RECURRENCE-FREE SURVIVAL IN PATIENTS WITH SMALL BREAST CANCERS - AN ANALYSIS OF CANCERS 10 MM OR LESS DETECTED CLINICALLY AND BY SCREENING

Objective: To evaluate survival of women with small breast cancers (10 mm or less in diameter) in a series almost unaffected by adjuvant med ical treatment. Design: Prospective study from a population who were r andomly allocated to be screened by mammography. Setting: University H ospital. Subjects: 324 patients with breast cancers 10 mm or less in d iameter who were operated on between 1978-85 (230 detected by screenin g, 21 interval cases and 73 from the control group). Main outcome meas ures: Recurrence free survival, recurrence rate, and breast cancer mor tality alone and in relation to node involvement during a median follo w up of 7 years (range 4 months-12.5 years). Results: Survival without distant metastases in life table analyses was 98.7% in 254 node negat ive cases and 79.3% in 30 node positive cases (p < 0.001). For the who le series survival without distant recurrence was 96.8%. There was no significant difference in recurrence free survival between cancers det ected by screening and those detected clinically. Lymph nodes were inv olved in 9% of the 221 detected by screening compared with 20% of the 89 detected clinically (p < 0.03). Conclusion: There was a very low ri sk of recurrence in small node negative breast cancers (irrespective o f the method of detection) indicating that adjuvant treatment may not be necessary for patients with small node negative breast tumours. The good prognosis of these patients also implies that the need for follo w up programmes must be discussed because they are probably unnecessar y.