Breast-Conservation Operations for Treatment of Cancer of the Breast

In this issue ofThe Journal, Lee-Feldstein et al¹report on the operative treatment and survival of patients with breast cancer categorized by the type and size of hospitals in which the therapy was performed. The authors conclude that a larger percentage of breast-conserving operations for small localized (negative axillary lymph nodes) or regional (positive axillary lymph nodes) cancers of the breast were done in teaching hospitals and a much lower percentage in small hospitals. The results of breast conservation were as good as the more radical operations. Local excision, lymph node dissection, and radiation therapy provided the best long-term results. Also, survival of patients with localized disease was significantly better at large community hospitals, compared with small hospitals, and was worse at health maintenance organization hospitals. Based on their observations and the recommendations of the National Institutes of Health (NIH) conference in 1990 on the treatment of early-stage