Treatment of primary breast cancer. Change without improvement.

Abstract

The arena wherein is decided the champion of therapy for primary breast carcinoma is filled with gladiators bearing different weapons. This crowd has gathered during the last decade. The old champion, radical mastectomy, is being challenged by advocates of these "newer" and simple approaches: (1) simple mastectomy plus radiation therapy; (2) simple mastectomy plus excision of axillary lymph nodes only when clinically positive; (3) local excision of the mass plus radiation therapy; and (4) local excision only. Surgeons may eventually recommend radiation therapy alone for both the primary lesion and the regional lymph nodes! As each author presents clinical data supporting his particular regimen, he notes that his approach produces survival rates similar to those following radical mastectomy (but never better) and quickly points out its strengths—his treatment "isn't worse" and is "much less mutilating." This latter is an argument seldom utilized by surgeons, except with respect to the female