The problem of bilateral independent mammary carcinoma

Abstract

T HE surgeon attending any medical meeting in recent years where the problem of cancer of the breast is being discussed wiI1 hear allusions or even defmite statements as to the advisabiiity of performing so-caIIed “prophylactic” simpIe mastectomy on the uninvolved side concomitant with radica1 mastectomy for mammary cancer. Such remarks are being made with mounting frequency with the, net resuit that an ever increasing number of histoIogicaIIy norma breasts are being removed “prophyIacticaIIy.” Every surgeon wishes to do his utmost to effect a cure for cancer and is more than wiIIing to extend the scope of the surgica1 procedure if this is necessary to accompIish such cure. On the other hand, the surgeon shouId have some proof at hand that the additiona surgery reaIIy offers his patient an improved chance for cure. It seems appropriate then, particuIarIy at this time, when there is a hue and cry against unnecessary surgery, to evaIuate the potentiaI benefits accruing to a woman with cancer of the breast by the addition of simpIe mastectomy of the contraIatera1 breast to the conventiona1 radica1 mastectomy. Interest has been focused on this problem because of Harrington’s4 exceIIent presentation of Iong term foIIow-ups on a Iarge number of mastectomized patients over a postoperative period of fifteen to forty years at Mayo Clinic. AnaIyzing a group of 4,753 patients who had radica1 mastectomies prior to 1934, he found that 116, or 2.4 per cent, underwent a subsequent radical mastectomy at the clinic for carcinoma of the remaining breast. This figure of 2.4 per cent is an artificiai one for many obvious reasons: (I) It is based on a group of primary operabfe cases who had radica1 mastectomies prior to 1934 and excludes a11 primary inoperabte cases, a11 refusing surgery, and a11 patients who had either their first or subsequent mastectomies elsewhere. (2) It furthermore excIudes aII patients in whom second primaries deveIoped who might have been seen in an inoperabIe phase of their second neoplasm, or who might have refused their second operation, or who were treated by x-ray