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document
Comparison of mastectomy with tamoxifen for treating elderly patients with operable breast cancer . STUDY OBJECTIVE Comparison of tamoxifen and mastectomy in treatment of breast cancer in elderly patients . DESIGN Randomised trial of treatment of operable breast cancer by wedge mastectomy or tamoxifen , with median follow up 24 and 25 months respectively ( range 1-63 ) . SETTING University hospital ; most patients from primary catchment area . PATIENTS 135 consecutive patients with breast cancer aged over 70 with operable tumours ( less than 5 cm maximum diameter ) ; 68 were allocated to tamoxifen group and 67 to mastectomy group . Histological diagnosis by biopsy . Two incorrect randomisations in each group . Patient characteristics similar in the two groups and all under care of one surgical team . INTERVENTIONS Mastectomy group received wedge mastectomy plus excision of symptomatic axillary lymph nodes . Tamoxifen group received continuous treatment with tamoxifen 20 mg twice daily . Patients in tamoxifen group received wedge mastectomy if there was sign of local progression . Those in mastectomy group received further excision or radiotherapy for locoregional recurrence and when local treatments had been exhausted or metastatic disease diagnosed they received tamoxifen . END POINT Treatment efficacy was assessed by local control of disease and by survival . MAIN RESULTS Mortality from metastatic cancer in tamoxifen group was 7 ( 10.6 % ) and in mastectomy group 10 ( 15.3 % ) ( NS ) . There was no difference in survival between the two groups . In mastectomy group 70 % remained alive and free of local recurrence at 24 months ; in tamoxifen group only 47 % remained alive and free of local progression . In mastectomy group locoregional recurrence occurred in 16 patients and metastatic disease in 13 ; in tamoxifen group locoregional progression occurred in 29 patients and metastatic disease in seven . CONCLUSIONS As a high proportion of patients treated with tamoxifen eventually required surgery treatment of elderly patients with breast cancer should include mastectomy . Optimum treatment may include both mastectomy and tamoxifen .
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Intervention_Surgical
mastectomy
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Intervention_Pharmacological
tamoxifen
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Intervention_Surgical
tamoxifen
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Intervention_Surgical
mastectomy
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Intervention_Surgical
wedge mastectomy
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Intervention_Pharmacological
tamoxifen
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Intervention_Pharmacological
tamoxifen group
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Intervention_Surgical
mastectomy group .
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Intervention_Surgical
wedge mastectomy plus excision of symptomatic axillary lymph nodes
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Intervention_Pharmacological
Tamoxifen
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Intervention_Pharmacological
tamoxifen 20 mg
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Intervention_Surgical
wedge mastectomy
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Intervention_Physical
radiotherapy
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Intervention_Pharmacological
tamoxifen
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Intervention_Pharmacological
tamoxifen
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Intervention_Surgical
mastectomy
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Outcome_Other
Treatment efficacy
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Outcome_Physical
local control of disease and by
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Outcome_Mortality
survival
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Outcome_Mortality
Mortality
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Outcome_Mortality
survival
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Outcome_Physical
free of local recurrence
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Outcome_Physical
locoregional recurrence
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Outcome_Physical
locoregional progression
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Participant_Age
elderly
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Participant_Condition
breast cancer
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Participant_Condition
breast cancer
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Participant_Age
elderly
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Participant_Sample-size
135
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Participant_Condition
breast cancer
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Participant_Age
70
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Participant_Condition
tumours
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Participant_Age
elderly
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Participant_Condition
breast cancer