Excision only for tubular carcinoma of the breast

The purpose of this study was to assess the rationale of excision only (without breast irradiation) in patients with small (< or =3 cm) tubular/well-differentiated breast cancers. A total of 44 patients with pure tubular invasive breast cancer who have undergone complete excision only and have had a minimum 1-year follow-up were identified from the Colorado Cancer Registry and assessed for recurrence rates as well as median local disease-free and overall survival. Treatment dates were October 1972 to April 2001. The median age was 67 years (range 40-96 years). The median tumor size was 6.5 mm (range 2-30 mm). All patients had a complete excision with negative margins. Staging was as follows: T1N0 (11), T1Nx (27), T2N0 (1), T1N1 (3); 2 were unable to be staged accurately. After a median follow-up of 5.4 years (range 1.1-26.3 years) there were only two local recurrences in the ipsilateral breast (at 7.6 and 8.8 years), for a crude local control rate of 96% (2/44). Both patients were salvaged, are alive, and currently have no evidence of disease (NED) at last follow-up of 9 and 13.3 years. Actuarial 5- and 10-year local control rates were 100% and 87%. Actuarial 5- and 10-year overall and disease-free survivals were 80% and 52%, and 100% and 91%. Twenty-five patients had more than 5 years of follow-up. The median follow-up for this group was 9.1 years (range 5.1-26.3 years) and both recurrences were in this group. Although the number of cases in this report is small, it represents the largest total and longest follow-up for tubular breast cancer cases after excision alone. This report suggests that breast irradiation could be omitted after conservative surgery in older patients with smaller (< or =3 cm) tubular/well-differentiated breast cancers. However, due to the retrospective nature of our report, we cannot categorically make this recommendation.