SUBAREOLAR BREAST-CANCER - LONG-TERM RESULTS WITH CONSERVATIVE SURGERY AND RADIATION-THERAPY

Purpose: It has been suggested that patients presenting with breast ca ncers within 2 cm of the nipple areolar complex represent a relative c ontraindication to conservative management due to either a compromised cosmetic result associated with sacrifice of the nipple areolar compl ex, reluctance to include the entire nipple areolar complex in the con edown field, or increased risk of multicentricity. We have reviewed ou r experience of conservatively treated patients with specific referenc e to the subset of patients presenting with tumors within 2 cm of the nipple areolar complex. Methods and Materials: Between January 1970 an d December 1989, 1014 patients with early stage breast cancer were tre ated at Yale-New Haven Hospital by excisional biopsy with or without a xillary lymph node dissection. Of the 1014 charts reviewed, a total of 98 patients fulfilled the criteria of having a central/subareolar bre ast cancer. Reexcision was performed on only 16 patients. Following co nservative surgery, patients were treated with radiation therapy to th e intact breast to a total median dose of 48 Gy with conedown to a tot al of 64 Gy. Adjuvant systemic therapy and regional nodal irradiation were administered as clinically indicated. Results: As of December 199 3, the median follow-up for the 98 patients in this study was 9.03 yea rs. The majority of patients had presented with either a palpable mass or a mammographically detected lesion. Three patients presented with Paget's disease, five with nipple discharge, and seven with nipple inv ersion. Ten of the 98 patients had the nipple areolar complex sacrific ed at the time of surgery, while the remaining 88 patients had the ent ire nipple areolar complex included in the conedown held. Four of thes e 88 patients had the nipple partially blocked during the electron con edown. There were no significant complications associated with includi ng the entire nipple areolar complex within the conedown field to a me dian dose of 64 Gy. Six of the 98 patients experienced a local recurre nce, three experienced a regional recurrence, and nine experienced dis tant metastasis. The actuarial 10-year survival (0.79 +/- 0.06), dista nt disease-free survival (0.88 +/- 0.04) and breast recurrence-free su rvival (0.84 +/- 0.07) were not significantly different from those pat ients who presented with cancers in other parts of the breast. Conclus ions: Patients presenting with subareolar breast cancers within 2 cm o f the nipple areolar complex are suitable candidates for conservative surgery and radiation therapy. In the majority of patients in this stu dy, the nipple areolar complex did not need to be sacrificed and could he safely included in the electron conedown field with acceptable com plications and cosmesis. A subareolar breast cancer does mot represent a relative contraindication to conservative management in patients wi th early stage breast cancer.