Surgery in the primary treatment of breast cancer

Breast Cancer Res Treat. 1981;1(4):339-48. doi: 10.1007/BF01806749.


Information available from NSABP protocols has contributed to an altered biological perception of breast cancer. The results of these studies lend support to a hypothesis which postulates that alterations in the loco-regional treatment of primary breast cancer will not change the natural history of the disease relative to distant metastasis and survivorship. Data from NSABP Protocol B-04 indicate that radical mastectomy provides no advantage over total mastectomy in clinically node-negative patients. Since 39% of this population had histologically positive nodes it may be concluded that leaving histologically positive nodes untreated results in no disadvantage. NSABP Protocol B-04 made available the scientific rationale for the study of breast-preserving operations in which the clinical significance of multicentricity will be determined. Although there is a sound scientific basis for the consideration of segmental mastectomy, there are no data available to justify the utilization of the procedure outside the context of a clinical trial. With the increased popularity and implementation of breast-preserving operations without the necessary supporting data, a potentially dangerous situation has been created which threatens to undermine the clinical trial process.

Publication types

  • Clinical Trial
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Axilla
  • Breast Neoplasms / surgery*
  • Clinical Trials as Topic
  • Female
  • Humans
  • Lymph Node Excision
  • Lymphatic Metastasis
  • Mastectomy / methods*
  • Random Allocation
  • Research Design
  • Risk