Therapeutic options for occult breast cancer: A survey of the American Society of Breast Surgeons and review of the literature

Background: Axillary presentation of occult breast cancer (OBC) is uncommon, and continues to be a diagnostic and therapeutic challenge to physicians. After our recent experience with a similar patient, a survey of the American Society of Breast Surgeons (ASBS) was conducted to assess the Society's member's opinions on treatment. Methods: A survey was sent by mail to 1837 members of the ASBS. The survey consisted of a brief case presentation after which the surgeon's preference for management of the breast was sought. The choices included "mastectomy," "whole breast radiation" or "other." Results: A total of 776 (42%) responses were received. The majority of respondents, 338 or 43% preferred "mastectomy," while 285 or 37% opted for "whole breast radiation." Twenty percent of respondents (153 responses) chose "other," of which 46 physicians (6% of total) indicated they would observe the patient. Conclusions: Although recent literature supports the use of whole breast radiation, these results demonstrate that a small majority of physicians still prefer mastectomy. The appropriate treatment of the breast after an axillary presentation of OBC continues to be a controversial issue. (c) 2005 Excerpta Medica Inc. All rights reserved.