Breast cancer is the most common cancer among Indian females. More than 25 % of all cancers in females are due to breast cancer. As you are aware, over the last decade the incidence of cancers is increasing at an alarming rate due to various factors. It is sad to know that the most common cancer in Indian females, is also the most common cancer which is not managed properly by treating doctors. Broadly, breast cancers are divided into locally advanced breast cancers(LABC) or advanced disease and operable breast cancers (OBC) or early disease. When a person has less than 5 cm tumor in breast with no or small lymph node spread in armpit, it is an early disease(OBC). On the contrary, if she has tumor more than 5 cm with large fixed nodes in armpit or neck it is advanced disease(LABC). One or two decades ago, almost 60 -75 % of Indian patients present to treating doctor in advanced stage of disease. But in recent times, the scenario is just reversed with 60 -75 % presenting in early stage of breast cancer in all urban areas. Thanks to media, internet and health awareness initiatives, which help people to present at more early stage. From 1850’s, for more than 125 years, the gold standard treatment for breast cancers for both early and advanced stages was mastectomy, which is complete removal of breast along with tumor and complete clearance of all lymph nodes in armpit. Even now mastectomy is the treatment of choice for advanced stage of disease. But in late 1970’s, surgeons in Western countries became aware that, for early tumors it is not necessary to remove entire breast. Hence, they started removing the tumor with a margin of normal tissue and removed all nodes in armpit through a separate incision in armpit. . Hence it was a sound technique, both in terms of oncological clearance and also cosmetically superior as compared to mastectomy. Also, radiation therapy was added to the breast to reduce risk of recurrence. This treatment is called breast conservation therapy(BCT). I would like to underline four important points on why breast conservation surgeries should be offered to all early breast cancers. Firstly, initial studies showed 14% more local recurrence in BCT as compared to mastectomy, but this has significantly reduced over last three decades to around 2-7% , owing to latest chemo and radiotherapy techniques. Patients should understand that even after mastectomy , 2-3% of them have recurrence, thus 100 % cure cannot be assured even if one has to undergo mastectomy. Thus it is clear that BCT has results on par with mastectomy. Secondly, even if there is minimal increase of local recurrence in BCT as compared to mastectomy, the number of years patients going to live will be the same with both these surgeries. Thirdly, recurrences in BCT can almost always be salvaged by mastectomy. Last but not least, a patient with mastectomy is physically, emotionally and sexually shattered. But patients undergoing BCT have a great body image and high positive attitude. Of course, not all patients may be fit for these conservation surgeries. To mention a few, very large tumors, disease at various parts of same breast, difficulty in receiving radiation therapy etc. One must understand that these conservation surgeries are not experimental techniques. Research has proven conservation surgeries are safe with more than 25 years of follow up of patients. Hence the gold standard treatment for early breast disease is BCT. Surgeons in developed countries understood this 30 -40 years ahead of us as the patients had very early disease even in late 70’s and 80’s owing to screening and better awareness about cancer in general public. India being a developing country, only in the last 10 -15 years we see this trend of early breast cancers, better awareness, affordability among patients and also availability of advanced facilities. Inspite of robust evidence, BCT is not widely practised in India. The reasons being, most of the treating surgeons and patients still feel more is better and hence opt mastectomy, also there is a lack of expertise, training and facilities in treating centres. As BCT are done only at specialised cancer centres , almost 90 % of primary care physicians and general surgeons are never exposed to these specialised techniques and hence never recommend BCT to their patients. In an era with more educated and working class women, where women empowerment is widely encouraged , BCT is a big boon to these patients. Again age is not a contraindication for this conservation procedure. A well motivated ,fit 75 year old lady also can receive this treatment and can retain her symbol of feminity. World is racing ahead with lot of new discoveries. Graham bells heavy telephone instrument which was invented around the same time as mastectomy came into vogue , has been replaced with ultra modern smart phones. But when it comes to conservation surgeries for early breast cancers , people are still a century behind, holding their prejudices to a outdated treatment . I must also mention the much more recent techniques like oncoplasty to improve cosmetic outcome and sentinel lymph node biopsies to reduce the side effects of lymph node dissection in armpit in suitable patients. We will see about these in detail in our next communication.