Breast cancer not helped by surgery or self-examination

Long-term data about breast cancer is currently pouring in, bringing both confirmations and surprises.

Two studies on breast surgery have recently reported the results of 20-year follow-ups to compare partial surgery, such as lumpectomy and quadrantectomy, with total breast removal. The question was simple: which technique prolonged life more? The answer was equally simple: neither.

There was no difference between the radical and partial surgical procedures in terms of overall survival. This is final confirmation of what many surgeons have long suspected, and should stop the last relics of the old surgical guard who persist in performing radical mastectomies without offering women a choice (N Engl J Med, 2002; 347: 1227-32, 1233-41, 1270-1).

* In contrast, the world of breast cancer has been taken by surprise by the results of a huge study from China.

For years, women have been exhorted to examine their breasts for lumps, sure in the knowledge that early detection means early treatment which, in turn, means better chances of cure. This has long been regarded as virtually self-evident - until finally being put to the test.

Over 130,000 Chinese female factory workers were taught how to do breast self-examination, then given regular encouragement to keep at it - for a full 10 years. These women were then compared with a similar group of women who did not practise breast examination.

The endpoint was crude: how many breast cancer deaths were there in each group? Although a few women (0.1 per cent) had died, the results were startling: there was no difference in death rates between groups.

If routinely encouraging breast self-examination is pointless, 'what does this mean?,' asks the puzzled editorial, commenting on the results (J Natl Cancer Inst, 2002; 94: 1445-57, 1420-1).