Treatment of Apparently Early Breast Cancer: 1. The Dilemma

Recently, surgeons have questioned the value of radical surgery and postoperative radiotherapy in the treatment of apparently early breast cancer. Some authors claim that treatment has no effect on the outcome of the disease, but others have shown that untreated patients die earlier with more uncontrolled local disease. The earlier treatment is carried out the more effective it is, but many patients delay through fear of operation or mutilation. Treatment that is effective for some patients seems to be harmful to others. Although treatment of the regional lymph nodes might be necessary if they contain tumour cells, this will not eradicate the disease if tumour cells have spread beyond the breast and regional lymph nodes. Although removal of the breast ensures complete removal of the primary tumour, wide excision of the tumour from the breast might be adequate and mastectomy might be an unnecessary mutilation. The optimal treatment for apparently early breast cancer is not known: conservative treatment might be more effective in some patients than is radical treatment.