This retrospective study compares in detail the pretreatment clinical findings and therapeutic results following initial treatment of 77 patients by various types of biopsy and major radiation therapy with those in a similar number having only radical surgery and a second group treated by radical mastectomy and postoperative irradiation. Of the 77 having biopsies, 27 had an aspiration, 33 incisional and 17 excisional biopsy or what may be considered a simple excision. The amount of primary irradiation delivered to these patients varied considerably but the best results were obtained following a total dosage of 6,000 rads or more. While none of these methods of treating primary operable and infiltrating carcinoma of the breast cured all the patients, there were significant differences in therapeutic results. Those subjected to a radical mastectomy with or without postoperative irradiation had a longer clinically free interval, a lower incidence of local recurrence, and a higher total survival rate than the patients treated by various biopsies and primary irradiation. The physical intolerance to a radical breast operation has greatly decreased, but there is now an increased emphasis on limited surgery by a few doctors so as to preserve feminine appearance. While this is desirable, there remains an essential need for more accurate and reliable means to select patients for such treatment in order to obtain therapeutic results equally good as those which follow radical mastectomy.
HE RECENT PROMOTION, IN LAY PUBLICA-
T tions,3,4,8,13 of limited surgery, with or without postoperative radiation therapy, for primary operable breast cancer is now prompting women to resist the standard radical mastectomy to preserve their feminine appearance in a bosom-oriented society. In addition, some patients successfully treated many years ago by the standard radical mastectomy are expressing regrets about their disfiguring, though curative, surgery. Unfortunately, many