Surgical procedures in the treatment of breast cancer

Only early breast cancer can be cured. The aim of treatment of early breast cancer should be to provide the patient with the best possible chance of being cured. This should be the surgeon's paramount objective. Many factors must be taken into consideration before deciding whether aggressive curative treatment is justified. These factors include the position and extent of the primary tumour within the breast, the degree of involvement of the regional lymph nodes and the presence or absence of distant occult metastases. Also important are the exact histological type of the tumour, its grade of malignancy and the receptor status, if known. The age, general health and personal attitudes of the patient also will be influential. Total mastectomy continues to be the treatment of choice for early, curable breast cancer, combined as appropriate with radiotherapy to the regional lymph nodes. The recent widespread enthusiasm for breast conservation operations is misplaced. Such procedures should still be regarded as experimental.