Early breast cancer: Part I: Surgical pathology and preoperative assessment

Author:

Hughes L E1,Forbes J F1

Affiliation:

1. University Department of Surgery, Welsh National School of Medicine, Cardiff

Abstract

Abstract The management of early breast cancer is showing a growing tendency to move away from radical surgery back towards conservative surgery and systemic adjuvant therapy. This paper and the one that follows review the data that underly this trend and consider the clinical and biological principles that are presently used to make a decision regarding the optimal primary treatment for breast cancer. The conclusion is reached that conservatism is based on a false understanding of the disease and on false conclusions drawn from premature analysis of data from clinical trials. Optimal management can be determined by appropriate preparative investigation. Breast cancer patients can be divided into three groups: early cases, with a good prognosis, late, incurable cases and an intermediate group. Radical therapy by surgery or surgery combined with radiotherapy gives better results than a conservative approach in the early and intermediate groups. The intermediate group should be seen as having a poor, but not necessarily hopeless prognosis. These cases may benefit particularly from adjuvant chemotherapy, but this should not be used as an excuse to deny the patient adequate local measures, which alone (at present) offer hope of cure. The problem posed by the third group should be seen as one of optimal palliation. Adjuvant systemic therapy raises hope of improving results, but no patient with breast cancer has yet been cured by chemotherapy or the application of immunological principles. Future improvements are most likely to derive from optimal use of each modality, and not at the expense of the most effective method at present available–radical surgery. The many remaining questions regarding management can best be answered by careful, controlled clinical studies, and every effort should be made to include patients with a poor prognosis in appropriate clinical trials.

Publisher

Oxford University Press (OUP)

Subject

Surgery

Cited by 15 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3