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Breast Cancer Detection and Treatment
A Personal and Historical Perspective
Roger S. Foster, Jr, MD
Arch Surg. 2003;138:397-408.
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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.
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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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