Segmental mastectomy plus radiation therapy for stage I cancer of the breast

Segmental mastectomy (surgical removal of the palpable tumor mass with a shell of normal tissue) plus irradiation to the entire remaining breast and regional lymph nodes is commonly used in other countries as a treatment for Stage I cancer of the breast. It is not, however, generally practiced or accepted in the United States. Adequate postoperative irradiation consisting of 4,500-5,000 rads to regional lymph nodes and a slightly higher dose to the breast itself will eliminate more than 90% of remaining subclinical tumor, as evidence by very low local recurrence rates. Many patients having local recurrence may then be salvaged by mastectomy or axillary node dissection. Equal five- and ten-year survival rates are obtained compared with radical mastectomy with less physical and psychological morbidity for the patient. While this treatment is not suitable for all Stage I cases, its efficacy should be more widely recognized.