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Between November 1, 1976 and December 31, 1981, 826 post-menopausal females with operable breast cancer were included into a trial comparing tamoxifen 40 mg daily for 2 years with no endocrine treatment. Patients without axillary lymph node metastases and tumors less than 30 mm received no other treatment whilst those with more advanced disease were in addition superrandomised to receive postoperative irradiation or 12 courses of CMF. With a mean follow-up of 44 months tamoxifen significantly reduced the incidence of recurrence. There was no significant interaction between the effect of tamoxifen and any other treatment or prognostic subgroup.

Since 1977 patients living in Stockholm with Stage I breast cancer fulfilling specific criteria are offered breast-conserving treatment. The treatment includes a partial mastectomy and a low-axillary dissection followed by radiotherapy, 5000 rad, to the remaining breast. Between 1977 and 1981, 262 patients underwent the breast conserving therapy. One hundred eighty-six patients had pathologic Stage I tumors. Radiotherapy was given to 158 of those patients. During the follow-up time (6 months to 5 years), 4 of 186 patients had recurrence to the breast. Two of those had not received radiotherapy. Recurrent tumor in regional lymph nodes occurred in 4/186, and distant metastases in 10/186 patients. Six patients have died of their disease. The cosmetic results were favorable overall, but often impaired when surgical complications occurred. A comparison between these results and those obtained in similar patients treated with modified radical mastectomy with a low-axillar dissection followed by radiotherapy to the remaining breast seems to be an alternative treatment to modified radical mastectomy. Longer follow-up time is needed before final conclusions can be drawn.

A randomized trial of preoperative radiotherapy in operable breast cancer was conducted from 1971 to 1976. The diagnosis was established by fine-needle aspiration biopsy. A dose of 4500 rad over five weeks was given to the chest wall, the breast and the lymph nodes of the axilla, the supraclavicular fossa and the internal mammary chain. Modified radical mastectomy was performed six weeks or more after completed radiotherapy. In control patients the same operation was performed without prior radiotherapy. By random allocation, one control group received no further treatment and postoperative irradiation was given to the other controls. Preoperative radiotherapy reduced the incidence of local and regional recurrence and of distant metastases, and also the mortality, as compared with the surgery only group. Postoperative radiotherapy as given in this trial gave almost equal reduction of local and regional recurrence but did not diminish the frequency of distant metastases or the mortality.

Serum levels of pregnancy-associated alpha-glycoprotein (alpha 2-PAG) and estradiol-17 beta (E2) and the estrogen receptor content (ER) in the tumor cytosol were measured in 174 women aged 24 to 94 years with primary breast cancer and the values were related to patient age, tumor size and clinical stage. While E2 levels were significantly lower and ER values significantly higher in older women, no significant correlation was found between alpha 2-PAG on one hand and the patients' age, E2 or ER values or tumor size on the other. A significant positive correlation (p = 0.016, Pearson correlation test) was found between alpha 2-PAG values and the clinical stage of the tumor. The results suggest the possible use of alpha 2-PAG as a marker for the monitoring of disseminated breast cancer during systemic therapy.