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From: werner@aecom.UUCP (Craig Werner)
Newsgroups: net.med,net.women
Subject: Breast Cancer Treatment.
Message-ID: <1765@aecom.UUCP>
Date: Sun, 23-Jun-85 01:57:10 EDT
Article-I.D.: aecom.1765
Posted: Sun Jun 23 01:57:10 1985
Date-Received: Tue, 25-Jun-85 09:57:02 EDT
Distribution: na
Organization: Albert Einstein Coll. of Med., NY
Lines: 57
Xref: linus net.med:1471 net.women:5650

The following study (of which I am quoting just the abstract) will probably
be debated for years to come, so I thought some people on USENET might be
interested, especially women ...

[Notes: In the study below, Total Masectomy denotes what is also called
Modified Radical Masectomy,  Segmental Masectomy is also sometimes called
Lumpectomy.]

From the NEW ENGLAND JOURNAL OF MEDICINE

Five-Year Results of a Randomized Clinical Trial
Comparing Total Masectomy and Segmental Masectomy
With or Without Radiation in the Treatment
of Breast Cancer.

   In 1976, we began a randomized trial to evaluate breast
conservation by a segmental masectomy in the treatment of
stage I and II breast tumors 4 cm or smaller in size.  The operation
removes only sufficient tissue to ensure that margins of resected
specimens are free of tumor.  Women were randomly assigned to
total masectomy, segmental masectomy alone, or segmental 
masectomy followed by breast irradiation.  All patients had
axillary disections, and patients with positive nodes received
chemotherapy. Life table estimates based on data from 1,843
women indicated that treatment by segmental masectomy, with
or without breast irradiation, resulted in disease-free, distant-
disease-free, and overall survival at five years that was no worse
than that after total breast removal.  In fact, disease-free survival
after segmental masectomy plus radiation was better than
disease-free survival after total masectomy (P=.04), and overall
survival after segmental masectomy, with or without radiation,
was better than overall survival after total masectomy (P=.07
and P=.06 respectively). A total of 92.3% of women treated with
radiation remained free of breast tumor at five years compared
with 72.1% of those receiving no radiation (P<.001). Among
patients with positive nodes, 97.9% of women treated with
radiation remained tumor free (P<.001) although both groups
received chemotherapy.  We conclude that segmental mastectomy,
followed by breast irradiation in all patients and adjuvant
chemotherapy in women with positive nodes, is appropriate 
therapy for stage I and II breast timors 4 cm or smaller, provided
that margins of resected specimens are free of tumor. (1985;
312:665-673) Bernard Fisher et al, National Surgical Adjuvant
Breast Project Headquarters, Room 914, Scaife Hall, 3550 Terrace
St., Pittsburg, PA 15261.


[Translation and The bottom line: For small breast cancers - the
 best treatment is to remove just the part of breast that has the
 cancer, and then treat with Radiation Therapy.  Therefore, it is no
 longer considered neccessary to remove the entire breast.]


-- 
				Craig Werner
				!philabs!aecom!werner
		"The world is just a straight man for you sometimes"