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Surgery: Overview 1997
Throughout time, breast cancer has always been a disease that was managed by surgeons. Recently its management has changed. For decades, the optimal management for patients with breast cancer was a radical mastectomy. In 1997, our knowledge of breast cancer has evolved tremendously. We now have other therapeutic options available for these patients.
One of the first surgical landmarks in breast cancer management was to realize that the survival and recurrence rates of patients who underwent a standard radical mastectomy were the same as for those patients who underwent a modified radical mastectomy. This was the initiation of the trend which led us to introduce more conservative measures.
The next stepping stone for more conservative therapeutic options was the keystone studies by Fisher et al. These studies demonstrated that survival and recurrence outcomes in early breast cancer rates were the same for patients who underwent a modified radical mastectomy as for those who underwent a lumpectomy/axillary dissection and radiotherapy. Simultaneously, an avalanche of studies demonstrated that multidrug chemotherapeutic and hormonal protocols could have a tremendous beneficial impact for these patients.
Currently, the surgeon has become the primary coordinator for the management team of physicians essential for the treatment of these breast cancer patients. This management team should include a surgeon, an oncologist, a radio-oncologist and a psychological support person. This concept of team management has slowly become the Standard of Care in all urban metropolises in the Western world.
In 1997, surgical procedures in the management of patients with breast cancer have been streamlined and are as follows :
Major changes are already on the horizon of this surgical field for the new millennium. First, new advanced technology is being introduced, such as the ABBI device, which could one day turn the lumpectomy into a simpler local procedure as it currently has for breast biopsies. Secondly, the issue of axillary dissection is being carefully evaluated.. The introduction of the Sentinel Node Technique (via dye or scintigraphy) is showing promise and may in the near future select patients who are candidates for an axillary dissection. Currently, the performance of the axillary dissection is being questioned. Axillary dissections are performed to detect malignant invasion of the axillary lymph nodes to determine if the patient should undergo more aggressive therapeutic protocols postop. Although many surgeons are no longer performing axillary dissections in elderly patients, with the introduction and identification of more risks factors many authors are now postulating this surgical procedure will eventually be replaced.
It has become quite evident the minimally invasive trend in the surgical management of breast cancer will eventually become the optimal choice of therapeutic treatment for the patient. Hopefully, radical surgical intervention for breast cancer will become obsolete.
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