A surgeon's view of the spread of breast cancer

✍ Scribed by Richard S. Handley

• Publisher: John Wiley and Sons
• Year: 1969
• Tongue: English
• Weight: 310 KB
• Volume: 24
• Category: Article
• ISSN: 0008-543X
• DOI: 10.1002/1097-0142(196912)24:6<1231::aid-cncr2820240628>3.0.co;2-v

✦ Synopsis

THE OUTSET OF

0 their careers at least-regarded breast cancer as a localized disease, every cell of which could be excised from the body if the clinical signs did not indicate that the tumor had transgressed the breast and its immediate neighborhood. They thought that the lymphatics were the only route of escape for tumor cells from the breast until late i n the natural history of the disease. Moreover, with a few exceptions, they considered that the axillary lymphatics were the only exit which mattered. Their treatment was planned on purely anatomical thinking and their yardstick of cure a 3-year survival free from recurrence. They felt that, with some progress in public education to bring the patient to the surgeon earlier, and some refinements in the minutiae of technique, the whole problem would be solved. At the present time, we know that surgeons, and indeed radiotherapists, will never completely solve the problem. We shall be shown the solution in due course by the cellular chemists and the immunologists, and can only hope that we may still find useful employment as surgeons i n an ancillary role. We now realize that the results of treatment in the earlier or operable case are not much better than those achieved by Halsted. We have discovered that a 10-year period of follow-up after treatment is more appropriate than a 3-year period and that even then we can give an individual n o absolute guarantee that her disease will not recur. I t seems to me that the disappointments we have suffered, in what have been very strenuous efforts at improvement, are due to a lack of understanding of the way in which breast cancer spreads.

Breast cancer spreads by the lymphatics and the bloodstream. To consider the latter first, there seems to be good evidence that tumor cells escape into the bloodstream at an early stage in the majority of cases. O u r meth-