[2-step diagnosis and conservative treatment of breast cancer]

Regular screening of women for early breast cancer is now possible by a completely noninvasive technique comprising thermography, clinical examination and ultrasound echography. Since it is completely harmless, this screening may be repeated when required. Its accuracy is very good (about 96%) even in small T1 tumours, and infraclinical cancers also may be detected. This first diagnostic step is carried out in every woman, whether symptomatic or not, attending the Jolimont Breast Unit. The second step serves for confirmation of diagnosis and consists of mammography (and related techniques) and thin-needle aspiration cytology. A conservative treatment has been developed for the small lesions (infraclinical, T1 and small T2). It consists of external radiotherapy (telecobalt), tumorectomy and axillary curage, and finally interstitial curietherapy with iridium 192 wires. In some selected cases chemotherapy is started immediately. Local control of the disease is achieved in 97% of cases and cosmetic results are good in 80% of the treated women. In only 5% of cases has a secondary mastectomy to be performed, due to local recurrence or treatment complications. Metastatic spread and survival rates favorably compare with results of conventional treatments involving mastectomy. The authors therefore consider that conservative treatment should be recommended in early-detected small breast cancers.