The conventional recommendation has been to remove the axillary lymph nodes , since about one-third of patients who do not have obviously enlarged nodes still have microscopic involvement (positive nodes reclassifies the disease as Stage II, a treatment category requiring adjuvant chemotherapy or hormone therapy).
Adjuvant Therapy For many years it was not customary to treat Stage I breast cancer with chemotherapy or hormone therapy. These patients generally have a good prognosis , with only about one chance in four of further tumor spread. For cancers smaller than 1 cm (1/2 in.) in diameter, the chance of recurrence is less than 10 percent within 10 years of diagnosis. The U.S. National Institutes of Health Consensus Conference on Treatment of Early Stage Breast Cancer in June 1990 suggested that it is reasonable not to give adjuvant treatment to patients with these very small tumors unless they are part of a clinical trial or high-risk factors are involved.
Recent trials suggest, however, that many other Stage I patients will benefit from adjuvant therapy. Two large trials by the National Surgical Adjuvant Breast Project (NSABP) showed significant reduction in recurrences in the opposite breast at four-year follow-up for estrogen-receptor-negative patients given chemotherapy and for estrogen-receptor positive patients treated with tamoxifen.
Although there is an early benefit for adjuvant treatment in patients with negative axillary lymph nodes, studies are continuing to see if there will be an improvement in survival.
