TREATMENT OF APPARENTLY EARLY BREAST CANCER 2. WHERE WE ARE GOING

Abstract

The results of various methods of treatment of breast cancer and the direction in which they are leading are examined. Methods vary from superradical mastectomy to local excision of the lump from the breast with or without postoperative radiotherapy to the chest wall or lymph nodes. In uncontrolled trials the methods have produced similar results regardless of lymph node involvement. A variety of controlled trials are not proceeding: the Manchester trial the National Surgical Adjuvant Breast Project the Copenhagen trial the Cambridge trial the Guys Hospital trial and the Edinburgh trial. Generally they have demonstrated no advantage for the more aggressive methods. In particular prophylactic postoperative radiotherapy to the chest wall or lymph nodes neither prolongs survival nor prevents metastases; delayed treatment of recurrence is as effective in the control of local disease avoiding unnecessary treatment and morbidity in other cases. The value of radical mastectomy is not yet settled although removal of the pectoral muscles and upper axillary nodes is probably unnecessary.