MULTIMODAL APPROACH IN BREAST CANCER TREATMENT

Breast cancer presents a true challenge for surgeons and for clinicians. If there is one pathology in which treatment revolves around a multidisciplinary approach, it is undoubtedly breast cancer. The reasons that led to the development of this treatment modality are numerous and, in all likelihood, beyond the scope of this study. At the core of this approach, as we always hope in medicine, lies the human being—in this case, the woman. From an epidemiological standpoint, breast cancer is one of the most prevalent malignancies, with an incidence that continues to rise. Consequently, increasing clinical pressure has led to growing attention from the scientific community, culminating in a marked, epoch-making acceleration in treatment over the past 30 years. This “revolution,” which began with the concept of organ preservation through quadrantectomy, has progressively evolved into the modern concept of lumpectomy with clear margins “no ink on tumor”. As a result, the array of possible surgical interventions to offer patients has expanded significantly and opened the possibility to treat patients before excluded. The progressive reduction in oncologic requirements for wide disease-free margins has enabled the design and implementation of a variety of surgical approaches to the breast. While oncologic surgery principles remain largely consistent across different malignancies and anatomical districts, the emotional impact of oncologic resection in a woman is unique, given that the organ involved is both distinctive and central to her identity. This awareness has driven the research and development of techniques aimed at optimizing not only oncologic outcomes but also aesthetic results; to meet these needs, fusion techniques combining ablative surgery and plastic surgery have emerged. Furthermore, with the advent of tailored medicine, clinicians and especially surgeons have stepped down from their metaphorical ivory towers, exposing themselves to patient-centered assessments through the introduction of Patient-Reported Outcomes (PROs). Within this clinical and cultural context, where the patient truly lies at the center, the scientific community has made further efforts to ensure that no patient cohort is excluded from the standard of care. For patients who are young and fit for surgery, the optimal therapeutic goal is to achieve oncologic radicality while minimizing the extent of surgery, following the principle of delivering the least invasive effective treatment. Conversely, in older patients with multiple comorbidities, the goal is to ensure surgical effectiveness without incurring additional morbidity linked to limited biological reserves. The present work aims to integrate these new philosophies of surgical management for patients with breast cancer into the reality of the Breast Surgery Clinic at Policlinico San Martino in Genoa.