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Breast cancer: death to the radical?

Breast cancer victims are just as well served by removal of only the tumor and adjacent tissue as by more extensive surgery, according to a five-year study of 1,843 women conducted at 89 institutions. And a 10-year study shows that these results can be expected to hold up over time, good news to the 1 of every 11 women in the United States who will get breast cancer. Reports of the work appear in the March 14 NEW ENGLAND JOURNAL OF MEDICINE (NEJM).

The studies were initiated as a result of increasing numbers of breast cancer victims seeking options other than the radical mastectomy, and medical reports of good results with less drastic surgery (SN: 3/7/81, p. 153; 7/11/81, p. 22). The radical mastectomy, developed in the early 1900s, involves removal of the breast tissue, underlying muscle and all lymph nodes in the armpit. In the two reports, radical mastectomy was compared with segmental mastectomy (lumpectomy), in which the tumor plus a margin of the surrounding normal tissue is removed; and with total mastectomy, in which the breast tissue is removed, along with a few lymph nodes if the cancer has spread, but muscle is allowed to remain.

In the five-year study, women with tumors 4 centimeters or smaller received a total or segmental mastectomy with no radiation or a segmental mastectomy with radiation. All had their underarm lymph nodes removed.

The researchers report that "disease-free survival after segmental mastectomy plus radiation was better than disease-free survival after total mastectomy, and overall survival after segmental mastectomy, with or without radiation, was better than overall survival after total mastectomy." Therapeutic radiation, which an accompanying NEJM editorial notes "has almost been discarded," showed a clear benefit: 92 percent of radiation-treated women were tumor-free after five years, compared with 72 percent of nonirradiated women.

The second trial compared radical mastectomy with total mastectomy in 1,665 women followed for about 10 years, and showed essentially the same outcome for the two procedures. Whether or not lymph nodes were removed, the researchers found no difference in disease progression or survival--"support," they note, "for our concept that regional lymph nodes are indicators rather than instigators, of distant disease."

The National Cancer Institute in Bethesda, Md., and the American Cancer Society in New York supported these National Surgical Adjuvant Breast Project studies.
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Title Annotation:good results with less drastic surgery
Author:Silberner, Joanne
Publication:Science News
Date:Mar 16, 1985
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