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A Point of View

Blake Cady, MD

AMA Arch Surg. 1972;104(3):270-275.

Abstract
Utilizing the Columbia Clinical Classification and a logical size criterion for the primary cancer, a treatment scheme for primary operable breast cancer has been adopted at the Lahey Clinic Foundation. Treatment aggressiveness is scaled to tumor aggressiveness based on sound clinical criteria of size, nodal involvement, and location. Total mastectomy with partial axillary dissection is the standard surgical procedure for stages A and B. Radiation therapy is restricted to those cases where local recurrence would be frequent. It is suggested that the accent on survival as a measure of treatment success diminish, and that concern for local recurrence and regional nodal spread be viewed in terms of their uncommon contribution to survival and their clear relationship to stage of disease. The earlier stages of disease now seen in American treatment facilities enable such an approach to be adopted with assurance.

Author Affiliations
Boston

From the Department of Surgery, Lahey Clinic Foundation, and the Harvard (Fifth) Surgical Service, Boston City Hospital, Boston.

Footnotes
Accepted for publication Oct 28, 1971.

Reprint requests to Lahey Clinic Foundation, 605 Commonwealth Ave, Boston 02215 (Dr. Cady).

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