Better local control not yet translated into improved survival

Although prospective randomised trials have shown that treating early breast cancer by conservative surgery and radiotherapy is as effective as mastectomy, revelations of scientific misconduct in the largest of these trials last year caused widespread public concern.1 Media reports that one contributor to the United States national surgical adjuvant breast and bowel project had altered some of his data suggested that patients could no longer trust the trial's conclusions, and it left many patients angry and frightened that they had not been treated appropriately. Three articles in last week's New England Journal of Medicine provide reassurance about the efficacy of breast conserving treatment.2 3 4

The first article is an audit of the trial from the United States National Cancer Institute. It reports that 97.5% of the data were entered correctly.2 The second article is a reanalysis of the audited data after 12 years of follow up. The trial compared the outcome in women with early breast cancer after total mastectomy alone or after lumpectomy with or without radiotherapy. The reanalysis shows no significant difference in survival between the three groups, although the incidence of ipsilateral tumour recurrence was 35% in the group treated by lumpectomy alone compared with 10% in the group treated with lumpectomy and radiotherapy.3 …