Table Of ContentLynda Wyld · Christos Markopoulos
Marjut Leidenius · Elżbieta Senkus-Konefka Editors
Breast Cancer
Management for
Surgeons
A European
Multidisciplinary Textbook
123
Breast Cancer Management for Surgeons
Lynda Wyld
Christos Markopoulos
Marjut Leidenius
Elżbieta Senkus-Konefka
Editors
Breast Cancer
Management for
Surgeons
A European Multidisciplinary Textbook
Editors
Lynda Wyld Christos Markopoulos
The Medical School Department of Oncology Athens University Medical School
University of Sheffield Athens, Greece
Sheffield, United Kingdom
Elżbieta Senkus-Konefka
Marjut Leidenius Department of Oncology & Radiotherapy
Helsinki University Hospital Gdańsk Medical University Department of Oncology
Helsinki, Finland & Radiotherapy
Gdańsk, Poland
ISBN 978-3-319-56671-9 ISBN 978-3-319-56673-3 (eBook)
https://doi.org/10.1007/978-3-319-56673-3
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V
Foreword
Foreword by: and are also robustly prepared to apply for the rel-
evant UEMS Exams. The superb textbook that you
Professor Vassilios Papalois have in your hands is testimony to this great effort.
Imperial College Healthcare NHS Trust, London, UK
Secretary General of the European Union of Medical I truly enjoyed reading each chapter that is written
Specialist (UEMS) most clearly and elegantly and addresses all ele-
ments of modern practice: evidence based
It is a great honour to offer this forward for this approach, multidisciplinary/ team work, state of
world class textbook for the multidisciplinary the art experience, expertise and clinical pathways
management of breast cancer for surgeons. I will as well as constructive use of technology.
first address with great pleasure the fact that this is
a European textbook reflecting the widely known I was particularly impressed by the fact that the
and well respected experience and expertise of textbook combines scientific accuracy and robust-
Colleagues across Europe with whom I had the ness with the authors’ genuine interest and truly
real privilege to work closely when I was President humane approach for the patients. The textbook is
of the Section of Surgery of the Union of European inspired by the Hippocratic (and pan-European!)
Medical Specialists (UEMS) and over the last two values of medical humanism.
years as UEMS Secretary General.
I believe that Colleagues of all specialties and ranks
The UEMS is an organisation with almost 60 years of who are actively involved in breast cancer treat-
history, representing, through their National Medi- ment will find this textbook a powerful ally and
cal Associations, 39 Countries in the EU and beyond, compelling navigator that will guide them through
a total of 1.6 million medical specialists. The UEMS the complexities of this ever evolving area of mul-
work on the ground is being done by 43 Specialist tidisciplinary practice that affects the lives of mil-
Sections that also collaborate though 15 Multidisci- lions of patients around the world.
plinary Joint Committees for areas of practice which
are of interest to more than one Section. Congratulations and Kudos to the Editors and the
Authors!
The UEMS prides itself for being an organisation
that develops real projects for real people in real life! Enjoy sailing through its pages!
The development of the UEMS European Training
Requirements (ETRs) and Exams are two flagship
projects for the UEMS. The ETRs and the Exams are
developed by the UEMS Sections in close collabora-
tion with the relevant European Scientific Societies.
This is being done through a truly wide and in depth
consultation across Europe that embraces Universi-
ties, Scientific Societies and Professional Colleges
and Associations; the final product has the review
and approval of the National Medical Associations
represented in the UEMS. I cannot really think of a
more robust process for developing such quality
control projects as the UEMS ETRs and Exams aim-
ing to advance and harmonise specialist practice in
Europe that will of course translate into top class
clinical care for patients.
The Divisions of Breast Surgery of the Section of
Surgery of the UEMS has been one of the most
active and productive players in the field of UEMS
ETRs and Exams. They have also gone one step fur-
ther and they have produced superb educational
material in support of Colleagues across Europe
who wish to ensure that their knowledge is up to
speed and meets the standards of the UEMS ETRs
Preface from the UEMS – EBS – Division of
Breast Surgery
A few years ago, EUSOMA (the European Society This textbook, written by European-based breast
of Breast Cancer Specialists) published a position cancer specialists from all management disciplines
paper on “Guidelines on the standards for the involved in modern breast cancer care, will serve as
training of specialized health professionals deal- the syllabus for the EBSQ in breast surgery exam.
ing with breast cancer”. Theoretical and practical Breast surgeons have a leading role in the manage-
requirements for the training of a “breast sur- ment of patients with breast cancer, and all current
geon” were described in detail, as well as an necessary knowledge for evidence-b ased breast
assessment strategy – specialist exams – on how a cancer management is included in its chapters. Fur-
candidate could be qualified as a “specialist in thermore, this textbook will also serve as a helpful
breast surgery”. reference tool in everyday practice for everyone
involved in the care of breast cancer patients.
Following that, the UEMS (European Union of
Medical Specialists) expressed its support for pro- On behalf of the UEMS-EBS-Division of Breast
posals in the guidelines, and as a result, the breast Surgery, I would like to express my deep apprecia-
surgery working group was established in the tion to the editors and co-authors of the book for all
UEMS Section of Surgery, and the breast surgery their efforts and to Springer for this great edition.
examination was launched in 2010.
Professor Christos J. Markopoulos
The exam is part of the series of professional exam- President of the Division of Breast Surgery
inations offered by the European Board of Surgery at the Section of Surgery of the UEMS-EBS
(EBS) and results in the award of a European
Board of Surgery Qualification (EBSQ) in breast
surgery examination. Graduates of the exam may
use the post-nominal FEBS or Fellow of the Euro-
pean Board of Surgery. Considering the recog-
nized success of the project, the UEMS proceeded
in 2015 to officially upgrade the breast surgery
working group to a full division within the Euro-
pean Board of Surgery, the Division of Breast Sur-
gery, recognizing its status as an increasingly
important specialist group of surgeons.
The EBSQ in breast surgery exam is organized
twice per year, and respected and recognized
breast surgeons from all over Europe are invited to
act as examiners. In our common effort to improve
the quality of health services for breast cancer
patients across Europe, we strongly believe that the
EBSQ exams play an important role. A breast sur-
geon holding an EBSQ diploma has official recog-
nition that she/he meets EBSQ application
requirements with regard to specialist education,
training and experience and has up-to-date knowl-
edge of breast cancer management.
VII
Preface from the European Society of Surgical
Oncology
Half a million women develop breast cancer, and This textbook summarizes the expected knowl-
100,000 women die of the disease each year in edge which any breast cancer surgeon has to pos-
Europe. This represents a massive health burden sess in order to pass the exam.
but one where outcomes are steadily improving.
Outcomes continue to vary widely across Europe I congratulate the editors and all contributors to
due to differences in early detection and wide this ambitious editorial and educational project; it
variance in therapy schedules. Breast cancer sur- is here to reassure all breast cancer patients that
geons play a leading role in the delivery of care to they will receive the best management possible
women with breast cancer, and over 60% of breast today and to lay the foundations for future research.
cancers are cured by surgery alone. However, the
increasingly complex treatment schedules require Professor Riccardo A. Audisio
that surgeons have in-depth knowledge of Immediate Past President of ESSO
evidence- based multidisciplinary practice.
Harmonization of outcomes across Europe
requires education, training and quality assurance.
Specialist breast units are being set up across
Europe as per European Parliament resolutions
and European guidelines for quality assurance. A
programme of breast unit quality assurance is in
progress in the EU at the moment. This critically
important action, implemented by the European
Union, would be entirely useless if there was no
quality assurance of surgical management and
training in breast surgery.
ESSO (the European Society of Surgical Oncol-
ogy) is committed to this task. Numerous courses
and masterclasses have been organized, specialists
have set up a network to facilitate training across
Europe, grants are available to train young breast
surgeons, and the UEMS examination is solidly in
place to certify competence and multidisciplinary
understanding.
IX
Contents
I Basic Science
1 Gross Anatomy of the Breast and Axilla .......................................................................................................... 3
Peter Palhazi
2 P hysiology and Developmental Stages of the Breast ............................................................................. 11
Theodore G. Troupis, Adamantios Michalinos, George Skandalakis, and Panayiotis Skandalakis
3 Breast Cancer Epidemiology.................................................................................................................................... 19
R.M. Parks, M.G.M. Derks, E. Bastiaannet, and K.L. Cheung
4 E ffect of Oestrogen Exposure, Obesity, Exercise and Diet
on Breast Cancer Risk ................................................................................................................................................... 31
Eleni Th. Petridou, Marios K. Georgakis, and Constantine N. Antonopoulos
5 H ereditary Breast Cancer Genetics and Risk Prediction Techniques ............................................ 43
Helena Carley and Anju Kulkarni
II Screening, High Risk Lesions, and Risk Management
6 S creening for High-Familial-R isk Women ....................................................................................................... 59
Athina Vourtsis
7 Risk-Reducing Breast and Ovarian Surgery for Women at High Familial Risk ....................... 69
Inkeri Schultz and Kerstin Sandelin
8 T he Role of Breast Cancer Chemoprevention in High-Risk Women ............................................... 79
Lynda Wyld
9 Molecular Profiling of Breast Cancer and DCIS ........................................................................................... 89
Christos Markopoulos
10 Pathology of High-Risk Breast Lesions ............................................................................................................. 103
Sarah E. Pinder and Abeer M. Shaaban
11 Ductal Carcinoma in Situ ............................................................................................................................................ 115
Stacey A. Carter, Sarah E. Pinder, and Alastair M. Thompson
12 I maging of the Breast ................................................................................................................................................... 127
Petra Steyerova
13 Breast Cancer Screening ............................................................................................................................................. 147
John Mathew and Mark Sibbering
III Early Breast Cancer: Diagnosis and Management
14 C linical Presentation, Diagnosis and Staging of Breast Cancer ....................................................... 159
Janez Zgajnar
X Contents
15 Pathology of Breast Cancer ...................................................................................................................................... 177
Frederique Penault-Llorca and Nina Radosevic-Robin
16 The Breast and Oncoplastic Multidisciplinary Team................................................................................ 193
Fiona MacNeill, Marios Konstantinos Tasoulis, and Melissa Ley Hui Tan
17 Surgery to the Breast: Mastectomy. .................................................................................................................... 203
Petros Charalampoudis and Tibor Kovacs
18 Surgery to the Breast: Breast Conservation Techniques ....................................................................... 213
Marjut Leidenius
19 O ncoplastic Breast-Conserving Therapy ......................................................................................................... 229
Elias E. Sanidas and Florian Fitzal
20 F at Transfer in Oncoplastic and Reconstructive Breast Surgery ...................................................... 245
Riccardo Bonomi, I. Fabio Rapisarda, Gilles Toussoun, and Loraine Kalra
21 B reast Surgery after Primary Systemic Treatment .................................................................................... 255
Thorsten Kuehn
22 S urgery for Locally Recurrent Breast Cancer ................................................................................................ 263
Roberto Agresti, Andrea Spano, Giulia Bianchi, and Giovanna Trecate
23 M anagement of the Axilla: Sentinel Lymph Node Biopsy ................................................................... 275
Leif Bergkvist and Jan Frisell
24 A xillary Node Clearance ............................................................................................................................................. 285
Tuomo J. Meretoja
25 Axillary Management in the Neoadjuvant Setting ................................................................................... 291
K. Wimmer, F. Fitzal, R. Exner, and M. Gnant
26 A xillary Reverse Mapping: ARM ............................................................................................................................ 303
Isabel T. Rubio, Ernest J.T. Luiten, and V. Suzanne Klimberg
IV Reconstructive Surgery
27 Immediate Reconstruction: General and Oncological Considerations ....................................... 315
Maria João Cardoso and Giuseppe Catanuto
28 D elayed Breast Reconstruction: General and Oncological Considerations ............................. 325
Zoltán Mátrai
29 Breast Implants: Design, Safety and Indications for Use ...................................................................... 355
Jana de Boniface and Inkeri Schultz
30 S pecific Implant-Based Techniques for Breast Reconstruction ........................................................ 365
Lorna J. Cook and Michael Douek
31 S pecific Autologous Flap Techniques ................................................................................................................ 381
Sinikka Suominen and Maija Kolehmainen
XI
Contents
32 G oldilocks Procedure ................................................................................................................................................... 393
Fiona MacNeill
33 N ipple Reconstruction ................................................................................................................................................. 401
Valentina Lefemine and Kelvin F. Gomez
34 Complications of Breast Surgery and Their Management ................................................................... 411
Michalis Kontos and Christos Markopoulos
V Adjuvant Therapy for Early Breast Cancer
35 A djuvant Endocrine Therapy ................................................................................................................................... 427
Manuela Rabaglio and Monica Castiglione
36 A djuvant Chemotherapy ............................................................................................................................................ 439
Giuseppe Curigliano, Angela Esposito, and Carmen Criscitiello
37 A djuvant Molecular Therapies in Breast Cancer......................................................................................... 447
A. Prove, L.-A. Teuwen, and L. Dirix
38 P rimary Systemic Therapy for Breast Cancer ................................................................................................ 453
Cornelia Liedtke and Hans-Christian Kolberg
39 Radiotherapy for Breast Cancer ............................................................................................................................ 463
Barbara Alicja Jereczek-Fossa, Maria Cristina Leonardi, and Samantha Dicuonzo
VI Breast Cancer in Special Groups
40 B reast Cancer in Special Groups: Young Women with Early Breast Cancer .............................. 487
Rossella Graffeo and Olivia Pagani
41 H ereditary Breast Cancer ........................................................................................................................................... 499
Teresa Ramón y Cajal, Anna Virgili, and Nuria Dueñas
42 B reast Cancer in Special Groups: Breast Cancer in Pregnancy ......................................................... 511
Matteo Lambertini, Hatem A. Azim Jr, and Fedro Alessandro Peccatori
43 F ertility Preservation in Women with Breast Cancer ............................................................................... 521
Anna Rachelle Mislang, Matteo Lambertini, and Laura Biganzoli
44 B reast Cancer in Older Patients ............................................................................................................................. 529
Anne Shrestha and Lynda Wyld
45 B reast Cancer in the Male Patient ........................................................................................................................ 541
M. Umit Ugurlu and Bahadir M. Gulluoglu
46 S arcoma of the Breast .................................................................................................................................................. 551
Erkki Tukiainen and Andrew Lindford
47 D esmoid (Aggressive) Fibromatosis of the Breast .................................................................................... 559
Nicholas C. Eastley, Jaroslaw Krupa, and Robert U. Ashford
