{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T07:22:55Z","timestamp":1765264975477,"version":"3.46.0"},"reference-count":10,"publisher":"BMJ","issue":"6688","license":[{"start":{"date-parts":[[1989,6,17]],"date-time":"1989-06-17T00:00:00Z","timestamp":614044800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.bmj.com\/company\/legal-information\/terms-conditions\/legal-information\/tdm-licencepolicy"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["BMJ"],"published-print":{"date-parts":[[1989,6,17]]},"abstract":"<jats:p>OBJECTIVE--To identify any excess mortality caused by adjuvant radiotherapy for early breast cancer. DESIGN--Prospective randomised clinical trial. Two thousand subjects needed for study to have a 90% chance of detecting a difference in survival rate of 7% with 95% significance. Patients were followed up until June 1988, giving follow up of 158-216 months. SETTING--A multicentre trial mainly drawing patients from centres in the United Kingdom. PATIENTS--2800 Women presenting with clinical stage I or II carcinoma of the breast from June 1970 to April 1975. INTERVENTIONS--One group of women (n = 1376) had simple mastectomy followed by immediate postoperative radiotherapy (1320 to 1510 rets). The remaining women (n = 1424) had simple mastectomy with subsequent careful observation of the axilla, radiotherapy being delayed until there was obvious progression or recurrence of disease locally. END POINT--Increased mortality in patients treated with radiotherapy from causes other than breast cancer. MEASUREMENTS AND MAIN RESULTS--Survival was measured from time of first treatment to death or last follow up. Deaths from any cause and from specified causes were counted as events. Comparison over the whole follow up showed a slight excess mortality in the group treated with radiotherapy (relative risk 1.04; 95% confidence interval 0.94 to 1.15). The relative risk of death from breast cancer was 0.97 (0.87 to 1.08) but that of death from other causes was 1.37 (1.09 to 1.72), the increase mainly being in women who had had tumours of the left breast (1.61 (1.17 to 2.24)) and had been treated with orthovoltage (1.85 (1.27 to 2.71)). Analysis of causes of death after five years showed a relative risk of 2.11 (1.25 to 3.59) for new malignancies and of 1.65 (1.05 to 2.58) for cardiac disease, the increase in cardiac mortality being most pronounced in patients who had had tumours of the left breast and whose treatment had included orthovoltage radiation (relative risk 2.67 (1.28 to 5.55)). CONCLUSIONS--Adjuvant radiotherapy after simple mastectomy for early breast cancer produces a small excess late mortality from other cancers and cardiac disease. The risk has to be balanced against the higher risk of local recurrence when immediate postoperative radiotherapy is not given. The balance has to be assessed for each patient, and for many patients radiotherapy will still be desirable in the initial treatment of their early breast cancer.<\/jats:p>","DOI":"10.1136\/bmj.298.6688.1611","type":"journal-article","created":{"date-parts":[[2009,4,2]],"date-time":"2009-04-02T15:19:55Z","timestamp":1238685595000},"page":"1611-1614","source":"Crossref","is-referenced-by-count":145,"title":["Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer."],"prefix":"10.1136","volume":"298","author":[{"given":"J. L.","family":"Haybittle","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D.","family":"Brinkley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J.","family":"Houghton","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"R. P.","family":"A'Hern","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M.","family":"Baum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[1989,6,17]]},"reference":[{"key":"ref_1","first-page":"118","article-title":"Post-operative radiotherapy in breast cancer","volume-title":"Prognostic factors in breast cancer","author":"Easson, E.C.","year":"1968","unstructured":"Easson EC. Post-operative radiotherapy in breast cancer. In: Forrest APM, Kunkler PH, eds. Prognostic factors in breast cancer. Edinburgh: Churchill Livingstone, 1968:118-27."},{"key":"ref_2","first-page":"55","article-title":"Cancer Research Campaign Working Party. Cancer Research Campaign (King's\/Cambridge) trial for early breast cancer: a detailed update of the tenth year","volume":"ii:","year":"1980","unstructured":"Cancer Research Campaign Working Party. Cancer Research Campaign (King's\/Cambridge) trial for early breast cancer: a detailed update of the tenth year. Lancet 1980;ii:55-60.","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1016\/S0140-6736(74)90142-1","article-title":"Decreased survival related to irradiation postoperatively in early operable breast cancer","volume":"ii:","author":"Stiensward, J.","year":"1974","unstructured":"Stiensward J. Decreased survival related to irradiation postoperatively in early operable breast cancer. Lancet 1974;ii: 1285-6.","journal-title":"Lancet"},{"key":"ref_4","first-page":"15","article-title":"Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer","volume":"71","author":"Cuzick, J.; Stewart, H.; Peto, R.","year":"1987","unstructured":"Cuzick J, Stewart H, Peto R, et al. Overview of randomized trials of postoperative adjuvant radiotherapy in breast cancer. Cancer Treat Rep 1987;71: 15-29.","journal-title":"Cancer Treat Rep"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1259\/0007-1285-57-676-309","article-title":"The Cancer Research Campaign (King's\/Cambridge) trial for early breast cancer: an analysis of the radiotherapy data","volume":"57","author":"Brinkley, D.; Haybittle, J.L.; Houghton, J.","year":"1984","unstructured":"Brinkley D, Haybittle JL, Houghton J. The Cancer Research Campaign (King's\/Cambridge) trial for early breast cancer: an analysis of the radiotherapy data. BrJ Radiol 1984;57:309-16.","journal-title":"BrJ Radiol"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"185","DOI":"10.2307\/2344317","article-title":"Asymptotically efficient rank invariant test procedures","volume":"135","author":"Peto, R.; Peto, J.","year":"1972","unstructured":"Peto R, Peto J. Asymptotically efficient rank invariant test procedures. Journal ofthe Royal Statistical Society Series A 1972;135: 185-98.","journal-title":"Journal ofthe Royal Statistical Society Series A"},{"issue":"42","key":"ref_7","first-page":"519","article-title":"The late effects of artificial menopause by Xradiation","volume":"1969","author":"Brinkley, D.; Haybittle, J.L.","unstructured":"Brinkley D, Haybittle JL. The late effects of artificial menopause by Xradiation. BrJ Radiol 1969;42:519-21.","journal-title":"BrJ Radiol"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1259\/0007-1285-49-579-224","article-title":"Late effects of X-irradiation in patients treated for metropathia menorrhagia","volume":"49","author":"Smith, P.G.; Doll, R.","year":"1976","unstructured":"Smith PG, Doll R. Late effects of X-irradiation in patients treated for metropathia menorrhagia. BrJX Radial 1976;49:224-32.","journal-title":"BrJX Radial"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/S0009-9260(89)80099-6","article-title":"Mortality pattems over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy","volume":"40","author":"Jones, J.M.; Ribeiro, G.G.","year":"1989","unstructured":"Jones JM, Ribeiro GG. Mortality pattems over 34 years of breast cancer patients in a clinical trial of post-operative radiotherapy. Clin Radiol 1989;40:204-8.","journal-title":"Clin Radiol"},{"key":"ref_10","first-page":"667","article-title":"The role of radiotherapy following total mastectomy for patients with early breast cancer","volume":"9","author":"Berstock, D.J.; Houghton, J.; Haybittle, J.L.; Baum, M.","year":"1980","unstructured":"Berstock DJ, Houghton J, Haybittle JL, Baum M. The role of radiotherapy following total mastectomy for patients with early breast cancer. World J7 Surg 1980;9:667-70."}],"container-title":["BMJ"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/data.bmj.org\/tdm\/10.1136\/bmj.298.6688.1611","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmj.298.6688.1611","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,9]],"date-time":"2025-12-09T07:19:42Z","timestamp":1765264782000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.bmj.com\/lookup\/doi\/10.1136\/bmj.298.6688.1611"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1989,6,17]]},"references-count":10,"journal-issue":{"issue":"6688","published-online":{"date-parts":[[1989,6,17]]},"published-print":{"date-parts":[[1989,6,17]]}},"alternative-id":["10.1136\/bmj.298.6688.1611"],"URL":"https:\/\/doi.org\/10.1136\/bmj.298.6688.1611","relation":{},"ISSN":["0959-8138","1468-5833"],"issn-type":[{"type":"print","value":"0959-8138"},{"type":"electronic","value":"1468-5833"}],"subject":[],"published":{"date-parts":[[1989,6,17]]}}}