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The surgeon's role in breast cancer: Changing concepts

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Summary

The magnitude of the breast cancer problem is presented along with changing therapeutic concepts, the surgeon's role in breast cancer therapy, and therapeutic options including the evaluation studies by the National Surgical Adjuvant Breast Project.

The importance of selective surgery and the criteria utilized for choosing the appropriate procedure, as well as the currently most popular surgical procedure and the major selective surgical approaches are discussed. A moderate selective surgical approach is presented along with a discussion about the possible implementation of lesser surgical procedures.

The results in 1,147 patients with potentially curable breast cancers (Stage 0, 1 and 2), followed for ten or more years, 82.9% of which were treated by less than a radical procedure, with the most popular procedure being a modified radical mastectomy, are presented. The ten year absolute, no evidence of disease survival rate for the entire group of patients was 64.8%, and for the 1,062 patients with only invasive cancers it was 62.1%. The local recurrence rate for the entire group was 7.3%, with an axillary recurrence rate of 0.7%. Only 2.1% of the patients were skin grafted.

7.3% unsuspected cancers were found in a series of 561 random biopsies of the other breast, and 19.7% unsuspected cancers were found in 127 prophylactic contralateral mastectomies in patients who were in the high risk group for developing cancer in the remaining breast. The better cosmetic and functional result obtained with lesser surgical procedures is emphasized along with the discussion regarding reconstructive surgery. Finally, the results are compared to those obtained with other types of surgical approaches and with primary radiotherapy.

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Authors and Affiliations

  1. Institute of Breast Diseases, New York Medical College, Valhalla, New York & Cabrini Medical Center, New York City, USA

    Henry Patrick Leis Jr. M.D.

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  1. Henry Patrick Leis Jr. M.D.
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Address for reprints: H.P. Leis, Jr., M.D., 55 E, 87th Street, Suite 1-F, New York, NY 10028.

Emeritus Clinical Professor of Surgery, Emeritus Chief of the Breast Service, Co-Director of the Institute of Breast Diseases, New York Medical College, Valhalla, New York, and Chief of Breast Surgery, Cabrini Medical Center, New York City.

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Leis, H.P. The surgeon's role in breast cancer: Changing concepts. Breast Cancer Res Tr 1, 5–15 (1981). https://doi.org/10.1007/BF01807886

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