Current methods of diagnosis and therapy of carcinoma of the breast

Abstract

Although prognosis of carcinoma of the breast in clinical stages I and II is conditioned by many factors, early diagnosis and prompt treatment are at present the most useful means at our disposal to achieve the best results. Early diagnosis, and better still the detection of tumours in a preclinical stage, can be arrived at by breast self-examination, periodic check-up and mammography. The latter is particularly useful in revealing clinically silent lesions. Only excisional biopsy can ascertain the diagnosis which it is important to establish when the intramammary lump, because of its small size, lacks any sign of malignancy. Recent studies of the lymphatic spread of breast carcinoma have demonstrated that the parasternal metastases are not a late manifestation of the disease but rather a frequent finding in cancer in clinical stages I and II. These metastases are correlated, not only to the site of the tumor in the inner quadrants of the mammary gland, but also to the metastatic index of the axillary lymph nodes. A similar correlation exists between the number of axillary nodes involved and the frequency of microscopic supraclavicular metastases. When radical surgery is indicated, it should comprise the excision of the internal mammary lymph nodes, and in case a supraclavicular dissection. Inoperable cases should be treated by radiotherapy and chemotherapy. Recently pre, intra and postoperative chemotherapy is being increasingly carried out in association with the basic radio-surgical therapy, but such treatment can only be of help as an adjuvant of radical surgery, not as a substitute for an incomplete operation.