1. Ismail Jatoi, MD, PhD, FACS Dale H. Dorn Chair in Surgery Professor and Chief, Division of Surgical Oncology University of Texas Health Science Center San Antonio, Texas

2.  Surgery  Radiotherapy  Systemic Therapy (Chemotherapy, Endocrine Therapy, Herceptin)

3. Virchow 1821- 1902 Halsted 1852- 1922 Surgical Treatment of Breast Cancer

4.  Lumpectomy (Partial Mastectomy, Segmentectomy, Quadrantectomy, Wide Local Excision, Tylectomy, Breast Conserving Surgery) + Removal of Lymph Nodes  Mastectomy + Removal of Lymph Nodes  Mastectomy + Removal of Lymph Nodes + Contralateral Prophylactic Mastectomy

5.  Generally required after lumpectomy (except for women over age 70 with tumors <2cm, node-negative, ER+, and agree to take endocrine therapy)  Generally not required after mastectomy (except for patients with tumors >5cm or more than 3 positive nodes)

6.  Pregnancy  Previous Radiotherapy  Collagen Vascular Disease  Large Tumor Size in Relation to Breast Size  Multi-centric Disease  Mutation Carriers (BRCA 1, BRCA 2, etc)

7.  Estrogen Receptor (ER status)  Progesterone Receptor (PR status)  HER-2 status  Tumor Size  Nodal Status

8.  ER+/PR+ - Endocrine Therapy (Tamoxifen or Aromatase Inhibitors)  HER-2 + - Herceptin with Chemotherapy  ER-/PR-/HER-2- (Triple Negative)

9.  Can Not Treat with Endocrine Therapy (Tamoxifen or Aromatase Inhibitors) or Herceptin  Only Chemotherapy is Beneficial  More Common among BRCA 1 mutation carriers  More Research Needed in Triple Negative Breast Cancers to Improve Outcomes

10.  Surgical Treatment of Triple Negative Breast Cancers is the Same as for all Breast Cancers  Radiotherapy for Triple Negative Breast Cancers is the Same as for all Breast Cancers  Drug Treatments for Triple Negative Breast Cancers Differ (Endocrine Therapy and Herceptin is not effective for Triple- Negatives, so chemotherapy alone is often used)  More Research Required to Improve Treatment for Triple Negative Breast Cancer