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Radical mastectomy - any benefit?

by Dr Norman Swan

A 25-year study has found that complete removal of the breast gives no more benefit to cancer patients than less drastic surgery.

19 09 2002

The nail has finally been driven into the coffin of a rather troubling episode in medical history.

There's a lot of evidence in many forms of cancer that if the surgeon removes a tumour completely, the outcome is much better.

In breast cancer this belief took the form of a radical mastectomy – where the breast, the chest muscles and the lymph nodes in the armpit were all removed.

But doctors introduced the operation without scientific testing and continued it despite evidence it wasn't working. This led some surgeons to conclude that even more radical surgery was warranted, while others said that perhaps less severe procedures followed by radiotherapy would be just as good and less disabling.

It took until 1971 for a proper trial to be conducted, which showed no extra benefit from radical mastectomy, compared to just removing the breast with or without radiotherapy.

Believers said, "Just you wait, and you'll find that the radical operation will be better in the long term".

But now an analysis of the 25-year results has confirmed the earlier findings – no significant benefit.

For women it's reassurance that they're not jeopardising their chances by having less mutilating operations.

For Reference

Title: New England Journal of Medicine
Author: Fisher B et al
URL: http://content.nejm.org/
2002 vol 347 pp 567-575