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Breast conserving therapy (BCT), consisting of breast conserving surgery and subsequent radiotherapy, is an equivalent option to mastectomy for women with early breast cancer. Although BCT after neoadjuvant systemic treatment (NAST) has been routinely recommend by international guidelines since many years, the rate of BCT worldwide varies largely and its potential is still underused. While the rate of BCT in western countries has increased over the past decades to currently about 70%, the rate of BCT is as low as 10% in other countries. In this review, we will evaluate the underused potential of breast conservation after NAST, identify causes, and discuss possible solutions. We identified clinical and non-clinical causes for the underuse of BCT after NAST including uncertainties within the community regarding oncologic outcomes, the correct tumor localization after NAST, the management of multifocal and multicentric tumors, margin assessment, disparities of socio-economic aspects on a patient and national level, and psychological biases affecting the shared decision-making process between patients and clinicians. Possible solutions to mitigate the underuse of BCT after NAST include interdisciplinary teams that keep the whole patient pathway in mind, optimized treatment counseling and shared decision-making, and targeted financial support to alleviate disparities. • Breast conserving therapy requires complex, multidisciplinary teamwork. • We identified reasons for its underuse after neoadjuvant treatment. • Clinical, socio-economic, and psychological factors were identified. • Solutions include interdisciplinary teams, optimized counseling, financial support. [ABSTRACT FROM AUTHOR]

Accurate information about locoregional treatments in breast cancer neoadjuvant systemic therapy (NST) trials is vital to support surgical decision-making and allow meaningful interpretation of long-term oncological outcomes. This systematic review (PROSPERO registration CRD42023470891) aimed to describe the current practice of outcome reporting in NST studies. A systematic search identified primary research studies published 01/01/2018-08/09/2023 reporting outcomes in patients receiving NST for breast cancer followed by locoregional treatment. Included were randomised controlled trials (RCTs) and non-randomised studies (NRS) with >250 participants reporting at least one locoregional treatment outcome. Outcomes were extracted verbatim and categorised using content analysis. Descriptive statistics were used to summarise results. Of the 3111 abstracts screened, 137 studies (22 RCTs and 115 NRS) reporting at least one locoregional outcome in 575,531 patients were included. The 137 studies reported a total of 510 surgical outcomes with a median of 3 (range 1–12) per study. No single outcome was reported in all studies. Type of breast (n = 129, 94.2 %) and axillary (n = 86, 62.8 %) surgery were reported most frequently. Only 34 % (n = 47) studies reported how treatment response was assessed and if/how this informed surgical decision-making. Only a fifth (n = 28) reported outcomes relating to surgical de-escalation. Only 72 studies (52.6 %) reported any radiation therapy (RT)-related outcome, most frequently whether RT had been received (n = 63/72, 87.5 %). Current reporting of locoregional treatment outcomes in NST studies is poor, inconsistent and urgently needs to be improved. A core outcome set and reporting guidelines may improve the quality and value of future research. [ABSTRACT FROM AUTHOR]

• Penetrance and phenotype of the TP53 pathogenic variant should be considered. • Tumor biology should be incorporated in the criteria for offering TP53 testing. • Mastectomy should be preferred to lumpectomy and radiotherapy avoided. • Risk-reducing contralateral mastectomy should be discussed. • Collaborative research efforts are strongly encouraged. Approximately 10% of breast cancers are associated with the inheritance of a pathogenic variant (PV) in one of the breast cancer susceptibility genes. Multiple breast cancer predisposing genes, including TP53 , are responsible for the increased breast cancer risk. Tumor protein-53 (TP53) germline PVs are associated with Li-Fraumeni syndrome, a rare autosomal dominant inherited cancer predisposition syndrome associated with early-onset pediatric and multiple primary cancers such as soft tissue and bone sarcomas, breast cancer, brain tumors, adrenocortical carcinomas and leukemias. Women harboring a TP53 PV carry a lifetime risk of developing breast cancer of 80–90%. The aim of the present narrative review is to provide a comprehensive overview of the criteria for offering TP53 testing, prevalence of TP53 carriers among patients with breast cancer, and what is known about its prognostic and therapeutic implications. A summary of the current indications of secondary cancer surveillance and survivorship issues are also provided. Finally, the spectrum of TP53 alteration and testing is discussed. The optimal strategies for the treatment of breast cancer in patients harboring TP53 PVs poses certain challenges. Current guidelines favor the option of performing mastectomy rather than lumpectomy to avoid adjuvant radiotherapy and subsequent risk of radiation-induced second primary malignancies, with careful consideration of radiation when indicated post-mastectomy. Some studies suggest that patients with breast cancer and germline TP53 PV might have worse survival outcomes compared to patients with breast cancer and wild type germline TP53 status. Annual breast magnetic resonance imaging (MRI) and whole-body MRI are recommended as secondary prevention. [ABSTRACT FROM AUTHOR]

Background: Switzerland is one of the few remaining European countries without a uniform national breast cancer screening program. Most Swiss cantons have initiated mammography screening programs, with the notable exceptions of the cantons of central Switzerland. The aim of this study is to compare the TNM (tumor-node-metastasis) status in woman diagnosed with screen- and non-screen-detected breast cancers. We compare TNM of breast cancers of cantonal screening cantons (Or-SC) with organized mammographic screening and opportunistic-screening cantons (Op-SC) without organized mammographic screening., Materials and Methods: We compared the TNM documented in cantons with organized screening (Or-SC) in the national cancer registry with those in the cantons of central Switzerland without organized screening (Op-SC) between 2014 and 2020. Since 2014, a total of 19 236 patients from Or-SC and 2282 from Op-SC with breast cancer were compared. Age groups were defined as younger than 50 years, between 50 and 69 years, and older than 70 years., Results: By comparison, women aged 50-69 years in the cantons of the Op-SC group exhibited significantly larger tumors T1-3 [point estimate of the difference with 95% confidence interval (CI) for T1: -7.7% (95% CI -11.0% to -4.4%); T2: 5.3% (95% CI 2.2% to 8.5%); T3: 2.5% (95% CI 0.8% to 4.2%)] and significantly fewer proportion of N0 [-5.7% (95% CI -9.0% to -2.5%)] without significant difference in the M status (P = 0.97)., Conclusion: Our study shows that patients aged 50-69 years from Op-SC have significantly larger tumors and higher incidence of lymph node metastases than women in the corresponding Or-SC group. This globally unique case within one single small country with very high living standards, but with different screening strategies, indicates the benefits of organized breast screening programs., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Introduction: Neoadjuvant systemic anticancer therapy (neoSACT) is increasingly used in the treatment of early breast cancer. Response to therapy is prognostic and allows locoregional and adjuvant systemic treatments to be tailored to minimise morbidity and optimise oncological outcomes and quality of life. Accurate information about locoregional treatments following neoSACT is vital to allow the translation of downstaging benefits into practice and facilitate meaningful interpretation of oncological outcomes, particularly locoregional recurrence. Reporting of locoregional treatments in neoSACT studies, however, is currently poor. The development of a core outcome set (COS) and reporting guidelines is one strategy by which this may be improved., Methods and Analysis: A COS for reporting locoregional treatment (surgery and radiotherapy) in neoSACT trials will be developed in accordance with Core Outcome Measures in Effectiveness Trials (COMET) and Core Outcome Set-Standards for Development guidelines. Reporting guidance will be developed concurrently.The project will have three phases: (1) generation of a long list of relevant outcome domains and reporting items from a systematic review of published neoSACT studies and interviews with key stakeholders. Identified items and domains will be categorised and formatted into Delphi consensus questionnaire items. (2) At least two rounds of an international online Delphi survey in which at least 250 key stakeholders (surgeons/oncologists/radiologists/pathologists/trialists/methodologists) will score the importance of reporting each outcome. (3) A consensus meeting with key stakeholders to discuss and agree the final COS and reporting guidance., Ethics and Dissemination: Ethical approval for the consensus process will be obtained from the Queen's University Belfast Faculty Ethics Committee. The COS/reporting guidelines will be presented at international meetings and published in peer-reviewed journals. Dissemination materials will be produced in collaboration with our steering group and patient advocates so the results can be shared widely., Registration: The study has been prospectively registered on the COMET website (https://www.comet-initiative.org/Studies/Details/2854)., Competing Interests: Competing interests: SM reports speaker honoraria from MSD, Roche, BD and Astra Zeneca; advisory boards for Lilly, Novartis, MSD, Roche and Astra Zeneca; conference travel and support from Roche, Lilly and MSD; and institutional research funding from Novartis. HI reports consulting fees from Daiichi Sankyo, Chugai, Astra Zeneca, Lilly, MSD, Pfizer and Gilead; honoraria from Daiichi Sankyo, Chugai, Astra Zeneca, Lilly, MSD, Pfizer, Taiho and Kyowa Kirin; and institutional research funding from Chugai, Daiichi Sankyo and Astra Zeneca. PD reports institutional research funding from Cepheid and Roche; consulting fees from Roche, and honoraria from Astra Zeneca and Oncoviews; and conference and travel support from Roche. H-BL reports research funding from Devicor Medical Product Inc. and is a co-founder and director of DCGen Co. Ltd. ALR reports consulting fees from Astra Zeneca and royalties from Myriad Genetics. GW reports consulting fees from Astra Zeneca, MSD, Novartis, Daiichi Sankyo and Roche; honoraria from Astra Zeneca, MSD, Novartis, Roche, Pfizer and Daiichi-Sankyo; and institutional research funding from Astra Zeneca/Medimmune, Roche/Genentech, GlaxoSmithKline, Novartis, Pfizer, Roche, MSD, Merck, Bayer, Janssen, Astellas Pharma, Libbs and Takeda. NZ reports consulting fees from Lilly, Eisai, Astra Zeneca, MSD, Novartis and Gilead; honoraria from Roche, Pfizer, Eisai, Amgen, Gilead, Novartis, Lilly and Astra Zeneca; and conference travel and support from Novartis, Astra Zeneca and Lilly. The remaining authors have no conflicts of interest to declare., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: A trend towards less male radiologists specializing in breast ultrasound was observed. A common notion in the field of breast radiology is, that female patients feel more comfortable being treated by female radiologists. The aim of the study was to understand and report the needs of women undergoing breast ultrasound with regards to the sex of the radiologist performing the investigation., Methods: Informed consent was obtained from all patients prior to inclusion in a prospective bi-center quality study. At center 1 (72 patients), the women were examined exclusively by female radiologists, at center 2 (100 patients) only by male radiologists. After the examination the patients were asked about their experiences and their wishes for the future., Results: Overall, women made no distinction between female and male radiologists; 25% of them wanted a female radiologist and 1.2% wanted a male radiologist. The majority (74%) stated that it made no difference whether a female or male radiologist performed the examination. The majority of women in group 2, who were investigated exclusively by male radiologists, stated that they had no preferences with regard to the sex of the radiologist (93%); 5% of the women wished to be investigated solely by a female radiologist and 2% exclusively by a male radiologist., Discussion: The majority of women undergoing breast ultrasound are unconcerned about the radiologist's sex. It would appear that women examined by male radiologists are less selective about the sex of the examining radiologist., Trial Registration: Written informed consent was obtained from all patients. All patient data were anonymized. The physicians had no access to any further personal data. National regulations did not require dedicated ethics approval with anonymized lists or retrospective questionnaires., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sartoretti et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Clinical axillary lymph node management in early breast cancer has evolved from being merely an aspect of surgical management and now includes the entire multidisciplinary team. The second edition of the "Lucerne Toolbox", a multidisciplinary consortium of European cancer societies and patient representatives, addresses the challenges of clinical axillary lymph node management, from diagnosis to local therapy of the axilla. Five working packages were developed, following the patients' journey and addressing specific clinical scenarios. Panellists voted on 72 statements, reaching consensus (agreement of 75% or more) in 52.8%, majority (51%-74% agreement) in 43.1%, and no decision in 4.2%. Based on the votes, targeted imaging and standardized pathology of lymph nodes should be a prerequisite to planning local and systemic therapy, axillary lymph node dissection can be replaced by sentinel lymph node biopsy ( ± targeted approaches) in a majority of scenarios; and positive patient outcomes should be driven by both low recurrence risks and low rates of lymphoedema., Competing Interests: Ana Bosch: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly, Roche, Novartis; Support for attending meetings and/or travel from Roche; Participation on a Data Safety Monitoring Board or Advisory; Giuseppe Curigliano: Consulting fees from BMS, Roche, Pfizer, Novartis, Lilly, Astra Zeneca, Daichii Sankyo, Merck, Seagen, Ellipsis, Gilead; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Lilly, Pfizer, Relay; Support for attending meetings and/or travel from Daichii Sankyo; Jana De Boniface: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Astra Zeneca; Carsten Denkert: Grants from Myriad, Roche, BMBF, European Commission, GBG Foundation; consulting fees from MSD Oncology, Daiichi Sankyo, Molecular Health, AstraZeneca, Roche, Lilly; Peter Dubsky: Honoraria for presentations and Advisory from Roche and Astra Zeneca to Hirslanden Klinik St. Anna; Michael Knauer: Grants or contracts Agendia BV; Consulting fees from Myriad, Exact Sciences; Thorsten Kühn: Consulting fees from Merit Medical, Endomag, Hologic, Sirius Medical; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from GILEAD, MSD, Pfizer, Exact Sciences; Support for attending meetings and/or travel from Gilead, MSD; Sibylle Loibl: Grants or contracts from Abbvie, AZ, BMS/Celgene, DAichi Synkyo, Gilead, Molecular Health, Novartis, Pfizer, Roche; Royalties or licenses for Ki 67 Analyser, VM SCOPE; Consulting fees from AZ, Amgen, Abbvie, BMS, Celgene, Daichi Sankyo Eirgenix, Gilead, Lilly, Merck, MSD, Novartis, Olema, Pfizer, Pierre Fabre, Relay Therapeutics, Incyte, Roche, Sanofi, Seagen; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from AZ, Gilead, Roche, Seagen, MSD, Pierre Fabre, MEDSCAPE; Patents planned, issued or pending EP14153692.0; EP21152186.9; EP15702464.7; EP15702464.7; Participation on a Data; Safety Monitoring Board or Advisory Board from Daichi Sankyo; Receipt of equipment, materials, drugs, medical writing, gifts or other services Daichiy Sankyo, Gilead, Novartis, AstraZeneca, Roche, Seagen; Icro Meattini: Consulting fees from Novartis, Pfizer, Eli Lilly, Seagen, Gilead; Katja Pinker: Consulting fees from Genentech, Inc., Merantix Healthcare, AURA Health Technologies GmbH; Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events: European Society of Breast Imaging (active), Bayer (active), Siemens Healthineers (ended), DKD 2019 (ended), Olea Medical (ended), Roche (ended); Trine Tramm: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Pfizer, Roche; Support for attending meetings and/or travel from Roche and Novartis; Jong Han Yu: Consulting fees from Gencurix; Walter Paul Weber: Payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from MSD; all other others have no conflicts of interest to declare., (© 2023 The Author(s).)

The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Aim: Demand for nipple- and skin- sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario., Methods: A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology., Results: The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recommendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR., Conclusions: The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BR., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)