LNSLNS

Our article did not intend to evaluate the primary surgical procedures for the development of recurrent tumors (1). Many studies with long term follow-up have confirmed the oncological safety of breast conserving surgery (2, 3, 4). The 30–40% recurrence rates that we reported relate to the total number of recurrent tumors; 20% of these are merely locoregional recurrences. More than 75% of these recurrences are treated with a curative intent, which means that only few—about 5%—of patients with a locoregional recurrence will die as a result of the tumor. Most patients develop distant metastases, which cannot be avoided when using “more radical” surgery that is particularly “tissue preserving,” as requested by Diemer. On the other hand, a return to more radical surgery would mutilate a large number of women unnecessarily without actually improving their chance of cure. Finally, locoregional recurrences develop even after mastectomy. Whether a locoregional recurrence develops mainly depends on the tumor biology, provided the surgery was conducted and adjuvant therapy administered according to the indication. Luminal A tumors, for example, have a significantly more favorable disease progression, with a recurrence-free 10 year survival rate of 92%, than for example HER2 positive or triple negative tumors, which have a 10 year survival rate of only 80% (5).

To conclude, we completely disagree with the opinion expressed by Diemer, that “even small tumors should be removed by using radical surgery ... [after] specialized surgical training.”

DOI: 10.3238/arztebl.2010.0629b

Prof. Dr. med. Bernd Gerber

Universitäts-Frauenklinik Rostock

Südring 81

18059 Rostock

bernd.gerber@med.uni-rostock.de

Conflict of interest statement
The authors of all contributions declare that no conflict of interest exists
according to the guidelines of the International Committee of Medical Journal
Editors.

1.
Gerber B, Freund M, Reimer T: Recurrent breast cancer:
Treatment strategies for maintaining and prolonging good quality of life [Rezidiviertes Mammakarzinom – Therapiekonzepte zum
Erhalt der Lebensqualität]. Dtsch Arztebl Int 2010; 107(6): 85–91. VOLLTEXT
2.
Gerber B, Krause A, Dieterich M, Kundt G, Reimer T: The oncological safety of skin-sparing mastectomy with conservation of the nipple-areola complex and immediate reconstruction: an extended follow-up study. Ann Surg; in press. MEDLINE
3.
Fisher B, Anderson S, Bryant J, et al.: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233–41. MEDLINE
4.
Veronesi U, Cascinelli N, Mariani L, et al.: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227–32. MEDLINE
5.
Voduc KD, Cheang MC, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H: Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 2010; 28: 1684–91. MEDLINE
1.Gerber B, Freund M, Reimer T: Recurrent breast cancer:
Treatment strategies for maintaining and prolonging good quality of life [Rezidiviertes Mammakarzinom – Therapiekonzepte zum
Erhalt der Lebensqualität]. Dtsch Arztebl Int 2010; 107(6): 85–91. VOLLTEXT
2.Gerber B, Krause A, Dieterich M, Kundt G, Reimer T: The oncological safety of skin-sparing mastectomy with conservation of the nipple-areola complex and immediate reconstruction: an extended follow-up study. Ann Surg; in press. MEDLINE
3.Fisher B, Anderson S, Bryant J, et al.: Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233–41. MEDLINE
4.Veronesi U, Cascinelli N, Mariani L, et al.: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 2002; 347: 1227–32. MEDLINE
5.Voduc KD, Cheang MC, Tyldesley S, Gelmon K, Nielsen TO, Kennecke H: Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 2010; 28: 1684–91. MEDLINE