Early Surgery or Standard Palliative Therapy in Treating Patients With Stage IV Breast Cancer

Inclusion Criteria: * Diagnosis of intact primary (not recurrent) invasive carcinoma of the breast * Stage IV disease * Confirmation of the primary tumor should be by needle biopsy (preferred) * Incisional surgical biopsy allowed as long as there is residual palpable or tumor image in the breast * Patients must be judged to be candidates for complete resection with free margins followed by radiation therapy (if radiation therapy is indicated) * For women not undergoing axillary dissection, sentinel node biopsy should document an axillary nodal burden of 1-2 involved lymph nodes (i.e., ACOSOG Z-11 criteria may be applied) * Prior non-invasive (Ductal Carcinoma In Situ) cancer allowed provided there has been no recurrence * Prior ipsilateral invasive cancer allowed if more than 5 years previous * Patients should have at least one organ system involved with distant metastatic disease * If patient has only one metastatic lesion/focus, this must be proven by biopsy and the pathology report confirming the diagnosis of primary breast cancer, as well as the metastatic site, must be available * Must have available radiologic reports documenting disease status within the past 6 weeks prior to initiating systemic therapy * CNS metastases allowed provided projected survival \> 6 months * Patients must have completed at least 16 weeks of optimal systemic therapy (appropriate to the tumor biological profile and the patient's age and menopausal status) * If systemic therapy is…