title: A randomised trial of primary tamoxifen versus mastectomy plus adjuvant tamoxifen in fit elderly women with invasive breast carcinoma of high oestrogen receptor content: long-term results at 20 years of follow-up.
abstract: BACKGROUND
  Long-term analysis of a randomised trial in Nottingham comparing tamoxifen versus surgery as initial treatment demonstrated that in oestrogen receptor (ER)-unselected cases, surgery achieved better local control, with no difference in overall survival. It was suggested that for patients with ER-rich tumours, local control and survival may be comparable. We now present long-term follow-up of a randomised trial designed to address this clinical scenario.
  
  
  METHODS
  One hundred and fifty three fit elderly (≥70 years) women with clinically node-negative primary invasive breast carcinoma <5 cm of high ER content [histochemical (H) score ≥100] were randomised 2:1 to primary tamoxifen (Tam) (N = 100) or mastectomy with adjuvant tamoxifen (Mx + Tam) (N = 53).
  
  
  RESULTS
  With median follow-up of 78 months, there was no statistically significant difference in 10-year rates of regional recurrence (9.0% versus 7.5%), metastasis (8.0% versus 13.2%), breast cancer-specific survival (89.0% versus 86.8%) or overall survival (64.0% versus 66.0%) between Tam and Mx + Tam; however, local control was inferior with Tam (local failure rates 43.0% versus 1.9%; P < 0.001).
  
  
  CONCLUSIONS
  Irrespective of the degree of ER positivity, surgery achieved better local control. However, there was excellent and similar survival in both groups. Tam could be considered in those who are 'frail', refuse or prefer not to initially undergo surgery.
authors.affiliation: Divisions of Breast Surgery.
authors.forename: S J
authors.initials: SJ
authors.lastname: Johnston
authors.affiliation: Divisions of Breast Surgery.
authors.forename: F S
authors.initials: FS
authors.lastname: Kenny
authors.affiliation: Divisions of Breast Surgery.
authors.forename: B M
authors.initials: BM
authors.lastname: Syed
authors.affiliation: Divisions of Breast Surgery.
authors.forename: J F R
authors.initials: JFR
authors.lastname: Robertson
authors.affiliation: Pathology, University of Nottingham, Nottingham.
authors.forename: S E
authors.initials: SE
authors.lastname: Pinder
authors.affiliation: Nottingham Breast Institute, Nottingham University Hospitals, Nottingham, UK.
authors.forename: L
authors.initials: L
authors.lastname: Winterbottom
authors.affiliation: Pathology, University of Nottingham, Nottingham.
authors.forename: I O
authors.initials: IO
authors.lastname: Ellis
authors.affiliation: Divisions of Breast Surgery.
authors.forename: R W
authors.initials: RW
authors.lastname: Blamey
authors.affiliation: Divisions of Breast Surgery. Electronic address: kl.cheung@nottingham.ac.uk.
authors.forename: K L
authors.initials: KL
authors.lastname: Cheung
mesh_terms: D000368:Aged; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D002277:Carcinoma / Q000378:metabolism / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008408:Mastectomy; D009361:Neoplasm Invasiveness; D009376:Neoplasms, Hormone-Dependent / Q000188:drug therapy* / Q000401:mortality; D011960:Receptors, Estrogen / Q000378:metabolism*; D018709:Statistics, Nonparametric; D013629:Tamoxifen / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D018931:Antineoplastic Agents, Hormonal; D011960:Receptors, Estrogen; D013629:Tamoxifen