It was the consensus of the panel that a procedure which preserves the pectoral muscles, i.e., a total mastectomy with axillary dissection, provides equivalent benefit to women who have Stage I and selected Stage II breast cancer. Therefore, total mastectomy with axillary dissection should be recognized as the current treatment standard. It was also the consensus that a two-step procedure should be done in most cases, i.e., a diagnostic biopsy should be studied by permanent histologic sections before definitive therapeutic alternatives are discussed with the patient. It was the consensus of this panel that the question of postoperative radiotherapy is moot pending further results of adjuvant clinical trials. Lesser surgical procedures such as segmental mastectomy with or without radiotherapy were discussed.
Segmental mastectomy poses the problem of leaving residual breast tissue.
The early data presented by Dr. Umberto Veronesi from the National Cancer Institute of Milano, Italy indicate that the residual breast tissue that remains after segmental resection and post-operative radiation does not appear to harbor clinically significant breast cancer. The length of patient follow-up of this trial is approximately four years. Primary radiation therapy provides two alternatives, either administered in addition to a minimal surgical procedure, or as a single mode of therapy. The trials utilizing primary radiation therapy and the trials dealing with segmental mastectomy are in a stage which is too early to allow determination of survival benefits, but control of local recurrence appears to be similar to current surgical procedures. The trials that explore the question of lesser surgical procedures and those trials exploring alternate modalities to surgery warrant further follow-up and enthusiastic support.