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.
Roger S. Foster, Jr, MD
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.
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.
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.
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.
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.
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