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A Personal and Historical Perspective

Roger S. Foster, Jr, MD

Arch Surg. 2003;138:397-408.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

INTRODUCTION

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.

Figure appears in full text version. Roger S. Foster, Jr, MD

The history of thinking about breast cancer as I narrate it will be highly colored by my own experience. I make no apologies for that. Every historian brings his own experiences and biases to the retelling of the past. My interest in the breast . . . [Full Text of this Article]

CULTURAL IMPORTANCE OF THE BREAST

EARLY HISTORY OF BREAST CANCER TREATMENT

NONTHERAPEUTIC MASTECTOMIES

RENAISSANCE

DISCOVERY OF THE LYMPHATIC SYSTEM

18TH CENTURY

19TH CENTURY

THE HALSTEDIAN ERA

THE EMPIRICAL CHALLENGERS

THE EXPERIMENTAL CHALLENGERS

PERSONAL REMINISCENCES AND MY MENTORS

EMERGENCE OF THE RANDOMIZED CLINICAL TRIALS

RADIATION THERAPY AFTER RADICAL MASTECTOMY

CLINICAL TRIALS LEADING TO CONSERVATIVE SURGERY

ADJUVANT SYSTEMIC THERAPY TRIALS

SUPPORT FOR THE SYSTEMIC DISEASE PARADIGM

BREAST CANCER SCREENING

REEXAMINATION OF THE LOCAL/REGIONAL TREATMENT PARADIGM

DUAL PARADIGMS: PARTIAL TRUTH IN EACH

THE FUTURE

CONCLUDING REMARKS

Wadley Glenn Professor of Surgery, Emory University, Atlanta, Ga, retired.

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