Surgical management of clinically early breast cancer

The management of patients with primary operable or potentially curable breast cancer continues to be controversial. Modified radical mastectomy is still considered the standard approach for patients with this problem, but certain carefully selected patients with smaller tumors are being treated in some centers with a breast-sparing operation, usually with some type of axillary dissection, followed by radical radiation therapy. The manner in which this option is presented to patients varies from the most optimistic (it is proven to be equal to mastectomy) to more guarded appraisals (it is experimental, with long-term results and complications yet to be measured). Lending weight to the latter interpretation is another option open to patients, i.e., to enter randomized prospective trials comparing various locoregional approaches. The approach of the authors to these patients will be discussed.