Large operable breast cancer: the applicability of primary chemotherapy

Abstract This study appraises the applicability of primary chemotherapy to enable breast conserving treatment in patients with large operable breast cancers. Between May 1991 and September 1992, 82 patients presented to the Guy's Breast Unit with tumours ≥4 cm; 40 (49%) had features of locally advanced or metastatic disease and 42 (51 %) had large operable tumours. Eleven of 41 evaluable patients with large operable tumours were considered unsuitable for primary chemotherapy on clinical grounds. Of the 30 for whom primary chemotherapy was considered appropriate, after full explanation of the treatment protocol, 14 (47%) chose mastectomy and 16 (53%) primary chemotherapy of whom eight achieved at least a partial response and underwent breast conserving treatment. Thus, only eight of the original 41 patients (20%) with large operable tumours were able to have initial breast preservation, but three ultimately needed mastectomy for recurrence in the conserved breast. Analysis of audiotaped consultations showed that most patients were given comprehensive information about the complexity of treatment during the decision-making process towards their choice on whether or not to pursue the possibility of breast conserving treatment. The analysis also provided a valuable insight into the communicative interactions between doctor and patient.