T1 G1 NO ER positive breast cancer—adjuvant therapy is needed J. Kirkby-Bott * , G. Cunnick, M.W. Kissin The Breast Unit, Department of Breast Surgery, Royal Surrey County Hospital, Guildford, Surrey GU2 5XX, UK Accepted 6 December 2004 Available online 29 January 2005 KEYWORDS Breast cancer; Radiotherapy; Tamoxifen; Margins Abstract Aims. To assess the outcome of treating patients with excellent prognosis (T1 G1 N0 ER Cve) breast cancers with breast conserving surgery alone. Methods. One hundred and twenty-one women with grade 1, node negative, ERC tumours, smaller than 20 mm who were treated by breast conserving surgery alone between 1991 and 2000. Margin width was always at least 5 mm. The following were recorded: local recurrence (LR), distant recurrence, new contra-lateral primaries and death. Recurrence rates were then compared to those in the largest series. Results. One hundred and twenty-one women were followed up for a median of 68 months. Fourteen developed further breast cancer in the same side and eight new cancers in the contra-lateral breast. There was one case of distant metastasis and no deaths. Local recurrence rate was significantly higher than other studies (pZ0.006). Conclusions. Although there is no detrimental effect on survival after this length of follow-up, the omission of radiotherapy and tamoxifen appears to increase the probability of LR. Patients with T1 G1 N0 ERC breast cancer treated by breast conserving surgery should be offered both radiotherapy and tamoxifen. q 2004 Elsevier Ltd. All rights reserved. Introduction Small (less than 2 cm), grade 1, node negative, ER positive invasive breast cancers have an excellent prognosis, with an expected 10-year survival of more than 94%. 1 No studies have yet shown that radiotherapy and tamoxifen can be safely omitted from any subgroup of patients with ER positive breast cancers treated by conservation surgery. 2–8 Several trials have looked at the effect of omitting adjuvant radiotherapy and tamoxifen in groups with small grade 1–3 tumours on ipsi-lateral and contra- lateral 3–5 and ipsi-lateral recurrence. 6–8 Only one other trial has addressed the ipsi-lateral recurrence rate in small, grade 1, ER positive, node negative tumours treated by surgery alone. 2 This study looks at contra-lateral and ipsi-lateral tumour recurrence in small grade 1 ER positive node negative tumours treated by surgery alone. The aim of this study was to determine the ipsi- lateral and contra-lateral recurrence rate of patients with a small grade 1 ER positive, node EJSO (2005) 31, 369–372 www.ejso.com 0748-7983/$ - see front matter q 2004 Elsevier Ltd. All rights reserved. doi:10.1016/j.ejso.2004.12.011 * Corresponding author. Address: Royal United Hospital, Combe Park, Bath BA1 2XH, UK. Tel.: C44 1225 428331; fax: C44 1225 821874. E-mail addresses: jameskirkby@rcsed.ac.uk (J. Kirkby-Bott), gcunnick@doctors.org.uk (G. Cunnick).