Alternatives to mastectomy now being tested

Press, 9 May 1985, Page 8

Alternatives to mastectomy now being tested

NZPA-AAP Sydney Women with early-de-tected breast cancer are less likely to undergo mutilating surgery in the future as countries around the world follow a trend begun in Italy, cancer expert Professor Bruno Salvador! has said in Sydney. Trials had shown that removal of only a quarter of the breast, coupled with radiotherapy, was a good alternative to radical mastectomy. Professor Salvador!, director of surgery at the National Cancer Institute in Milan, presented data on successful “conservative” treatment of cancer to the Australasian College of Surgeons scientific meeting recently.

“Our trials show that on tumours less than two centimetres, quadrectomy (removal of a quarter of the breast) along with radiotherapy is a good alternative to radical mastectomy,” he said. “Our next clinical trials will be on an even more conservative treatment —

lumpectomy — which is a technique delivering an even better cosmetic result.” Professor Salvador! said

the brighter prospects for women with breast cancer followed not only advances in surgical techniques and radiotherapy, but also early diagnosis. “Early detection is very important and it comes from better education,” he said.

“One thing follows another as once, when women were fearful that removal of the breast was the only alternative, they put off telling their doctor.

“Now that we offer an alternative — the maximum cosmetic result with the minimum of mutilation — they are coming forward earlier.”

Dr Stuart Renwick, chairman of the Section of Breast Surgery of the Australasian College of Surgeons, stressed that conservative treatment was open to only a limited group of women — those with early breast cancer, with tumours 2cm or less. He said the Italian data, published eight years ago, had been followed in Australia and women in Sydney who were suitable candidates had been offered the quadrectromy alternative for the past six years. “Australian surgeons are picking up the data and

starting to use it,” he said. “But we have been stung before.

“It has been found in the past that four or five years after conservative treatment things go wrong — the tumour may recur or the woman may die of the cancer.

But the Italian study now has 12 years behind it with good results.” Dr Renwick said quadrectomy treatment in Australia was confined to capital cities because it was best done in institutions where radiotherapists worked alongside surgeons. “That is the importance of a scientific meeting like this one which is attended by many country surgeons who take the knowledge away with them,” he said. “So if they find someone with a small tumour for whom this treatment would be effective they can refer them.”

Dr Renwick said new data from a Pittsburg surgeon, Bernard Fisher, who had treated tumours up to 4cm without mastectomy or radiotherapy, had not showed a good enough result after five years to be followed in Australia.

Dr Renwick said surgeons from the Milan institute, headed by Professor Umberto Veronesi, had told him they had “a gut feeling that lumpectomy treatment would prove as successful as quadrectomy.

“But we won’t have a definite answer on this for four or five years,” he said.