Clarifying the Management Decision for Early Breast Cancer

Dolan JG A survey of clinicians' opinions regarding the value of published decision analyses as sources of clinically useful information. Med Decis Making. 1997;17:427-30.

Carter KJ , Ritchey NP , Castro F. , et al. Treatment of early-stage breast cancer in the elderly: a health-outcome-based approach. Med Decis Making. 1998;18:213-9.

In order to keep this letter to a reasonable length, only a sampling of the relevant literature is cited. Interested readers may obtain complete references from the author. See for example: NIH consensus conference. Treatment of early-stage breast cancer. JAMA. 1991;265:391-4

; and Recht A. , Houlihan MJ Axillary lymph nodes and breast cancer. A review. Cancer. 1995;76:1491-512.

Silverstein MJ , Gierson ED , Waisman JR , Colburn WJ , Gamagami P. Predicting axillary node positivity in patients with invasive carcinoma of the breast by using a combination of T category and palpability. J Am Coll Surg. 1995;180:700-4

; and Wilhelm MC , Edge SB , Cole DD , DeParedes E. , Frierson Jr HF Nonpalpable invasive breast cancer. Ann Surg. 1991; 213:600-5.

Complete citations may be found in: Marks LB , Prosnitz LR Lumpectomy with and without radiation for early-stage breast cancer and DCIS. Oncology, 1997;11:1361-71

; and Recht A. , Houlihan MJ Conservative surgery without radiotherapy in the treatment of patients with early-stage invasive breast cancer. A review. Ann Surg. 1995;222:9-18. The randomized trials were published prior to submission of the Carter paper

Jaiyesimi IA , Buzdar AU , Decker DA , Hortobagyi GN Use of tamoxifen for breast cancer: twenty-eight years later. J Clin Oncol. 1995;13:513-29.

Leborgne F. , Leborgne JH , Ortega B. , Doldan R. , Zubizarreta E. Breast conservation treatment of early stage breast cancer: patterns of failure . Int J Radiation Oncol Biol. Phys. 1995;31: 765-75.

Ryden S. , Ferno M. , Moller T. , et al. Long-term effects of adjuvant tamoxifen and/or radiotherapy-The South Sweden Breast Cancer Trial. Acta Oncol. 1992;31:271-4.

Harris JR , Morrow M. , Norton L. Malignant tumors of the breast. Chapter 36. In: DeVita VT Jr , Hellman S , Rosenberg SA (eds). Cancer. Principles & Practice of Oncology. 5th ed. Philadelphia, PA: Lippincott-Raven, 1997, p 1602.

Verhoef Lcg , Stalpers JA , Verbeek Alm , Wobbes T. , van Daal Waj. Breast-conserving treatment or mastectomy in early breast cancer: a clinical decision analysis with special reference to the risk of local recurrence. Eur J Cancer. 1991; 27.1132-7.

For opposing points of view: Kantorowitz DA , Poulter CA , Sischy B. , et al. Treatment of breast cancer among elderly women with segmental mastectomy or segmental mastectomy plus postoperative radiotherapy. Int J Radiat Oncol Biol Phys. 1988;15:263-70

; and von-Rueden DG , Sessions SC Alternative therapy for elderly patients with breast cancer. Am Surg. 1994;60:72-8.

See, for example: Crisp WJ , Higgs MJ , Cowan WK , et al. Screening for breast cancer detects tumours at an earlier biological stage. Br J Surg. 1993;80:863-5

; and Tinnemans Jgm , Wobbes T. , Holland R. , Hendriks Jhcl , van der Sluis RF , DeBoer Hhm. Treatment and survival of female patients with nonpalpable breast cancer. Ann Surg. 1989;209:249-53.

Roberts MS The powers and pitfalls of simplifying assumptions. Med Decis Making. 1997; 17:496-7.

Hayman JA , Hillner BE , Harris JR , Weeks JC Cost-effectivess of routine radiation therapy following conservative surgery for early-stage breast cancer. J Clin Oncol. 1998;16:1022-9.

Carter KJ , Ritchey NP , Castro F. , et al. Treatment of early-stage breast cancer in the elderly: a health-outcome-based approach. Med Decis Making. 1998;18:213-19.

Recht A. , Houlihan MJ Axillary lymph nodes and breast cancer, a review. Cancer. 1995;76:1491-512.