THE NATIONAL CANCER DATA-BASE REPORT ON THE RESULTS OF A LARGE NONRANDOMIZED COMPARISON OF BREAST PRESERVATION AND MODIFIED RADICAL-MASTECTOMY

BACKGROUND, Although the conclusions reached in the National Surgical Adjuvant Bowel and Breast Protocol B-06 trial and other clinical trial s appear to remain intact, questions persist regarding the equivalency of breast preservation compared with modified radical mastectomy for patients with invasive carcinoma. Documentation and assessment of comp arative survival rates in a large cohort of nonrandomized breast carci noma patients was undertaken to understand better these outcome patter ns. METHODS. Information gathered from the medical records of 96,030 w omen diagnosed with early stage carcinoma of the breast between 1985 a nd 1988 was reviewed to determine the age at diagnosis; tumor stage, g rade, dimension; treatment; and disease status. RESULTS, Of these 96,0 30 Stage I and II (based on the American Joint Committee on Cancer sta ging system) patients, 8583 (8.9%) were treated with segmental mastect omy, axillary lymph node dissection, and radiotherapy without systemic treatment. Three thousand seven hundred and ninety-seven patients (4. 0%) were treated with segmental mastectomy, axillary lymph node dissec tion, radiotherapy, and systemic therapy. Forty-four thousand two hund red and forty-nine patients (46.0%) were treated with modified radical mastectomy without systemic therapy, and 18,322 patients (19.1%) were treated with modified radical mastectomy with systemic therapy. Withi n each stage, reported survival was equal to or more favorable for pat ients managed with breast preservation compared with those treated wit h modified radical mastectomy. This comparability was observed in all subsets analyzed including those defined by age at diagnosis, histolog ic grade, and tumor dimension. CONCLUSIONS. These findings are consist ent with the hypothesis that AJCC Stage I and II patients treated with breast preservation appear to have survival rates equivalent to those treated with modified radical mastectomy. (C) 1997 American Cancer So ciety.