# Milan I at twenty years: breast-conserving surgery against radical mastectomy for small breast cancers

Source: https://onco.cc/key-papers/paper-veronesi-milan-i-twenty-year-nejm-2002/  
OnCo record `paper-veronesi-milan-i-twenty-year-nejm-2002` (Key paper). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The twenty-year report of the Milan trial: women with breast cancers of 2 cm or less who had a quadrantectomy and radiotherapy lived as long as women who had the whole breast, chest muscles and nodes removed.

## Summary

From 1973 to 1980, 701 women with breast cancers measuring no more than 2 cm were randomly assigned at the Istituto Nazionale Tumori in Milan to radical (Halsted) mastectomy (349) or to quadrantectomy followed by radiotherapy to the remaining breast (352). After 1976, node-positive women in both groups also received adjuvant CMF chemotherapy.

Thirty women in the breast-conserving group had a recurrence in the same breast against eight after radical mastectomy (p<0.001), a crude cumulative incidence of 8.8 against 2.3 per cent at 20 years. Contralateral cancers, distant metastases and second primaries did not differ. After a median follow-up of 20 years, death from all causes was 41.7 against 41.2 per cent (p=1.0) and death from breast cancer 26.1 against 24.3 per cent (p=0.8).

## Fields

- Kind: Key paper
- Last checked: 2026-11-03
- Journal: New England Journal of Medicine
- Year: 2002
- DOI: 10.1056/NEJMoa020989
- Authors: Veronesi U, Cascinelli N, Mariani L, et al.
- Findings: Death from any cause at 20 years 41.7 per cent after quadrantectomy with radiotherapy against 41.2 per cent after radical mastectomy (p=1.0).; Death from breast cancer 26.1 against 24.3 per cent (p=0.8).; Recurrence in the same breast 8.8 against 2.3 per cent (p<0.001), with no difference in contralateral cancers, distant metastases or second primaries.
- What it means: For a small breast cancer, keeping the breast does not cost survival. It is half of the evidence, with the American NSABP B-06, on which breast-conserving surgery became the standard of care.
- Caveats: Tumours of 2 cm or less only; the operation tested, quadrantectomy, removes more tissue than a modern lumpectomy.; Recruitment ended in 1980, before modern imaging, systemic therapy and radiotherapy techniques.

## Sources

- N Engl J Med 2002: https://doi.org/10.1056/NEJMoa020989
- PubMed: https://pubmed.ncbi.nlm.nih.gov/12393819/

## Connected records

- cancers: [Breast cancer (all types)](https://onco.cc/cancers/breast-cancer/)
- institutions: [Fondazione IRCCS Istituto Nazionale dei Tumori](https://onco.cc/institutions/int-milan/)
- trials: [Milan I (quadrantectomy against radical mastectomy)](https://onco.cc/trials/milan-i/)
- people: [Umberto Veronesi](https://onco.cc/people/umberto-veronesi/)
- journals: [New England Journal of Medicine](https://onco.cc/journals/nejm/)

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