The management of patients with primary operable or potentially curable breast cancer continues to be controversial. Modified radical mastectomy is still considered the standard approach for patients with this problem, but certain carefully selected patients with smaller tumors are being treated in some centers with a breast-sparing operation, usually with some type of axillary dissection, followed by radical radiation therapy. The manner in which this option is presented to patients varies from the most optimistic (it is proven to be equal to mastectomy) to more guarded appraisals (it is experimental, with long-term results
and complications yet to be measured). Lending weight to the latter interpretation is another option open to patients, i.e., to enter randomized prospective trials comparing various locoregional approaches. The approach of the authors to these patients will be discussed.
Cancer 53:685-690, 1984.
HE MANAGEMENT of patients with clinically early
T breast cancer continues to be a subject of controversy in oncology. Although the term "clinically early breast cancer" is difficult to define precisely, it includes those patients with potentially curable disease, and perhaps to some clinicians that subgroup of patients with smaller diameter tumors (2 cm or less) and no involved axillary lymph nodes on clinical examination (so-called clinical
Stage I or T 1 NOMO disease).' Breast cancer is diagnosed in I of I 1 American women, or approximately 110,000 new cases per year.2 It is the most commonly occurring cancer in women in this country, accounting for 27% of all cancers in females. There is hope that patients can have breast cancer detected at early stages of disease. In a 5-year summary report of the Breast Cancer Detection Demonstration Project (BCDDP), over 4000 cancers were found by a combination of periodic physical examination and mammogr a ~h y . ~ One third of the patients had smaller cancers, either noninfiltrating or infiltrating cancers less than 1 cm. More importantly, over 80% had no evidence of axillary nodal involvement, suggesting that they should enjoy a high cure rate. If the screening policies of the BCDDP were to be followed more widely, it is apparent