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





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Breast Cancer: Historical Treatment: 1

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

   
 

A short history of breast cancer treatment 

At the beginning of the 20th century, surgery had evolved into a mature discipline – thanks to the advent of anesthesia in the middle of the 19th century. Breast cancer usually came to the attention of physicians at late stages, and treatment was generally unsuccessful. William Halsted, a pioneering American surgeon and master technician working at Johns Hopkins, devised a radical operation to encompass the disease in the breast and axilla. The radical mastectomy removed the breast, the underlying chest wall muscles and all the lymph nodes in the axilla (axillary dissection). Because a large amount of skin was removed with this operation, it was usually accompanied by a skin graft. Halsted's procedure met with better success than any other at the time and was widely adopted.   

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Breast Cancer: Historical Treatment: 2

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It was not until the 1970s that a surgeon named Patey in Britain demonstrated that a less radical procedure – the modified radical mastectomy – was equally effective for similar stages of disease. In this procedure, the major chest wall muscle, the pectoralis major, was left in place and less skin was sacrificed, leaving less deformity. The increased residual tissue also allowed for better reconstruction  with the implants that were first appearing at that time. During this same time, a few cancer centers (notably Memorial Sloan Kettering and Columbia in New York) were still reporting better results with more radical operations, but Patey's more conservative approach won the day.    

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Breast Cancer: Historical Treatment: 3

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The next significant advance was the abandonment of the concept that once a knife touched the patient's skin, the procedure must be carried through to its ultimate conclusion based on frozen section examination while the patient was on the operating table. Frozen section is less reliable than permanent section, and put the pathologist, surgeon, and patient in a dangerous position. The theoretical rational for this procedure was that surgically violating the area of the tumor raised the risk of disseminating cells, and that therefore surrounding tissue must be removed expeditiously if cancer was present. This put the patient in the terrible position of not knowing whether she would wake up without a breast. Fortunately, it became evident that the manipulation and timing were not critical, and the two-step procedure was adopted.    

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