{"entity":{"id":"paper-veronesi-milan-i-twenty-year-nejm-2002","kind":"paper","name":"Milan I at twenty years: breast-conserving surgery against radical mastectomy for small breast cancers","aka":[],"tldr":"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.\n\nThirty 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).","asOf":"2026-11-03","links":[{"label":"N Engl J Med 2002","url":"https://doi.org/10.1056/NEJMoa020989"},{"label":"PubMed","url":"https://pubmed.ncbi.nlm.nih.gov/12393819/"}],"tags":[],"related":[],"cancers":["breast-cancer"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":["int-milan"],"pathways":[],"terms":[],"trials":["milan-i"],"people":["umberto-veronesi"],"bottlenecks":[],"keyPapers":[],"journals":["nejm"],"dependsOn":[],"notes":[],"journal":"New England Journal of Medicine","year":2002,"doi":"10.1056/NEJMoa020989","pmid":"12393819","authors":"Veronesi U, Cascinelli N, Mariani L, et al.","paperType":"rct","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."],"whatItMeans":"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."],"changedPractice":true,"participants":701},"route":"/key-papers/paper-veronesi-milan-i-twenty-year-nejm-2002/","neighbours":{"cancer":[{"id":"breast-cancer","kind":"cancer","name":"Breast cancer (all types)","route":"/cancers/breast-cancer/"}],"institution":[{"id":"int-milan","kind":"institution","name":"Fondazione IRCCS Istituto Nazionale dei Tumori","route":"/institutions/int-milan/"}],"trial":[{"id":"milan-i","kind":"trial","name":"Milan I (quadrantectomy against radical mastectomy)","route":"/trials/milan-i/"}],"person":[{"id":"umberto-veronesi","kind":"person","name":"Umberto Veronesi","route":"/people/umberto-veronesi/"}],"journal":[{"id":"nejm","kind":"journal","name":"New England Journal of Medicine","route":"/journals/nejm/"}]}}