Implications for the Care of the Breast Cancer Patient
Clinicians’ increasing interest over the last decade in psychological aspects of breast cancer reflects a conceptual shift in our model of the disease itself. It is now more than one hundred years ago that Dr. Halsted from the Johns Hopkins Hospital, Baltimore, described the classic radical mastectomy, an operation that was developed as a result of certain firmly held assumptions about the behavior of the disease. The viewpoint in retrospect appears extremely mechanistic. The cancer was believed to arise as a single focus within the breast, enlarging with time and spreading continuously along the lymphatics. It was assumed that the disease was arrested in the axillary lymph nodes, and these were looked on as filters. With the passage of time, it was thought, the filters became exhausted. The cancer continued to spread through the efferent lymphatics along fascial planes, and, after penetrating the deep fascia vital organs such as the liver, it finally infiltrated brain and bone marrow. With this view, it seemed entirely plausible that a simple mastectomy would only cure those women whose disease was confined to the breast, and that, to improve the cure rate, the tissue removed had to be extended. Furthermore, to avoid transecting the lymphatics and spilling cancer cells in the operative field, this operation had to be done en bloc. Thus, the classic Halsted radical mastectomy involved removal of the breast, the pectorals major, pectoralis minor, and the axillary lymphatic tissue in continuity.
KeywordsToxicity Depression Europe
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