c l i n i c a l f o l i o s : n a r r a t i v e





A D V E R T I S E M E N T

 

Breast Cancer: Historical Treatment: 4

A D V E R T I S E M E N T

   
 

Also in the 1970s, the wide publicity of Betty Ford's breast cancer raised public awareness of the disease, and the number of women performing breast self-examination and seeking medical examination increased dramatically. The advent of mammography increased the early detection of the disease at the same time. In the 70s and 80s, the first major unified multi-center controlled trials of varying therapeutic regimens began in the form of the National Surgical Adjuvant Breast Project (NSABP). For the first time, large numbers of patients were treated and evaluated in a rigorous way. Much of our current knowledge has come from these ongoing trials.    

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Breast Cancer: Historical Treatment: 5

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There has been a parallel development in the fields of medical oncology (chemotherapy and hormonal therapy) and radiation oncology over the past several decades leading to a multidisciplinary approach to breast cancer. Multimodality therapy for each patient is typically discussed in multidisciplinary conferences called tumor boards.

The basic concepts in breast cancer treatment have also evolved in the past few decades. While Halsted approached the disease as a physical entity to be extirpated, the concept that arose out of the NSABP was that breast cancer should be approached as a systemic disease almost from the outset. This is the philosophy that drives current management and underlies the rational for adjuvant chemo and radiotherapy even in the absence of obvious spread.    

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Breast Cancer: Historical Treatment: 6

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In conjunction with this philosophy, the scale of the axillary dissection was reduced and was called axillary sampling for prognostication and therapeutic planning rather than a therapeutic axillary dissection aimed at extirpating all disease. In addition, a cuff of lymphatics is left on the axillary vein to minimize the possibility of arm swelling (edema). Despite the shift toward the systemic approach, one of the pioneers of the NSABP recently reminded us that in its earliest stages, breast cancer is truly a local disease and subject to surgical cure.     

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This page was last modified on 7/9/1999.