Milan I Study: Breast Conserving Surgery

Milan I study:
- Was a prospective randomized trial
- Conducted by the Milan Cancer Institute:
  - From 1973 to 1980
Milan I study:
- Played a critical role in the establishment of breast conserving surgery (BCT):
  - As a preferred mode of treatment for women with small breast cancers (≤ 2 cm)
- For this study, 701 women with tumors ≤ 2 cm and clinically negative axillary examinations:
  - Were enrolled and randomized to radical mastectomy (n = 349) versus BCT (quadrantectomy and axillary node dissection) followed by radiotherapy (n = 352)
- Results from Milan I:
  - Were concurrent with those from NSABP B-06 trial:
    - Showing no appreciable differences in long-term survival between the groups:
      - Despite a higher cumulative incidence of recurrence at 20 years in patients treated with BCT
        
        Ipsilateral breast tumor recurrence rates after 20 years follow-up were:
        
        8.8% for the BCT group compared to a 2.3% rate of local recurrence for the radical mastectomy group (P<0.001)
      - Additionally, there were no significant differences between the two groups in the rates of contralateral breast cancer, distant metastases, or secondary primary cancers.
Overall, Milan I concluded that:
- Long-term survival was the same for women who underwent radical mastectomy as those who received BCT:
  - Thus providing more evidence to support breast-conserving surgery as treatment for women with small cancers
References
- Veronesi U, Cascinelli N, Mariani L, Greco M, Saccozzi R, Luini A, et al. Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med. 2002;347(16):1227-1232.
- Julian TB, Venditti CA, Duggal S. Landmark clinical trials influencing surgical management of non-invasive and invasive breast cancer. Breast J. 2015:21(1);60-66.