Locally advanced noninflammatory breast cancer

Locally advanced noninflammatory breast cancer represents 10% to 15% of all patients at diagnosis. The greatest risk for these patients is the development of distant metastases that lead to death. Local therapies, including surgery and radiation therapy, used in combination result in improved locoregional control but have no significant effect on survival. The institution of mulitmodality treatment regimens that include systemic chemotherapy has improved distant disease-free survival. The appropriate sequencing of local and systemic treatment still is debated. Advantages to preoperative chemotherapy are assessment of in vivo chemosensitivity and the option for breast-conserving surgery in patients with tumor down staging.