Surgical approaches to the treatment of early breast cancer.

Various methods have been explored for treating early breast cancer with conservation of the breast. Although local recurrence increased, early trials indicated that in patients with clinical stage I disease (T1 or T2 NO or N1a), wide excision and radiotherapy of the breast and gland fields resulted in the same distant recurrence and survival rates as the radical operation. It was suggested that local control of the disease was not important in the ultimate prognosis, that minimal surgery incurred no penalty and that breast cancer would soon be treated by radiotherapy alone. Four recent developments affected this forecast. 1. Assays of hormone receptors in primary tumours give important information on prognosis in early cancer. 2. In clinical stage II disease (T1 or T2 N1b), limited surgery exacts a penalty in terms of distant recurrence and survival. 3. The number in involved axillary lymph nodes must be known to evaluate prognosis 4. Adjuvant chemo- or endocrine therapy is effective in patients with extensive involvement of axillary nodes. Currently, only modified radical mastectomy effectively fulfils the requirements resulting from these developments.