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PubMed1986

Lumpectomy vs mastectomy. The costs of breast preservation for cancer.

Current data on the surgical management of breast carcinoma support the selective use of conservative surgery, ie, lumpectomy, axillary sampling, plus irradiation, rather than modified radical mastectomy. An economic comparison of these two forms of surgical therapy was conducted. Total charges for treatment (hospital and physician) of 79 patients with stage I or II breast cancer at our hospital during 1983 and 1984 utilizing either therapy demonstrated that mean total charges per patient for lumpectomy (N = 49) were $14,176 +/- $4262, and for mastectomy (N = 30) were $10,345 +/- $3134. Although hospital inpatient fees were significantly less for lumpectomy ($5741) than for mastectomy ($7328), mean total physician fees were significantly higher for lumpectomy ($4505). Radiotherapist fees and the substantial radiation therapy hospital outpatient charge for lumpectomy ($5015) made the mean total charges for lumpectomy significantly higher than for mastectomy.

Breast Neoplasms↗

PubMed1995

Influence of local treatment on the recurrence rate of ductal carcinoma in situ.

BACKGROUND: Screening mammography has resulted in a significant increase in the diagnosis of ductal carcinoma in situ (DCIS). The role of breast conservation therapy and the long-term recurrence rate are still controversial. This article compares mastectomy, wide excision alone, and wide excision with radiation as treatments for DCIS. STUDY DESIGN: One hundred twenty-four cases of DCIS were retrospectively reviewed and were found to be pure DCIS by a senior pathologist. The mean age at diagnosis was 60 years (range, 33 to 81). Originally, 101 patients (81 percent) presented with calcification on mammogram, and 23 (19 percent) presented with a palpable mass. Histologic data showed that 54 (44 percent) had noncomedo type lesions, 46 (37 percent) had comedo type, and 24 (19 percent) had unknown type DCIS. RESULTS: Four of the 124 patients had a recurrence during a mean follow-up period of 43 months. Recurrence is defined as any development of DCIS or invasive carcinoma in the ipsilateral breast. There was one (1.3 percent) recurrence in the 75 patients treated with mastectomy (an adenocarcinoma of the chest wall), which occurred at 59 months. Treatment was 5,750 cGy to the chest wall and the patient is free of disease 37 months postradiation. There were three (11 percent) recurrences at 14, 21, and 29 months, respectively, in the 28 patients treated with wide excision alone. All three recurrences were found by calcifications on mammogram and all patients had comedo type original lesions. Two recurrences were pure DCIS of the breast. Both patients were treated with mastectomy and are free of disease at 33 and five months, respectively. The third recurrence was an invasive colloid carcinoma of the breast. Treatment was a modified radical mastectomy; the patient is free of disease after 62 months. There were no recurrences in the 21 patients who were treated with wide excision and radiation. Average total dose of radiation was 5,835 cGy (range, 4,500 to 6,480). CONCLUSIONS: The results of this study indicate that both mastectomy and wide excision with radiation are associated with very low recurrence rates. Wide excision alone is associated with a higher recurrence rate. However, all recurrences were detected mammographically and all lesions were salvaged by mastectomy. Therefore, the ultimate local control and survival rates were similar for all three modalities.

Adult↗

PubMed1987

Psychological response to mastectomy. A prospective comparison study. Psychological aspects of Breast Cancer Study Group.

This study reports data from 412 women prospectively studied over a 1-year period from five collaborating centers: one group had modified radical mastectomy for Stages I and II breast cancer, 145; cholecystectomy for gallbladder disease, 90; biopsy for benign breast disease, 87; and healthy women, 90. All were between the ages of 30 and 70 years, without pre-existing psychiatric illness and absence of current physical illness. All women were seen initially within 3 months of surgery. Data were analyzed from structured interviews, speech samples, and questionnaire responses which measured presence and degree of psychopathological symptoms, mood, physical complaints, self-esteem, and quality of interpersonal relationships. Principal components analysis was used to generate seven identifiable factors which were analyzed by MANOVA (multiple analysis of variance). Women with breast cancer showed greater psychological distress related to social and interpersonal relationships. More distress was seen in women with Stage II disease, and they also had more negative attitudes toward self and the future, concern with physical symptoms, anxiety, strain, and interpersonal difficulties. They did not, however, show any greater signs of psychopathological symptoms severe enough to warrant psychiatric intervention than the other groups over the year following surgery. The findings suggest that healthy women without prior psychiatric disorder or concurrent physical illness experienced some post-surgical distress, primarily in psychosocial functioning which was more than that in women after cholecystectomy or biopsy, but severe psychopathological symptoms over the year following surgery were conspicuously absent. These data do not support the belief that severe psychiatric sequelae follow a mastectomy in psychologically healthy women.

Adult↗

PubMed1996

Kaposi's sarcoma on a lymphedematous arm after mastectomy.

Two patients with Kaposi's sarcoma developing in an area of lymphedematous arm postmastectomy are reported. The Kaposi's sarcoma occurred after latent periods of 26 and 7 years following radical and modified-radical mastectomy, respectively, in the edematous tissue of the ipsilateral arm. The cutaneous nodules were purple in color and ranged in size from a few millimeters to > 1 cm in diameter. The results of routine laboratory tests were all within normal limits. Human immunodeficiency virus (HIV) antibody and cytomegalovirus (CMV) antigen, using enzyme-linked immunosorbent assay (ELISA), were negative.

Aged↗

PubMed1991

Results of mastectomy and postoperative irradiation in the management of locoregionally advanced carcinoma of the breast.

Between 1955 and 1984, 376 patients with locoregionally advanced breast carcinoma were treated at The University of Texas M. D. Anderson Cancer Center with mastectomy and irradiation and without adjuvant chemotherapy. Patients with inflammatory carcinoma or synchronous bilateral primary tumors were excluded. There were 202 patients with Stage IIIA disease and 174 patients with Stage IIIB disease (AJC Staging--1983). In 124 patients the surgical management was confined to the breast only--total mastectomy (BR) and in 252 dissection of the axilla was performed--extended total, modified radical, or classic radical mastectomy (BR + AX). All patients had postoperative irradiation. The follow-up period ranged between 8 and 34 years. At 10 years, the actuarial disease-specific, relapse-free survival (DSRFS) rate for the entire group was 40%, and the actuarial locoregional control rate was 82%. For patients with Stage IIIA disease the DSRFS was 48% and locoregional control rate was 88%. For those with Stage IIIB disease, the figures were 30% and 74%, respectively. Most of the failures occurred within 5 years of the mastectomy and essentially all occurred within 10 years. When analyzed by type of surgery, both the locoregional control and DSRFS rates were improved by the axillary dissection, the difference being largely caused by fewer axillary node recurrences after dissection of both the breast and axilla than after removal of the breast alone. In the 252 patients in whom the axilla was assessed, the number of positive nodes was a powerful predictor of both locoregional control and survival. The DSRFS rates at 10 years for patients with 0, 1-3, and greater than or equal to 4 positive nodes were 63%, 48%, and 30%, respectively. The actuarial locoregional control rates at 10 years exceeded 95% for patients with 0-3 positive nodes and 75% for those with greater than or equal to 4 nodes. These results show that locoregionally advanced breast cancer is not a uniformly fatal disease when treated without chemotherapy and provide a baseline upon which to assess the value of adjuvant systemic therapy for this stage of disease.

Adult↗

PubMed1983

Breast reconstruction--selection, timing, and local recurrence.

Although reconstruction is now a standard part of the care of breast cancer patients, certain unresolved issues surround local recurrence. A percentage of women can be expected to develop local recurrence after mastectomy, whether or not they have reconstruction. This study provides a baseline for local recurrence in breast reconstruction candidates. Between 1955 and 1975, 1,110 patients underwent modified radical mastectomy at the Cleveland Clinic. This group of patients was analyzed to provide information about local recurrence in breast reconstruction candidates. The data were also analyzed for the effects of timing and nodal status. On the basis of this study, we have concluded that the number of involved axillary lymph nodes alone should not exclude a woman from having reconstruction. We also conclude that there is no oncological justification for imposing a specified waiting time between mastectomy and reconstruction.

Breast↗

PubMed2000

Lymphatic mapping and sentinel lymphadenectomy in early stage breast carcinoma.

The rate of axillary lymph node metastases is low in early stage breast carcinoma and axillary lymph node dissection is controversial in the treatment of these patients. Intraoperative lymphatic mapping technique is suggested for the identification of metastatic lymph nodes. Intraoperative lymphatic mapping was performed on 60 clinical stage I and II patients who were treated at Ankara Oncology Hospital between 1996-1998. Patent blue dye was injected in all cases, as the tumor was totally excised before mastectomy, into the surrounding breast tissue at four different quadrants. Presence of metastases were examined on stained lymph nodes (sentinel lymph node: SLN) by frozen-section. Modified radical mastectomy was performed including level I, II, III lymph node dissection. Metastases were evaluated on the remnants of frozen-section tissues and unstained lymph nodes (nonsentinel lymph node: nSLN) in axilla on hematoxyline-eosin stained slides and by immunohistochemistry. Forty-nine (81.6%) SLNs were identified among 60 cases. In 18 (36.7%) of these 49 patients, metastases were detected in SLNs by frozen section. In one case micrometastasis was detected in the remnants of frozen-section by immunohistochemistry though it was negative with hematoxyline-eosin. There were no metastases in nSLNs of 27 cases whose SLNs's frozen-sections were tumor free. In 3 cases SLNs were negative but metastases were detected in nSLNs (false negative: 6.1%). There were no local or systemic complications due to injections of dye. Selective lymph node dissections can be performed on early stage breast cancer patients by means of lymphatic mapping. This minimally invasive technique identifies metastatic axillary lymph nodes with a high degree of accuracy, so we can suggest that, non-metastatic patients can be treated without axillary dissection.

Adenocarcinoma, Mucinous↗

PubMed2003

Skin-sparing mastectomy with conservation of the nipple-areola complex and autologous reconstruction is an oncologically safe procedure.

OBJECTIVE: Is skin-sparing mastectomy (SSM) with conservation of the Nipple-Areola Complex (NAC) and immediate autologous reconstruction as safe in oncologic terms as SSM with resection of the NAC as modified radical mastectomy (MRM)? SUMMARY BACKGROUND DATA: The originally described technique of SSM included the removal of gland, NAC, and biopsy scar. However, the risk of tumor involvement of NAC in patients with breast cancer has been overestimated. PATIENTS AND METHODS: Between 1994 and 2000, 286 selected patients with an indication for MRM and tumor margins of greater than 2 cm from the nipple were presented with the alternative of a SSM. Regular follow-up data were evaluable of 112 patients with SSM and 134 patients with MRM. Immediate reconstruction was achieved by latissimus dorsi flap or TRAM flap. The mean follow-up time was 59 (18 to 92) months. RESULTS: Patients with SSM were significantly younger than those with MRM but were comparable regarding clinical data, tumor parameters, adjuvant treatment, and overall complications. After intraoperative frozen sections of the NAC-ground, the NAC could be conserved in 61 (54.5%) but was resected in 51 (45.5%) of the 112 patients with SSM. The aesthetic results after SSM were evaluated as excellent or good in 91.1% (102/112) patients and were significantly better after preservation of the NAC (P = 0.001). Six (5.4%) recurrences occurred in 112 patients with SSM compared with 11 (8.2%) cases after MRM. Only 1 recurrence in a conserved nipple was treated by wide excision of nipple with conservation of the areola. This patient is still free of disease after 52 months. CONCLUSION: In patients who are candidates for a mastectomy and tumors distant from the nipple, SSM with intraoperative frozen section of the NAC ground offers the opportunity of NAC conservation without increasing the risk of local recurrences.

Adult↗

PubMed1987

Clinically occult breast lesions: localization and significance.

From early 1974 through September 1985, 927 needle-guided breast biopsies were performed for clinically occult breast lesions. Two hundred and seventy (29%) of these lesions were malignant. This frequency of malignancy was comparable to a 20% frequency in biopsy samples obtained because of clinical (palpable) findings. Of 142 patients with nonpalpable invasive lesions who underwent axillary dissection, 42 (30%) had histologically confirmed axillary metastases. Although these invasive lesions may be clinically occult, they are not inconsequential and demand appropriate treatment. For those patients in this series undergoing mastectomy, the frequency of multicentric cancer in the same breast was 39%. The past 10 years have witnessed a trend in surgical management away from the standard radical or modified radical mastectomy toward limited surgery and radiation therapy for so-called early breast cancer. When planning treatment for these occult lesions, one must consider their biological potential to metastasize as well as their propensity for multicentricity.

Adult↗

PubMedDate not supplied

Mammary gland architecture as a determining factor in the susceptibility of the human breast to cancer.

The developmental pattern of the breast can be assessed by determining the composition of the breast in specific lobular structures, which are designated as lobules type 1 (Lob 1), lobules type 2 (Lob 2), and lobules type 3 (Lob 3), with Lob 1 being the less developed and Lob 3 being the most differentiated or with the highest number of ductules per lobular unit. In the present work, the patient population consisted of three groups of women who underwent surgical procedures: The first group included women who underwent reduction mammoplasty (RM) for cosmetic reasons. The second group included women who underwent prophylactic subcutaneous mastectomy after genetic counseling for either carrying the BRCA-1 gene or belonging to a pedigree with familial breast cancer (FAM), and the third group included women who underwent modified radical mastectomy (MRM) for the diagnosis of invasive carcinoma. The RM group consisted of 33 women, of whom 9 were nulliparous and 24 were parous. The FAM group consisted of 17 women, of whom 8 were nulliparous and 9 were parous. The MRM group consisted of 43 women, of whom 7 were nulliparous and 36 were parous. The analysis of the lobular composition of all of the samples from the RM group, which is considered the control group, revealed that Lob 1 represented 22%, Lob 2 represented 37%, and Lob 3 represented 38%, whereas the tissue examined from the FAM and MRM groups contained a preponderance of Lob 1 at 48% and 74%, respectively, over Lob 3, which was 10% and 3%, respectively. When the results of the analysis of breast tissue were separated according to the pregnancy history of the donor, it was found that in the control group or RM, there was a significant difference in lobular composition. Nulliparous women of the RM group showed a preponderance of Lob 1 (46%) over parous women, which contained only 17%, whereas the percentage of Lob 3 in the nulliparous group was significantly lower (7%) than the parous group (48%). In the breast tissues obtained from FAM and MRM, no significant differences in lobular composition were observed, as all of the samples contained a higher concentration of Lob 1, independent of the pregnancy history. The breast tissue of FAM and MRM of parous women had a developmental pattern that was similar to that of nulliparous women of the same group and that was less developed than the breast of parous women of the control group. An important difference between the Lob 1 of the FAM group versus the control (RM) and the MRM group was that most of these lobules had thin ductules with an increase in hyalinization of the intralobular stroma manifested in the whole-mount preparation as an alteration in the branching pattern. The data suggest that the breast tissue of women with invasive cancer, as well as those from a background of familial breast cancer, have an architectural pattern different from the control or normal tissues and that the BRCA-1 or related genes may have a functional role in the branching pattern of the breast during lobular development, mainly in the epithelial stroma interaction.

Adult↗

PubMedDate not supplied

Male breast cancer: report of 2 cases and review of the literature.

Male breast cancer is rare and accounts for 1% of all breast cancers. The authors report two cases of male breast cancer at Stage III and review the literature. A Madden mastectomy with axillary clearance was performed. Patients were given adjuvant chemotherapy and started on tamoxifen. At one year follow-up the patients are alive and free from disease. Modified radical mastectomy is the preferred surgical approach for localized disease. Adjuvant hormonal therapy with tamoxifen is recommended as first-line treatment. Adjuvant chemotherapy has a role in node-positive cancer and locally advanced disease. Men should be made more aware of the disease and multicentric clinical trials encouraged to ensure an appropriate treatment on the basis of prospectively collected data.

Aged↗

PubMed1977

Surgical treatment of primary breast cancer.

Radical mastectomy should be replaced by a number of different types of operation which are either more conservative or more extended according to the spread of the disease. For T1N0 cases a new procedure consisting of removal of a quadrant of the breast, with axillary dissection plus radiotherapy on the residual breast tissue, is under evaluation. In T2N0 cases modified radical mastectomy is suggested as a procedure of choice, whilst T3 cases and all N1 cases should still undergo radical mastectomy. Cases with tumor of inner quadrants with positive axillary nodes with benefit from removal of internal mammary nodes. Superradical mastectomy is limited to selected special cases with extensive lymphnode invasion. All N+ cases receive adjuvant chemotherapy (CMF). In locally advanced cases "reductive" surgery may form part of an aggressive chemotherapy programme.

Antineoplastic Agents↗

PubMed1977

Surgical treatment of primary breast cancer according to disease extent.

Radical mastectomy should be replaced by a number of different types of operation, either more conservative or more extended according to the extent of the disease. For cases T1NO a new procedure consisting of the removal of a quadrant of the breast, with axillary dissection plus radio-therapy on the residual breast tissue, is under evaluation. In cases T2NO modified radical mastectomy is suggested as a procedure of choice, whilst T3 cases and all N1 cases should still be submitted to radical mastectomy. Cases with tumor of inner quadrants with positive axillary nodes will benefit from the removal of the internal mammary nodes. Superradical mastectomy is limited to special selected cases with extensive lymph-node invasion. All N+ cases are submitted to adjuvant chemotherapy (CMF). In locally advanced cases "reductive" surgery may be part of an aggressive chemotherapy program.

Adult↗

PubMed2000

National Cancer Data Base survey of breast cancer management for patients from low income zip codes.

BACKGROUND: The National Cancer Data Base (NCDB), a joint project of the American College of Surgeons Commission on Cancer and the American Cancer Society, is a cancer management and outcomes data base for health care organizations. It provides a comparative summary of patient care that is used by participating hospitals and communities for self-assessment. The most current (1995-1996) breast cancer data on patients from low income zip codes are described here. METHODS: Since 1989, eight Calls for Data have been issued, yielding a total of 191,714 reports of non-Hispanic white patients with breast cancer for the years analyzed, 1995-1996. A total of 1961 hospital cancer registries have participated in at least one of the Calls for Data. RESULTS: A diverse range of breast cancer cases was reported from a variety of geographic locations and medical care environments. There were general similarities in the treatment of patients from the different income groups; however, some differences were reported. Among patients from lower income zip codes, 60.7% were age 60 years or older, compared with 55.1% from other income zip code groups. The AJCC stage distribution was reported as less favorable for patients from low income zip codes than for other patients. The percentage of patients from low income zip codes diagnosed as Stage 0 or I was 51.2%, compared with 55.9% of patients from the other income zip codes. Of patients from lower income zip codes, 12.1% were reported to have Stage III or IV disease, compared with 10.0% of patients from other income zip codes. Patients from low income zip codes received less tissue-sparing surgery. Of patients from low income zip codes, 14.9% received partial mastectomy with or without radiation or systemic therapy, compared with 18.3% of patients from other income zip codes. The percentage of patients from low income zip codes who received a partial mastectomy with axillary lymph node dissection was 23.3% for patients from other income zip codes, the percentage was 30.5%. Conversely, 49.8% of patients from lower income zip codes received a modified radical mastectomy, compared with 40.5% of patients from other income zip codes. CONCLUSIONS: Further improvements in the early diagnosis and surgical treatment of low income patients can probably be achieved. Programmatic activities that further explain or reduce the apparent nonpreferred treatment of some low income patients should be encouraged.

Adult↗

PubMed1979

Cutaneous melanoma of the breast.

A study of 115 cutaneous melanomas of the breast demonstrated that these neoplasms follow different metastatic patterns than do primary carcinomas of the breast and require a different therapuetic approach. Lesions located below a 3 cm from the clavicle metastasized exclusively to the axillary nodes regardless of location. None of 19 internal mammary node chains examined histologically contained tumor deposits. Microstaging of the primary lesion correlated closely with prognosis and lymph node metastasis. Treatment by mastectomy (radical, modified, extended radical) offered no advantage over local excision of the primary plus axillary dissection. The latter procedure is recommended for all cutaneous melanomas of the breast which require node dissection. Mastectomy is not indicated unless the breast is in the field of wide local excision. Internal mammary node dissections are not indicated.

Adolescent↗

PubMed2000

Locoregional recurrence in patients with one to three positive axillary nodes after mastectomy without adjuvant radiotherapy.

PURPOSE: To retrospectively assess the risk of locoregional recurrence (LRR) and analyze the prognostic factors of this pattern of failure in patients with breast cancer and one to three positive axillary lymph nodes treated with modified radical mastectomy (MRM) without adjuvant radiotherapy. METHODS: From April 1991 through December 1997, 649 patients received a diagnosis of invasive breast cancer, and 545 were treated with MRM. Eighty-one of these patients who were found to have one to three positive axillary nodes and had a minimum follow-up of 2 years were included in this study. None of the 81 patients received adjuvant radiation therapy after mastectomy; 43 patients received adjuvant chemotherapy; and 60 patients received adjuvant hormone therapy. The median duration of follow-up was 39 months. RESULTS: Thirteen patients had LRR during follow-up, all within 2 years after mastectomy. The 3-year LRR rate was 14%. The 3-year rates of distant metastasis for patients with and without LRR were 48% and 14% (p = 0.03), respectively. The 3-year survival rates for patients with and without LRR were 73% and 87% (p = 0.01), respectively. In univariate analysis, age (p = 0.01), estrogen receptor (ER) status (p = 0.02), and the addition of hormone therapy (p < 0.001) were significant risk factors for LRR; in multivariate analysis, negative ER status (p = 0.02) was the only statistically significant risk factor. The 3-year LRR rates for ER-negative patients and those with positive or unknown ER status were 31% and 11%, respectively. CONCLUSIONS: LRR after mastectomy is a substantial clinical problem, despite the use of adjuvant chemotherapy and/or hormone therapy. Further randomized trials of postmastectomy radiotherapy for patients with one to three positive axillary nodes and specific risk factors are urgently needed to determine its potential benefit in locoregional control and survival, especially for young and ER-negative patients.

Adult↗

PubMed1990

Effect of preoperative chemotherapy on mastectomy for locally advanced breast cancer.

Mastectomy is frequently performed after intensive chemotherapy for locally advanced breast cancer. The effects of preoperative chemotherapy on the postoperative course and the timing of subsequent adjuvant therapy, however, have not been defined. We therefore reviewed the perioperative course of 54 patients undergoing mastectomy after combination (CAMFPT) chemotherapy for stage IIIA,B (IIIA - 25 pts; IIIB noninflammatory - 5 pts; IIIB inflammatory-24 patients) breast cancer. A median of 7 cycles (6 months) of chemotherapy was administered preoperatively. Mastectomy was performed a median of 20 days after last chemotherapy; white blood cell count (WBC) and platelet counts returned to normal limits preoperatively. Total mastectomy with or without axillary node dissection was performed in 53 patients, and a Halsted radical mastectomy in 1 patient. Negative margins on breast and/or axillary tissue were achieved in 47 patients (87.0%). Postoperative complications included skin flap necrosis in 8 patients (14.8%), seroma formation in 5 patients (9.3%), and wound infection in 1 patient (1.9%). Median operative blood loss (550 cc), hospital stay (8 days), and duration of wound catheter drainage (6 days) were comparable to published reports for modified radical mastectomy without preoperative chemotherapy. Systemic chemotherapy was resumed a median of 16 days after mastectomy, and radiotherapy started a median of 33 days after mastectomy. These findings indicate that intensive preoperative chemotherapy does not increase the hospital course or the postoperative complications of mastectomy for locally advanced breast cancer. In view of the current interest in treatment of stage I and II breast cancer with preoperative chemotherapy, this information may be useful in their management as well.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1976

Changing patterns of breast cancer. Lucy Wortham James lecture (clinical).

At present, through public awareness and the use of improved diagnostic aids, increasing numbers of patients are being seen with localized "minimal" breast cancer. In our own experience, the average measured size of the primary tumor has diminished from 3.2 cm in 1955 to 2 cm in 1974. Although the incidence of axillary node metastases has diminished only from about 50% to 42% during this interval, the extent of involvement and the distribution of nodal disease has improved markedly with a marked decrease in apical node involvement. Mammography has been responsible for the detection of more than 50% of our "minimal" breast cancers. This improved patient material presents a great potential for improved control of this disease. In planning the choice of surgery for primary breast cancer, its multicentric origin, and regional nodal spread to axillary and internal mammary nodal areas must be considered. There is no single ideal operation for all breast cancers. The scope of surgery should be correlated with the clinical and pathologic extent of disease in the individual patient with the aim of removing all disease present while preserving appearance and function-the main goal being removal of disease. We have utilized three operative procedures: total mastectomy with axillary dissection, radical mastectomy, and extended radical mastectomy. With this approach a 10-year survival rate of 61% with a local recurrence rate of 7.7% has been attained in a group of 565 patients with 40% axillary node involvement. The best salvage obtained in patients with "minimal" breast cancers-noninfiltrating cancers and infiltrating cancers under 1 cm in diameter with clinically negative axillae-was 95% survival at 10 years following modified radical mastectomy (total mastectomy with axillary dissection). When disease has extended to the axillary nodes the more extensive procedures have proved more effective in achieving long term control-54% 10 year survival in patients with axillary node metastases treated by the extended radical mastectomy. An increasing number of patients are being seen who can be treated adequately by less than a radical mastectomy. Careful clinical judgment and close liason with a competent pathologist must be combined in selecting the proper operative procedure for each individual patient. Statistics concerning therapeutic effects based on current material, unless they are based on accurate data covering extent of disease, cannot be compared with previous data because of the improved patient material now being encountered. Adjuvant multiple chemotherapy appears promising as a supplement to surgical treatment of breast cancer. However, it should not be used to replace or minimize the role of primary surgery, but should be combined with the optimum procedure for each individual patient.

Breast Neoplasms↗