A randomised trial comparing tamoxifen vs. surgery in patients over the age of 70 with operable breast cancer--final results after 28 years of follow-up.

A final review of a historical trial commenced in 1982 comprising 200 patients aged 70 or over with operable breast cancer randomised to surgery or tamoxifen with crossover on recurrence has shown that at 21-28 years follow-up,all have died from verified causes. 43 in the surgical arm and 40 in the Tamoxifen arm died of breast cancer (41.5% in total). 117 patients (58.5%) died of other verified causes unrelated to breast cancer. These patients in effect achieved a cure from breast cancer. The survival curves for both those treated by surgery or Tamoxifen are similar as are the associated curves comparing deaths from breast cancer and other causes. However although 50% of deaths from breast cancer occurred within the first five years of follow-up, further deaths from breast cancer occurred up to 25 years later. Thus at long term follow-up in a highly selected and favourable group of patients recurrence and death from breast cancer still occurred. This confirms the view that at no time in the post treatment period can one state that any patient is cured of breast cancer. However with favourable patient presentation and optimal current treatment there is a high probability that in a significant number of patients a personal cure will be achieved as described by Brinkley and Haybittle.