Conservation Trials in Early Breast Cancer

Abstract

The first controlled trial on conservation treatment in the management of early breast cancer was carried out at Guy’s Hospital in London between 1961 and 1975. It was conducted in two series; entry to the first was between 1961 and 1971 and to the second between 1971 and 1975. The difference between the two series was that the first included all patients aged 50 years or over with operable breast cancer, irrespective of the axillary-node status. In the second series, patients under 50 years of age were also included, but only those who did not have clinically involved lymph nodes. The patients were randomly assigned one of two treatment options. The first option was modified radical mastectomy, in which the whole breast was removed with all the axillary contents and that part of the pectoralis major muscle lying behind the tumour. The second option was wide local excision, in which the tumour was removed together with 3 cm of normal breast tissue surrounding it. All patients were subsequently treated by radiation therapy to the lymphatic drainage fields, and those treated by wide excision were also given radiation therapy to the retained breast. Precise details of the treatment and the doses of radiation have been described elsewhere [2].