• Conservative surgery plus radiotherapy is not suggested if there are multiple malignant or in situ tumors in
one breast, widespread microcalcifications on mammography or a history of collagen vascular disease. The
latter patients often develop scar tissue (reactive fibrosis) with radiation therapy , undesirable breast changes
that might require additional surgery.
• A small percentage of patients will develop a recurrence in the breast area following limited surgery to
conserve the breast. Mastectomy may still be able to control the disease in most cases.
• Radiotherapy or chemotherapy should not be given during pregnancy because of the hazard to the fetus.
• Another factor in selecting this option is the location of the primary tumor . Tumors in or near the nipple will
require its removal. Sometimes conservative surgery followed by radiation can still be done, but in some cases,
extensive disease is found extending along the ducts from the nipple to the base of the breast, which would
then require mastectomy. There is no unanimous agreement on the type of surgery needed for cancers near or
involving the nipple.
Adjuvant Chemotherapy and Hormone Therapy After surgical treatment to control local disease in the breast, adjuvant hormone or chemotherapy is recommended to reduce the risk of recurrence.
• Drug combinations shown to improve survival include CMF (cyclophosphamide + methotrexate +
5-fluorouracil [5-FU]) with or without VP (vincristine + prednisone), and CAF (cyclophosphamide +
