LARGE OPERABLE BREAST-CANCER - THE APPLICABILITY OF PRIMARY CHEMOTHERAPY

This study appraises the applicability of primary chemotherapy to enab le breast conserving treatment in patients with large operable breast cancers. Between May 1991 and September 1992, 82 patients presented to the Guy's Breast Unit with rumours greater than or equal to 4 cm; 40 (49%) had features of locally advanced or metastatic disease acid 42 ( 51%) had large operable rumours. Eleven of 41 evaluable patients with large operable rumours were considered unsuitable for primary chemothe rapy on clinical grounds. Of the 30 for whom primary chemotherapy was considered appropriate, after full explanation of the treatment protoc ol, 14 (47%) chose mastectomy and 16 (53%) primary chemotherapy of who m eight achieved at least a partial response and underwent breast cons erving treatment. Thus, only eight of the original 41 patients (20%) w ith large operable tumours were able to have initial breast preservati on, but three ultimately needed mastectomy for recurrence in the conse rved breast. Analysis of audiotaped consultations showed that most pat ients were given comprehensive information about the complexity of tre atment during the decision-making process towards their choice on whet her or not to pursue the possibility of breast conserving treatment. T he analysis also provided a valuable insight into the communicative in teractions between doctor and patient.