One of the longest-running studies of breast-cancer treatments in the U.S. shows no gain in survival rates for women who underwent radical mastectomies compared with those who received less-extensive surgeries.

The study, published in Thursday's New England Journal of Medicine, also found that the survival rates of patients who had radiation treatments were about the same as those who didn't. The study measured survival rates 25 years after initial discovery of the breast cancer.

The results provide more grist for proponents of a minimalist approach in treating the disease. "What we're saying is that bigger operations are not going to cure more people," said Bernard Fisher, who headed the study. Dr. Fisher is scientific director of the National Surgical Adjuvant Breast and Bowel Project, a cancer-research center in Pittsburgh that is funded by the National Cancer Institute.

The study, also funded by the National Cancer Institute, is also likely to rekindle controversy over radiation treatment, which has been gaining popularity in recent years.

The study has served as the base for a lot of talk in the medical profession, with bits and parts of its findings discussed in clinical and research circles during the past two decades, notes Susan Love, adjunct professor of surgery at the University of California at Los Angeles. "The study is the foundation in breast-cancer research, and it's reassuring to know that the foundation is still standing after 25 years," says Dr. Love, author of the best-selling book "Dr. Susan Love's Breast Book."

About 225,000 women are expected to be diagnosed with breast cancer this year, up from about 180,000 a year in the mid-1990s, according to national statistics.

Radical mastectomy -- which includes the removal of the breast, muscles in the chest wall and lymph nodes -- used to be the standard therapy until the mid-1960s. But as researchers gained knowledge about how the cancer spreads, doctors became divided, with some advocating more limited use of the knife while others opted for alternative treatments including chemotherapy and other anticancer drugs.

For the study, researchers enlisted 1,665 women with various breast-cancer diagnoses during the early to mid 1970s and tracked their conditions to the present. Since a vast majority of breast cancers are first diagnosed in women over 50, 70% of the study subjects had reached that age or higher.

Patients belonged to two groups: Those whose cancer had possibly spread to the lymph nodes -- characterized as positive nodes -- and those with no signs of a spread, or negative nodes.

Radical mastectomies were performed on a third of the negative-node group. Another third received less-extensive surgery such as simple mastectomies, in which just the breast tissue is removed. The last third received a combination of less-extensive surgery and radiation treatment.

From this negative-node group, 22% of women who received radical mastectomies were still alive 25 years after diagnosis, compared with 21% of those with smaller operations and 17% of those who underwent surgery combined with radiation. Because the margin of error in the study was plus or minus three percentage points, Dr. Fisher said the differences were not statistically significant.

Among the positive-node patients, half received radical mastectomies. The other half were treated with smaller operations plus radiation. The study showed that 13% in the radical-mastectomy group had survived the 25-year follow-up period, and 12% among those receiving less-extensive surgery and radiation.

About 31% of all the deaths in the study were unrelated to breast cancer, with a higher proportion of positive-node patients taken by the disease. But differences in treatment didn't change the proportions of cancer and noncancer deaths.

The research showed that radiation helped keep the cancer from reappearing at the site of the tumor in a small number of patients but showed no 25-year survival advantage.

After falling out of favor because of similar, earlier findings, radiation treatment has resurged since the late 1990s, after studies by Danish and Canadian researchers showed that radiation and chemotherapy greatly increased the chance of going cancer-free for at least 10 years.

Dr. Fisher said that because such a large group of women died of unrelated causes, more is needed to be learned about the causes of their deaths and any impact breast-cancer treatments may have had.

Write to Joseph Pereira at joe.pereira@wsj.com⁷

Updated August 22, 2002 12:23 a.m. EDT

DOCTORS AROUND THE COUNTRY are pioneering ways to remove breast cancer without cutting into the breast.

The procedures aren't yet being performed outside clinical trials, and therefore aren't available to most women. Nonetheless, the promise of a "nonsurgical lumpectomy" -- in which the cancer is obliterated inside the breast rather than cut away -- is a startling advance in treating a disease that has traditionally left women severely scarred or deformed.

"We're just right at the doorstep, looking at an array of technologies to ablate cancer without surgery," says Eva Singletary, professor of surgery at the University of Texas MD Anderson Cancer Center in Houston.

Currently, breast-cancer surgery options include mastectomy, in which the whole breast is removed, and traditional lumpectomy, in which the tumor and a small margin of surrounding tissue are excised. Although women who undergo lumpectomy have a greater chance of a recurrence than those who have mastectomies, the recurrent cancer is generally easily treated, and long-term survival rates are the same for both procedures.

But even lumpectomy leaves an unsightly scar and misshapen breast. The nonsurgical methods under study use radiofrequency heat, laser heat or freezing techniques to kill cancer cells deep inside the breast. And because they require only a small nick in the breast, they leave minimal scarring.

SO FAR, Dr. Singletary has used a radiofrequency ablation technique on 17 breast-cancer patients. The approach uses ultrasound to locate the tumor. Then, a metal probe about as thick as a toothpick is inserted into the breast, and tiny wires in the probe are splayed into the tumor. Those wires vibrate, creating a frictional heat that ultimately destroys the tumor.

Patients with tumors close to the skin or the chest wall probably won't be eligible for the treatment because there wouldn't be enough space to manipulate the probe and surface tissue might burn. In addition, the treatment is currently being studied only for use with very small, early-stage tumors. Patients with malignant calcifications aren't candidates because their cancers can't be seen on a sonogram. That means that ultimately only about 25% of breast-cancer patients are likely to be eligible for the treatment.

Because the method is still in the study phase, all 17 MD Anderson patients who received the treatment later underwent a lumpectomy or mastectomy to check its effectiveness. In 16 of the patients, studies of the breast tissue that was surgically removed showed that all of the cancer had been eradicated. In the remaining patient, all the targeted cancer was destroyed, but some tumor cells that hadn't been detected on the ultrasound were found elsewhere in the breast tissue.

This spring, MD Anderson will conduct a new 30-patient study of nonsurgical lumpectomy. But most of the women in this group will keep their breasts intact. In the study, patients with small tumors will undergo the radiofrequency ablation, and two to four weeks later a needle biopsy will be performed to verify that their cancer was destroyed. If the biopsy is negative, the patient will be treated with radiation therapy, a procedure that is recommended after surgical lumpectomy as well. If the biopsy is positive, the patient will undergo a traditional lumpectomy.

"This could ultimately be an office procedure, and the only visible scar on the breast would be a small skin nick that one would cover with a Band-Aid after completion of the procedure,'' says Dr. Singletary. "We hope that from a cosmetic point of view, it would be a big improvement.''

DOCTORS IN NEW YORK at the Weill Cornell Breast Center have performed the technique on six patients. The ablation procedure destroyed 100% of the targeted cancers, but tissue studies showed that two of the patients had other cancer in the breast that wasn't visible on the ultrasound.

"It destroys cancer completely,'' says Rache Simmons, associate professor of surgery at New York Presbyterian Hospital and Weill Cornell Breast Center. "The issue is determining that the patient doesn't have any other disease than what you can see sonographically. That's been the limitation."

An Italian study published in the journal Cancer last fall used the method to treat 26 women with early cancer. The heat treatment killed all cancer cells in 25 of the women, although tissue studies showed one woman had cancer cells elsewhere in her breast tissue. One patient who had a tumor close to the skin was treated successfully for cancer but suffered burns from the procedure.

Although the idea of leaving even dead cancer tissue inside the body rather than cutting it out sounds surprising, cancer researchers already have a long track record using the method to treat inoperable liver tumors. MD Anderson began using the ablation technique on liver tumors in 1997. In addition to liver and breast cancer, ablation is being studied as a treatment for prostate and lung cancer.

Ablation technology is also promising as a way to treat benign breast tumors, which are often uncomfortable and have to be surgically removed. Dr. Simmons is studying an ablation technique that uses freezing instead of heat to destroy benign tumors inside the breast. The dead tissue is eventually absorbed by the body, and the patient isn't left with a scar.

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Updated January 18, 2002