A Comprehensive Review on the Surgical Landscape in Breast Cancer Management

Abstract

Purpose: The purpose of this narrative review is to examine the literature on the topic of breast surgery and its benefits for women with metastatic breast cancer. Breast surgery can involve either a mastectomy, which involves removing the entire breast along with lymph nodes, nipple, and areola, or a lumpectomy, which involves removing breast tissue and tumour but leaving the nipple and areola intact. Methodology: We included any English-language study published between 2000 and 2021 that looked at the effects of breast surgery on survival or quality of life for women with metastatic breast cancer, whether it was an interventional study or an observational study. We utilised a combination of keywords like "Breast surgery," "mastectomy," "lumpectomy," "metastatic disease," "survival," "observational studies," "intervention studies," and "quality of life" to scour sources like PubMed and Embase. We considered randomised controlled trials that contrasted hormonal therapy, radiation, chemotherapy, biologic therapy, and supportive care with breast surgery alone or in combination with systemic therapy. A variety of outcomes were considered, including overall survival, quality of life, toxicity from local treatment as measured by one-month mortality, survival without progression, and survival specific to breast cancer. Findings: The evidence from randomised controlled trials is limited and not conclusive, while observational studies do suggest that breast surgery may benefit with metastatic breast cancer. Since observational studies are prone to problems like selection bias and unmeasured confounding, it is difficult to draw any conclusions regarding the advantages of breast surgery without solid proof from RCTs. Implications to Theory, Practice and Policy: Each woman diagnosed with metastatic breast cancer should be considered individually when deciding whether or not to undergo surgery. This should be done until results from big ongoing RCTs are available. When considering treatment options, the patient and doctor must weigh the pros and cons of each, as well as the associated costs. The current lack of strong evidence calls for more randomised controlled trials (RCTs) in both developing and developed nations, with bigger sample sizes.