Risk factors and management of local recurrence following breast conservation surgery.

Although a number of histologic and treatment factors that individually and in combination predict for an increased risk of local recurrence after breast conserving surgery can be identified, none so obviously compromises survival that breast conservation is contraindicated because that risk factor is present. In-breast recurrence is associated with the risk of any disease remaining after lumpectomy if the breast is not irradiated and the risk of large amounts of residual disease if irradiation is used. Some risk factors appear to predict for both local recurrence and distant recurrence, whereas others predict an increased risk of local recurrence but appear to have little effect on the risk of metastatic disease. Overall, the relation between in-breast recurrence and the risk of systemic metastases is poorly understood. Furthermore, the efficacy of chemotherapy in decreasing the risk of systemic metastases after in-breast recurrence has not been evaluated. Mastectomy is the treatment of choice for in-breast recurrence after breast conserving surgery and radiation therapy. A few patients are candidates for a second attempt at breast conservation.