0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Presidential Address |

Breast Cancer Detection and Treatment:  A Personal and Historical Perspective

Roger S. Foster, Jr, MD
Arch Surg. 2003;138(4):397-408. doi:10.1001/archsurg.138.4.397.
Text Size: A A A
Published online

Extract

Two paradigms—breast cancer initially as a local and regional disease or breast cancer initially as a systemic disease—have affected the approach to detection and treatment of breast cancer throughout history. If breast cancer is a local/regional disease process, then there is a role for the surgeon in its cure. If breast cancer is a systemic disease, then surgery alone cannot cure it, and any cure must come from systemic treatments. If over time breast cancer progresses from a local disease to a systemic disease, then there may be a role for earlier detection of breast cancer.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption

Roger S. Foster, Jr, MD

Graphic Jump Location
Place holder to copy figure label and caption
Figure 1.

Survival curves for patients with untreated breast cancer at Middlesex Hospital, 1805-1933, vs patients with breast cancer treated by Halsted radical mastectomy at Johns Hopkins Hospital, 1899-1931. Reprinted with permission from The New England Journal of Medicine.12 Copyright 1980, Massachusetts Medical Society. All rights reserved.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Survival free of distant disease (A) and overall survival (B) during 25 years of follow-up after surgery among women with clinically negative axillary nodes and women with clinically positive axillary nodes. There were no significant differences among the groups of women with negative nodes or between the groups of women with positive nodes in either analysis. Reprinted with permission from The New England Journal of Medicine.59 Copyright 2002, Massachusetts Medical Society. All rights reserved.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Ten-year survival among approximately 3100 women in 7 randomized trials comparing mastectomy with breast-conserving surgery plus radiotherapy. Error bars represent SD. Reprinted with permission from The New England Journal of Medicine.62 Copyright 1995, Massachusetts Medical Society. All rights reserved. The figure has been modified to reflect the published correction.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Absolute effect of ovarian ablation in the absence of routine chemotherapy on survival in all trials combined among women younger than 50 years at the time of entry into a randomized trial. Error bars represent SD. Reprinted with permission from Lancet.64 Copyright 1996, Elsevier Science.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Cumulative rates of invasive (A) and noninvasive (B) breast cancers in participants receiving placebo or tamoxifen. The P values are 2-sided. Reprinted with permission from Journal of the National Cancer Institute.69 Copyright 1998, Oxford University Press.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 2

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Table 9.2-2 Refuted Evidence From Studies of Physiologic or Surrogate Endpoints

The Rational Clinical Examination
Make the Diagnosis: Breast Cancer

brightcove.createExperiences();