Future prospects in limited surgery for early breast cancer

There is a strong body of opinion that favours conservative surgery in early breast cancer, with certain provisos. If an operation that is less than a mastectomy is to be performed, it is essential that by histological assessment, the resection margins be > or = 10 mm clear, preferably 20 mm. Extensive DCIS is a serious stumbling block, as it suggests the possibility of multicentricity. It would seem that postoperative radiotherapy is always indicated on the grounds of an unacceptable local recurrence rate and thus an expression of a later higher risk of distant metastases. Because of the fact that recurrence both local and distant, are expressed by the nodal state, it is essential to assess the axillary lymph nodes. If they are positive, there are two choices, namely total axillary clearance or postoperative axillary radiotherapy; opinion is divided as to the best management. Because of the good prognosis in well treated pT1pN0 patients, it appears logical to offer these patients conservative surgery, postoperative radiotherapy and adjuvant therapy. The complications of this therapy are far outweighed by the advantage of a cure. In the node-positive patient, it is essential to offer the triumvirate of treatment, surgery, radiotherapy and adjuvant therapy (chemotherapy and tamoxifen) to try and reduce local and regional recurrence and distant metastases.