Conservative surgical treatment for primary breast cancer

The definition of conservative surgery should be limited to procedures preserving at least part of the breast. A randomized trial on conservative treatment of breast cancer, using in the control arm the Halsted mastectomy and in the second arm the QU.A.RT. method (quadrantectomy, axillary dissection, radiotherapy) was started in June 1973 at the National Cancer Institute of Milan. Patients with clinical or mammographic evidence of a breast cancer less than 2 cm in diameter without palpable lymph nodes (T1N0) were selected for the trial. The results lead to the conclusion that radical mastectomy appears to involve unnecessary mutilation in this kind of patients. Many problems are now connected with the future of conservative surgery of the breast. The first is the choice of cases, the second is multicentricity of breast cancer, the third is the risk of delayed carcinogenesis connected with the irradiation of the breast. Anyway, it is likely that a great proportion of breast cancers will benefit from a treatment which, without decreasing the survival rates, will be less multilating and therefore the quality of life will improve.