Reservations about conservative surgery for early breast cancer are unjustified

BMJ 1996;313:113 (13 July)

Letters

Reservations about conservative surgery for early breast cancer are unjustified

EDITOR,--E A Benson suggests that tumours over 2 cm in sizeshould not be treated by breast conservation surgery becausethey seem to be associated with an increased risk of local recurrence.¹To support this Benson reports data from Nottingham.²

In a comprehensive review of factors affecting local recurrenceafter breast conservation (wide excision and quadrantectomyand postoperative radiotherapy) we have identified 28 publicationsthat have correlated tumour size and local recurrence. In 25there seems to be no relation between tumour size and the riskof local relapse. Even in the Nottingham study the actuarialrecurrence curves for tumours less than or greater than 2 cmapproach each other at eight years, which suggests that withincreased follow up the difference in local recurrence ratesbetween these two groups may not be substantiated. The messagefrom the literature is clear: the size of a tumour is not relatedto . . . [Full text of this article]