What is the best management of early stage breast cancer in patients with a minimal life expectancy (<10yrs)?

I believe in individualized, whole patient care. Life expectancy is incredibly difficult to estimate, but if we are somehow certain a patient will live less than 10 years, then quality (rather than quantity) of life likely becomes the primary concern of a patient with early stage breast cancer. We do have data from multiple trials (CALGB 9343, the Uppsala-Orebro BCSG, GBSG, NSABP B-21, PRIME II) involving early stage breast cancer patients demonstrating a significant reduction in local recurrence with the addition of whole breast radiation to breast conserving surgery (with or without tamoxifen). The BASO II trial attempted to further narrow down selection criteria to the “best of the best” early stage breast cancer patients, randomizin...

I'm assuming that the patient is older and that there are significant comorbidities. The benefit inradiation drops with increasing age. The improvement in survival ís sêen late. For thís reason, I agree with the personalization òf care. The first Milan trials randomized to quadrantectomy (but 3% òf patients had positive margins), and the benefit to radiation is not ás great as in NSABP trials, I assume thís ís due to bigger surgery. Some comorbidities add to toxicity. For instance, if the patient has severe COPD, the risk of pneumonitis increased.

Ìf you are worried about life expectency, I would consider reexcision and base your treatment on thêse results. Ìf this ís extensive DCIS and no residual, I would be OK with observation alone. Ìf ...