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Role of mastectomy in breast cancer.

B REAST CANCER is the number-one cancer killer of women in this country. As the average age of our female population increases and the incidence of breast cancer becomes higher with advancing years, it increases in frequency each year. The epidemic status of this disease makes it imperative that we continue with unrelenting vigor to attack the disease as we find it, maximize use of presently available diagnostic methods, and seek better methods of earlier diagnosis. We must also continually evaluate treatment methods, being as sure as possible that our desire to rehabilitate does not jeopardize prognosis. Quality of survival is a consideration second only to survival itself, and the abandonment of standard treatment modalities that have stood the test of time in favor of some newer, or indeed seemingly newer, operation that may lessen the chance to cure the patient should be undertaken only after careful scientific scrutiny. Halsted’s standard radical mastectomy was developed because there was no satisfactory method of treating breast cancer at that time. Indeed, it is apparent in the writings of Theodore Billroth that local excision of the cancerous area of the breast seldom resulted in a cure.’ The earlier partial mastectomies or lumpectomies were abandoned when it was shown that they did not offer chance for cure. In all fairness,, it is probable that few lesions so treated were diagnosed when small and grossly localized. A more extensive operation involving removal of the entire breast including the pectoralis major and the lymph nodes of the axilla was subsequently carried out