New advances in the surgical treatment of breast cancer

The introduction of a national breast screening programme’ and the re-organization of cancer services in the UK* has had an immense effect on public expectation, and on those providing breast cancer services. Recognition of the need for greater collaboration and expertise3 has coincided with profound changes in specialist training programmes which will lead to earlier specialization.4 Meanwhile the profession has responded by developing a curriculum for trainees with an interest in breast disease,5 heralding the birth of a new generation of specialist breast surgeons. Even so, some of today’s consultants and their trainees feel uneasy about these changes which threaten to ‘box them in’, committing them to work in a narrow field of surgery which offers few technical challenges and a disproportionate amount of clinical pressure. Others recognize that specialization provides unique opportunities to build on previous surgical experience and to learn and master new techniques. Arrangements for cross-specialty training will help to accelerate this process, broadening experience in a limited time-frame. This article attempts to summarize some of the significant advances in the surgical management of breast disease in a climate where the greater use of adjuvant treatment has led to a steady increase in the use of breast-conserving surgery (BCS).“’ Increasing patient expectation and cost-containment are leading to a rising demand for immediate breast reconstruction (IBR)9 and reduced lengths of stay in the USA.” Similar pressures are already affecting practice in Europe.