sparing procedures is increasing. Overall the low rates of local recurrence are attributed to the combination of surgery and targeted adjuvant and radiation therapies.