The present paper reports on the local treatment of breast cancer from a historical perspective. A search for articles written in English was made in the Medline and EMBASE databases, and 40 papers were selected. Over the past 10 years, various randomized, controlled clinical trials on the local treatment of breast cancer indicated that patients with the same molecular subtype may receive different individualized surgical treatments aimed at optimizing systemic adjuvant therapy. With a view to retaining the gains made in disease-free and overall survival, surgical techniques have advanced from radical surgery to conservative mastectomies, thus reducing sequelae, while adjuvant and neoadjuvant therapies have contributed toward controlling the disease, both distant metastases and local recurrence. Current studies evaluate whether future breast cancer therapy may even succeed in eliminating surgery to the breast and axilla altogether.

We have previously reported the impact of covid-19 pandemic on breast cancer screening, in Brazil: among women aged 50–69 years, mammography attendance decreased by 42% in public healthcare (SUS), comparing 2019 and 2020. In this short communication, we wish to present: a) an update of the number of mammograms performed, in 2021; b) an exploratory analysis of the characteristics of the screened population between 2019 and 2021. A total of 1.675.307 mammograms were performed in 2021, nearly 15% lower than pre-pandemic levels. Almost a third, 29.5% of them, had intervals greater than three years. In accordance with our previous study, the number of patients with palpable lumps on physical exam increased. The consequences of postponing breast cancer screening during the pandemic are still uncertain. Unfortunately, as of December 2021, screening attendance has not resumed. On the contrary, our results show an increase in the fraction of women with mammography delayed beyond three years.

To evaluate local recurrence (LR), distant recurrence (DR) and death in non-metastatic patients undergoing breast-conserving surgery (BCS) or mastectomy following current neoadjuvant chemotherapy (NAC) regimens. Patients submitted to NAC in 2013–2023 were evaluated (n = 365; mastectomy: 165; BCS: 200). More mastectomy patients were over 70 years old (12.7% versus 7%; p = 0.02) and had T4b tumors (16.4% versus 4.5%; p = 0.0003), whereas more BCS patients had node-negative axilla (42% versus 31.5%; p = 0.02). After a mean follow-up of 65 months (range: 4-124), LR and DR were similar in the mastectomy and BCS groups (4.8% versus 5.0%; p = 0.95 and 10.9% versus 9%; p = 0.58, respectively). More deaths occurred in the mastectomy group (8.5% versus 3%; p = 0.03). Ten-year LR-free survival was higher in the BCS group (98.5% versus 95%; HR: 3.41; 1.09–10.64; p = 0.03), while 10-year DR-free survival was similar in both groups (91% BCS versus 89% mastectomy, HR: 1.25; 0.65–2.42; p = 0.4). Overall survival was better in the BCS group (97% versus 91.5%; HR: 2.62; 1.06–6.69; p = 0.03). Estimated 10-year disease-free survival, stratified according to tumor stage, showed no significant difference except for T4 disease, for which the risk was greater in the mastectomy group (94.5% versus 81.8%; HR: 2.86, 1.54–5.30, p = 0.0008). In the multivariate analysis, T3/T4 staging (OR: 4.37, 1.03–21.91; p = 0.04) and axillary dissection (OR: 5.11, 1.14–35.52; p = 0.04) were associated with LR in the BCS group. In this cohort of patients receiving contemporary NAC, BCS proved to be a safe alternative to mastectomy following treatment with NAC, even in cases of locally advanced BC.

Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.