Refuses mastectomy then will it be neoadj- bct or direct bct?

refuses mastectomy then will it be neoadj- bct or direct bct?

If a patient refuses mastectomy and opts for breast-conserving therapy (BCT), the approach to treatment would typically involve a lumpectomy followed by adjuvant therapy. Neoadjuvant therapy, which is administered before surgery, is usually reserved for cases where the tumor size makes it difficult to achieve clear surgical margins with a lumpectomy alone, or in cases where downstaging the tumor prior to surgery might improve surgical outcomes.

Here’s how the decision-making process might unfold:

  1. Evaluation: The patient undergoes thorough evaluation, including imaging studies (such as mammography, ultrasound, and possibly MRI) and possibly a biopsy to determine the extent and characteristics of the tumor.
  2. Surgical Consultation: The patient discusses treatment options with a surgical oncologist. Since mastectomy is refused, the focus would be on discussing the feasibility of lumpectomy and the need for adjuvant therapy.
  3. Lumpectomy: If the tumor is deemed suitable for breast conservation, the patient undergoes a lumpectomy to remove the tumor and a margin of surrounding normal tissue.
  4. Adjuvant Therapy: After surgery, the patient may require adjuvant therapy, which typically includes radiation therapy to the remaining breast tissue to reduce the risk of local recurrence. Depending on the tumor characteristics, systemic therapies such as chemotherapy, hormonal therapy, or targeted therapy may also be recommended.

In summary, if a patient refuses mastectomy, the next step would likely be breast-conserving therapy with a lumpectomy followed by appropriate adjuvant therapy. The decision regarding neoadjuvant therapy would depend on the specific characteristics of the tumor and whether it’s deemed necessary to downstage the tumor prior to surgery. This decision would be made by the multidisciplinary team in consultation with the patient.