Does local therapy affect survival rates in breast cancer?

Background: The goal of this study was to challenge the hypothesis that loc al recurrence of breast cancer does not affect survival rates, by determini ng whether survival rates differ for conservative and radical surgical poli cies. Methods: This study used prospective long-term follow-up monitoring of two contemporaneous groups of patients, within a single unit, who were treated identically except for the one variable of local treatment policy, i.e., co nservative or radical. A total of 451 patients with operable breast cancer were chosen from 567 consecutive patients with breast cancer who were treat ed between 1970 and 1979 in the University Department of Surgery. The rate of survival 132 months after treatment was used as an outcome measure. Results: Two hundred forty-one patients were treated using a conservative a pproach and 210 were treated using a radical approach. At 132 months, the s urvival rate (58% vs. 42%) and median survival time (>132 vs. 100 months) w ere significantly improved for the radically treated group (P < .01). The t reatment groups were comparable in terms of age, menopausal status, tumor s ize, histologic grading, and Nottingham Prognostic Index values. The advant age of the radical policy persisted when examined in relation to each of th ese prognostic factors. Conclusions: Use of radical local treatment yielded a highly significant su rvival benefit (comparable to that obtained with adjuvant therapy), compare d with a conservative approach. This was related to a reduced locoregional recurrence rate and provides evidence that local therapy influences long-te rm outcomes for patients with breast cancer. High-quality locoregional cont rol should be emphasized, as is systemic therapy, in management policies. A ssessment of surgical techniques, particularly in relation to locoregional recurrence rates, should be included in all studies in which surgery is a c omponent of therapy.