Treatment of minimal breast cancer

Modified radical mastectomy was performed in 162 patients with minimal breast cancer between 1953 and 1972 (JAU). The majority of lesions were small infiltrating cancers (52), non-infiltrating duct cancer (37), lobular carcinoma in situ (49), Paget's disease with non-infiltrating cancer (12), and also a small group of miscellaneous low-grade cancers (7), and malignant cystosarcoma phyllodes (5). Major indications for surgery were the presence of a mass, nipple ulceration, positive mammograms, and the discovery of an occult cancer on contralateral biopsy. Mammography was accurate in 60% of patients with minimal breast cancer. Contralateral biopsy proved to be a very sensitive diagnostic technique, and was positive in 35 patients, most of whom were negative by clinical examination and mammography. Residual cancer was found in the mastectomy specimens in 52% after generous excisional biopsies. Sixteen percent of patients with minimal infiltrating cancer and clinically negative axillae had micrometastases (2mm or less) in axillary nodes. The crude survival rate free of disease was 93 of 95 patients (98%) at 5 years, and 42 of 44 patients (95%) at 10 years. There were no local recurrences. No postoperative radiation was used on these patients. Modified radical mastectomy is recommended as the ideal treatment for minimal breast cancer as it yields excellent long term salvage, complete local control, and is more acceptable cosmetically than the classical radical mastectomy. It is to be preferred over extended lumpectomy (tylectomy) with radiation therapy since it avoids the potential long-term carcinogenic effects of ionizing radiation. The excellent results obtained by adequate treatment of minimal breast cancers attest to the need for reliable mass screening techniques to detect occult, asymptomatic breast cancer, and for the availability of these techniques to the public at large.