Evaluation of the treatment of cancer of the breast with a suggestion for its modification

Abstract

In the treatment of cancer of the breast, we have reached a place where the prospects of reducing the early mortality or extending the span of life seems to have reached an impasse, unless we can better apply the tools at our disposal. Much has been accomplished by publicizing the prevalence and curability of cancer in its early stages, and while these efforts should be continued, no great impression will be made in the vital statistics by this alone. No longer should carcinoma of the breast be so designated without miscroscopical examination of the tissue, and compilation of cases treated without such verification should not be given printer's space. The punch biopsy only in its positive reports of carcinoma is entitled to any consideration from a diagnostic standpoint, and it would be far better if the method were abandoned altogether. Brodus has definitely established the value of grading cancer, and every effort should be made to get in line with his observations. We have two methods of attacking cancer of the breast, irradiation and surgery, and it is very questionable if we have exhausted the possibilities of the two, particularly as a dual method of attack. There has been too much half-hearted cooperation between the surgeon and roentgenologist. Irradiation alone has not lived up to the expectations; or possibly too much was anticipated, no doubt predicated upon a limited experience or a few outstanding cases. If the methods of treatment by irradiation now in vogue have failed materially to increase the number of cures or prolong life, possibly the utilization of this potent therapeutic measure can be better adapted and coordinated with surgery. It is conceded that irradiation inhibits many malignant growths, and any treatment that can arrest the propagation of cancer cells has a place in the treatment of cancer. Combined with surgery, irradiation can play an important part in the treatment of cancer of the breast. Preoperatively, a short period of intensive treatment by x-ray or radium, should be followed immediately by radical surgery. Irradiation alone, or delayed surgery after irradiation has not been justified by the end results. Postoperative irradiation has been rather “hit or miss” in its application, no effort apparently having been made to standardize the treatment in dosage, periodicity in relation to the operation or careful tabulation in regard to the extent, type or grade of cancer, except in few of the centers in which this problem is a matter of major importance. Unfortunately perhaps, most of the cases are not treated in the best organized clinics. The postoperative treatment of cancer of the breast, we believe, needs coordinating. Irradiation should be carried out early in the convalescence of the patient and repeated at two-year intervals regardless of recurrence or in the absence of recurrence, over a period of four to six years, assuming the patient survives. Notations as to the type and grade of cancer, metastasis, local recurrences are essential to supply data that can be applied to formulate future treatment of carcinoma of the breast. Until we utilize irradiation in an intelligent manner in combination with surgery, we shall just muddle along in a therapeutic rut. It is incumbent upon us to apply, with a sense of responsibility, all those measures that we have in our hands and not casually wait for some genius to throw in our laps a specific “carcinomastat.” This program will require years to consummate, but it will be worth the labor.