The long term outcome (more than 15 years) of adjuvant treatment in patients with primary operable breast cancer has rarely been examined.

A randomised clinical trial of radiotherapy, chemotherapy or both on women with primary operable breast cancer (n= 322) was followed-up for a median of 27 years.

260 (81%) patients died, 204 (78%) from breast cancer. Cancer specific survival (SE) at 10 years, 20 years and 30 years was 41 (3)%, 34 (3)% and 33 (3)% respectively. Presence of more than 3 involved lymph nodes increased cancer-specific mortality (HR 1.88, 95% CI 1.34-2.63) after adjustment for age, socio-economic deprivation and adjuvant treatment. Both age (HR 1.63, 95% CI 1.19-2.22) and involved lymph nodes (HR 1.59, 95% CI 1.17-2.14) were significant predictors of all-cause mortality after adjustment for other factors. There was no significant difference in all-cause or cancer-specific survival between patients in each of the 3 treatment arms.

The present study highlights the long term impact of node positive disease but does not indicate that any regimen was associated with significantly better long-term survival.

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