Node-negative minimal invasive breast cancer patients are not candidates for routine systemic adjuvant therapy

Ninety-one patients with invasive breast carcinoma with a diameter of 1 cm or less and histologically negative axillary nodes were treated between 1976 and 1986 with radical surgery alone (67), or with conservative surgery (24). Cases were analyzed in relation to tumor size, steroid receptors, histologic and nuclear grade, age, and type of therapy, none of which showed a significant relationship to relapse or survival. There were 22% well-differentiated, 20% moderately differentiated, and 56% poorly differentiated or anaplastic tumors. Estimated disease-free survival (DFS) for this group was 91% at 7 years, and overall survival 96% for the same period. There were five relapses (all among poorly differentiated tumors) and three deaths unrelated to breast cancer. With the three deaths censored, 100% of the well-differentiated and moderately differentiated tumors were disease-free at 7 years versus 91% for poorly differentiated and anaplastic tumors (P = 0.076). These data suggest that node-negative patients with minimal invasive breast cancer are highly curable by primary surgical therapy alone, and the authors believe that these patients are not appropriate candidates for adjuvant therapy until such time as subgroups at high risk of recurrence can be identified.