The significance of local control in the primary treatment of breast cancer. Lucy Wortham James clinical research award.

Two sequential clinical trials were carried out to compare wide excision with radical mastectomy in patients with early breast cancer with clinically negative nodes. In the first study there was an increased incidence of local recurrence in patients who had wide excision, but distant recurrence and survival were unaltered. In the second study, the distant recurrence and survival rates were also significantly impaired. A new analysis showed that there were significantly more patients with T1 tumors in the second study than in the first. Comparison of treatments by T status indicates that radical mastectomy gives significantly better results in patients with T1 tumors. There is no difference between the results of the two treatments in patients with T2 tumors. We comment on the implications of these findings for conservation treatment of early breast cancer.