To the Editor.—For more than 15 years the Guy's Hospital trials have been providing valuable information on breast-preserving surgery in the treatment of cancer. Hayward and Caleffil recently analyzed 630 patients treated in two series by either radical mastectomy or wide excision and suboptimal radiation therapy. They reported that among patients with clinical stage I disease with T1 lesions, radical mastectomy provided a significantly better prognosis than wide excision. Among patients with larger tumors, there was no survival advantage with radical surgery. This conflicts with the more traditional view expressed in the same issue of the Archives by Maddox et al2: "Patients with more advanced disease substantially benefit from a more comprehensive operation." Hayward and Caleffi offered no explanation for their perplexing results.
I believe that the study by Tartter et al3 helps resolve these conflicting conclusions. They demonstrated a strong correlation between low preoperative natural killer