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The Treatment of Primary Breast Cancer: 
Management of Local Disease

National Institutes of Health
Consensus Development Conference Statement
June 5, 1979

Conference artwork, a stylized female profile with the title. below.

This statement is more than five years old and is provided solely for historical purposes. Due to the cumulative nature of medical research, new knowledge has inevitably accumulated in this subject area in the time since the statement was initially prepared. Thus some of the material is likely to be out of date, and at worst simply wrong. For reliable, current information on this and other health topics, we recommend consulting the National Institutes of Health's MedlinePlus http://www.nlm.nih.gov/medlineplus/.

This statement was originally published as: The Treatment of Primary Breast Cancer: Management of Local Disease. NIH Consens Statement 1979 Jun 5;2(5):29-30.

For making bibliographic reference to the statement in the electronic form displayed here, it is recommended that the following format be used: The Treatment of Primary Breast Cancer: Management of Local Disease. NIH Consens Statement Online 1979 Jun 5 [cited year month day];2(5):29-30

Introduction

A Consensus Development Conference on "The Treatment of Primary Breast Cancer: Management of Local Disease" was held at the National Institutes of Health on June 5, 1979. The purpose of the conference was to address the following question: Are there clinical alternatives to radical mastectomy which minimize patient morbidity and do not decrease a patient's survival potential?

The NIH consensus development program brings together practicing physicians, biomedical research scientists, consumers, and others in an effort to reach general agreement on the safety and efficacy of a medical technology, whether it be a drug, device or medical or surgical procedure.

At the treatment of primary breast cancer meeting, three broad categories of surgical techniques were discussed:

  • Radical mastectomy
  • Total mastectomy which removes axillary lymph nodes, but preserves the pectoralis muscles
  • Lesser surgical procedures such as segmental mastectomy with or without radiotherapy

 

There was also discussion of radiotherapy as a primary treatment of local breast cancer.

The Halsted radical mastectomy initially introduced for locally advanced breast cancer has been the traditional treatment for the past 80 years. Selection in the past appears to have been based on this tradition rather than tailored to a patient's stage of disease or histologic type. As breast cancer has been diagnosed with greater frequency in its earlier stages (Stage I and Stage II), a major question has been posed to the medical community as to whether this "standard," developed at a time when most women had not been diagnosed until they had extensive local disease, needs to be changed.

There were a variety of surgical options to the Halsted radical mastectomy discussed by the panel. The data that have been generated in several series indicate that a total mastectomy with axillary dissection can be considered as a satisfactory alternative to the Halsted radical for those women with Stage I and Stage II disease. The axillary dissection in this procedure is done for staging purposes as well as for therapeutic benefit.

It was the consensus of the panel that a procedure which preserves the pectoral muscles, i.e., a total mastectomy with axillary dissection, provides equivalent benefit to women who have Stage I and selected Stage II breast cancer. Therefore, total mastectomy with axillary dissection should be recognized as the current treatment standard.

It was also the consensus that a two-step procedure should be done in most cases, i.e., a diagnostic biopsy should be studied by permanent histologic sections before definitive therapeutic alternatives are discussed with the patient.

It was the consensus of this panel that the question of postoperative radiotherapy is moot pending further results of adjuvant clinical trials. Lesser surgical procedures such as segmental mastectomy with or without radiotherapy were discussed. Segmental mastectomy poses the problem of leaving residual breast tissue. The early data presented by Dr. Umberto Veronesi from the National Cancer Institute of Milano, Italy indicate that the residual breast tissue that remains after segmental resection and post-operative radiation does not appear to harbor clinically significant breast cancer. The length of patient follow-up of this trial is approximately four years.

Primary radiation therapy provides two alternatives, either administered in addition to a minimal surgical procedure, or as a single mode of therapy. The trials utilizing primary radiation therapy and the trials dealing with segmental mastectomy are in a stage which is too early to allow determination of survival benefits, but control of local recurrence appears to be similar to current surgical procedures. The trials that explore the question of lesser surgical procedures and those trials exploring alternate modalities to surgery warrant further follow-up and enthusiastic support. These studies should also help to answer the question of the clinical significance of multifocal disease.

Specifically, the panel supported further clinical investigation into the roles of segmental mastectomy and primary radiotherapy. The National Surgical Adjuvant Breast Project (NSABP) protocol was endorsed in regard to answering the question about the effectiveness of lesser surgical procedures in women with Stage I and Stage II carcinoma of the breast. These ongoing clinical trials, because of their exciting preliminary results, warrant support both from patients and physicians so that the continuing search for the optimal patient treatment can progress to the point of maximal patient survival and minimal patient morbidity.  

Consensus Development Panel

John Moxley, III, M.D., Chairman
University of California
La Jolla, California,
Joseph C. Allegra, M.D.
National Cancer Institute
John R. Durant, M.D.
University of Alabama in Birmingham
Bernard Fisher, M.D.
University of Pittsburgh
Pittsburgh
Samuel Hellman, M.D.
Harvard Medical School Boston
Jane Henney, M.D.
National Cancer Institute
Mrs. Rose Kushner
Breast Cancer Advisory Center
Kensington, MD
Franco Muggia, M.D.
National Cancer Institute
Bernard Pierquin, M.D.
Universitaire Henri Mondor
France
Jerome Urban, M.D.
Memorial Sloan Kettering Cancer Center
New York
Umberto Veronesi, M.D.
Instituto Nazionale per le Studiole Ia Cura Dei Tumor
Italy

Conference Sponsors

National Cancer Institute

Office of Medical Applications of Research

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