Primary surgical treatment of breast cancer

An unexpected rise in breast cancer mortality has been reported for 1984 and 1985 in white women below 50 years of age in the United States. During the preceding 10 years, there had been a progressive drop of approximately 1% in breast cancer mortality for each successive year. This recent increase in mortality occurred despite the increased use of adjuvant chemotherapy; it is most likely a direct result of the current tendency to downgrade the need for adequate primary therapy. Several recent prospective randomized studies that evaluated the relative efficacy of mastectomies of varying extent have shown a direct relationship between local control and long-term survival. They also demonstrated that specific operative procedures were most effective for the appropriate clinicopathological stage of disease. Stage I cancers can be treated effectively by modified mastectomy, but radical mastectomy is superior for control of stage II and stage III disease. Inner-quadrant cancers are most effectively managed by extended radical mastectomy, which includes excision of the internal mammary nodes. Excellent surgical technique was employed in all studies, which included observed follow-up of 10-20 years. Optimal local control and long-term survival were achieved by the appropriate operative procedure.