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Is there a price to pay for inadequate surgery in breast cancer? [Abstract]

Mansel, Robert Edward 2002. Is there a price to pay for inadequate surgery in breast cancer? [Abstract]. International Journal of Cancer 100 (S13) , p. 43. 10.1002/ijc.9999

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The Halstedian concept of total ablation, which held sway for nearly a century, has given way to the Fisherian where the role of surgery is local disease control in a systemic disease. Fisher hypothesises that metastasis occurs early and all patients can be regarded as having metastatic disease at diagnosis, which should then be managed by systemic therapies. Certainly it can be argued that the approach of systemic therapy has been successful as patient survival has definitely improved in the last 20 years. However it is clear that surgery alone can “cure” some patients as long term survivors were seen in the pre-chemotherapy era after treatment by surgery alone. Whereas the surgical emphasis in the past was on maximal removal of tissue, the current philosophy is minimal normal tissue removal with reliance on adujuvant treatment to destroy residual low volume cancer. But can this process go too far? The Milan group showed clearly in an elegant series of controlled trials that getting closer to the tumour carried the penalty of higher local recurrence (in reality continuing growth of cancer left behind), of up to 20% especially if radiotherapy is omitted. These studies and many others in both invasive cancer and DCIS show that careful conservative surgery can produce low levels of local recurrence with reasonable cosmesis. More recently it has emerged that inadequate surgery with consequent high local recurrence rates may have a small but significant effect on survival as demonstrated in the Oxford overview of 2000. If these effects are true for in-breast recurrences they may be even greater for local recurrence in the axilla where there is ready access to systemic dissemination via the lymphatic channels. These concepts suggest that surgeons should be very careful to make sure that the trend for minimal surgery in the axilla in the form of sentinel node biopsy should be carried out to a high standard with due attention to training and learning curves.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Additional Information: Eighteenth UICC International Cancer Conference June 30-July 5, 2002
Publisher: John Wiley & Sons
ISSN: 0020-7136
Last Modified: 04 Jun 2017 04:45

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