The surgeon's role in primary XXXX .

@entity5 @entity1 @entity0
During the 1960s, it was suggested that, at least in clinical stage I disease, simple mastectomy or even wide excision, plus radiotherapy to the breast and gland fields resulted in the same distant recurrence rate and survival as the orthodox radical operation. It was thought that local control of the disease was not important in terms of ultimate prognosis and it was felt that minimal surgery incurred no penalty. It was forecast that @entity0 would soon be treated by radiotherapy alone, possibly even without @entity5 . Four developments have materially affected the situation. 1. It has been shown that assays of hormone receptors should be carried out on all primary @entity5 . 2. In clinical stage II disease, it has been demonstrated that restricted surgery results in a penalty in terms of distant recurrence and survival. 3. It is now realised that the number of involved axillary lymph nodes must be known to evaluate future prognosis. 4. Adjuvant chemo or endocrine therapy have proved to be effective in treating @entity1 with heavy axillary node involvement. These developments mean that the effective treatment of early @entity0 must entail @entity5 , achieve local control of disease and include axillary node dissection. Currently, only the modified radical mastectomy effectively equates with these three aims. Nevertheless, it is possible that @entity5 excision, irradiation to the @entity5 bed and breast, and axillary node dissection would achieve the same object whilst conserving the breast.
