Surgical management of palpable breast cancer.

The surgical treatment of primary breast cancer must cope with its multicentric origin, its occasional bilaterality, and its primary lymphatic drainage to the axillary and internal mammary nodes. The scope of the surgical procedure should correlate with the extent of disease in the individual patient with the primary aid of removing all disease present in these areas. We have used and continue to use three operative procedures--modified mastectomy (total mastectomy with thorough axillary dissection), radical mastectomy, and extended radical mastectomy. With this selected approach, we have attained a ten-year survival rate of 57% with a 4% local recurrence rate as the first sign of recurrent cancer--8.3% overall local recurrence rate--in a group of 515 patients with infiltrating cancer and 44% proven axillary nodal involvement treated between 1955 and 1964. This includes Stages I, II and III cases. These data are crude and uncorrected for age, intercurrent disease, and lost to follow-up. Forty-three percent of patients received adjuvant x-radiation therapy--4500 rads T.D. to the peripheral nodes. No chemotherapy was given. Similar local control and long term salvage has not been attained by conservative surgery with aggressive x-ray therapy. Long term follow-up--ten years at the minimum--with accurate information regarding extent of disease (nodal status), local recurrence, and survival rate is essential to evaluate the efficacy of a treatment regimen for primary breast cancer.