title: Inadequate treatment of symptomatic breast cancer.
abstract: BACKGROUND
  Early trials that compared breast and axillary treatments showed differing recurrence rates without significant differences in survival. Consequently, there was a wide range of opinion and practice in the management of breast cancer. The present study explored this variability in surgical management to determine the impact of breast and axillary treatment on recurrence and survival.
  
  
  METHODS
  The records of 2776 women with histologically confirmed invasive breast cancer diagnosed between 1986 and 1991 were reviewed. The relationship between adequacy of breast and axillary treatment, recurrence and survival was examined in 2122 women who had surgery with curative intent. A Cox proportional hazards model that included tumour size, node status, grade, socioeconomic status and use of adjuvant therapy was used.
  
  
  RESULTS
  Inadequate treatment was associated with a significantly higher risk of local recurrence after breast-conserving surgery (relative hazard ratio (RHR) 4.19 (95 per cent confidence interval (c.i.) 2.73 to 6.43); P < 0.001). Inadequate axillary treatment was associated with a significantly higher risk of regional recurrence (RHR 2.29 (95 per cent c.i. 1.65 to 3.16); P < 0.001). The risk of death from breast cancer was significantly higher if locoregional treatment was inadequate (RHR 1.29 (95 per cent c.i. 1.07 to 1.55); P = 0.008).
  
  
  CONCLUSIONS
  Adequate surgery is fundamental to the optimal treatment of breast cancer. Inadequate surgery resulted in higher recurrence rates despite adjuvant treatments.
authors.affiliation: University Department of Surgery, Western Infirmary, Glasgow, UK.
authors.forename: D B
authors.initials: DB
authors.lastname: Kingsmore
authors.forename: D J
authors.initials: DJ
authors.lastname: Hole
authors.forename: C R
authors.initials: CR
authors.lastname: Gillis
authors.forename: W D
authors.initials: WD
authors.lastname: George
mesh_terms: D000328:Adult; D000368:Aged; D001365:Axilla; D001943:Breast Neoplasms / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000401:mortality; D008207:Lymphatic Metastasis; D008408:Mastectomy / Q000379:methods / Q000401:mortality; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D011787:Quality of Health Care; D012307:Risk Factors; D012606:Scotland / Q000453:epidemiology; D016019:Survival Analysis; D016896:Treatment Outcome