title: Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer.
abstract: BACKGROUND
  We conducted 20 years of follow-up of women enrolled in a randomized trial to compare the efficacy of radical (Halsted) mastectomy with that of breast-conserving surgery.
  
  
  METHODS
  From 1973 to 1980, 701 women with breast cancers measuring no more than 2 cm in diameter were randomly assigned to undergo radical mastectomy (349 patients) or breast-conserving surgery (quadrantectomy) followed by radiotherapy to the ipsilateral mammary tissue (352 patients). After 1976, patients in both groups who had positive axillary nodes also received adjuvant chemotherapy with cyclophosphamide, methotrexate, and fluorouracil.
  
  
  RESULTS
  Thirty women in the group that underwent breast-conserving therapy had a recurrence of tumor in the same breast, whereas eight women in the radical-mastectomy group had local recurrences (P<0.001). The crude cumulative incidence of these events was 8.8 percent and 2.3 percent, respectively, after 20 years. In contrast, there was no significant difference between the two groups in the rates of contralateral-breast carcinomas, distant metastases, or second primary cancers. After a median follow-up of 20 years, the rate of death from all causes was 41.7 percent in the group that underwent breast-conserving surgery and 41.2 percent in the radical-mastectomy group (P=1.0). The respective rates of death from breast cancer were 26.1 percent and 24.3 percent (P=0.8).
  
  
  CONCLUSIONS
  The long-term survival rate among women who undergo breast-conserving surgery is the same as that among women who undergo radical mastectomy. Breast-conserving surgery is therefore the treatment of choice for women with relatively small breast cancers.
authors.affiliation: Department of Senology, European Institute of Oncology, Milan, Italy. umberto.veronesi@ieo.it
authors.forename: Umberto
authors.initials: U
authors.lastname: Veronesi
authors.forename: Natale
authors.initials: N
authors.lastname: Cascinelli
authors.forename: Luigi
authors.initials: L
authors.lastname: Mariani
authors.forename: Marco
authors.initials: M
authors.lastname: Greco
authors.forename: Roberto
authors.initials: R
authors.lastname: Saccozzi
authors.forename: Alberto
authors.initials: A
authors.lastname: Luini
authors.forename: Marisel
authors.initials: M
authors.lastname: Aguilar
authors.forename: Ettore
authors.initials: E
authors.lastname: Marubini
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000188:drug therapy / Q000401:mortality / Q000532:radiotherapy / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015409:Mastectomy, Radical; D015412:Mastectomy, Segmental; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D016609:Neoplasms, Second Primary / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate