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Biology and surgical management of Breast Cancer

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Abstract

The surgical treatment of breast cancer has been a source of controversy. The controversy arises from the differences in physicians’ philosophies regarding the biology of breast carcinoma. Traditionally, surgeons have emphasized the potential therapeutic value of regional lymph node dissection, maintaining that adequate loco-regional treatment is of prime concern in patients with localized tumors. On the other hand, medical oncologists have always stressed the systemic nature of cancer. However, breast cancer is a very heterogeneous disease with an enormous range of different biologic characteristics, and new information is continually becoming available on the natural history of breast cancer. Therefore, we should seek a more rational theory based on the clinical evidence which can explain the biologic characteristics of breast cancer. We have proposed a new spectrum hypothesis as follows: (a) tumor cells traverse lymphatics to lymph nodes by direct extension, and there is an orderly pattern in the early stage of lymph node metastases; (b) regional lymph nodes are able to trap tumor cells but are ineffective or incomplete barriers to tumor cell spread; (c) regional lymph nodes have biologic importance, and a positive lymph node is an indicator of a host-tumor relationship that correlates with the subsequent appearance of distant disease; (d) lymphatic and hematogenous dissemination occur not serially, but in a parallel fashion; (e) many palpable invasive breast cancers are a systemic disease, but non-invasive or minimally invasive breast cancers are likely to be a local disease; (f) early detection and treatment of in-breast cancer improves survival, but variations in regional therapy are unlikely to have a major influence on survival.

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References

  1. Fisher B: The revolution in breast cancer surgery; Science or anecdotalism.World J Surg 9:655–666, 1985.

    Article  PubMed  CAS  Google Scholar 

  2. Hellman S, Harris JR: Natural history of breast cancer. In: Diseases of the Breast, 2nd ed. JR Harris ed, Lippincott Williams & Wilkins, Philadephia, pp407–423, 2000.

    Google Scholar 

  3. Noguchi M: Is the value of regional lymph node dissection different in breast cancer and gastrointestinal cancer.Breast Cancer 6:171–174, 1992.

    Article  Google Scholar 

  4. Veronesi U, Costa A: The role of surgery in the management of primary breast cancer, In: Clinics in Oncology 1(3), M, Baum ed, W.B. Saunders, London, pp853–873, 1982.

    Google Scholar 

  5. Hellman S, Harris J: The appropriate breast carcinoma paradigm.Cancer Res 2:339–342, 1987.

    Google Scholar 

  6. Cady B, Stone MD, Schuler JG,et al: The new era in breast cancer. Invasion, size, and nodal involvement dramatically decreasing as a result of mammographic screening.Arch Surg 131:301–308, 1996.

    PubMed  CAS  Google Scholar 

  7. Tabar L, Gunnar F, Hsiu-Gsi C,et al: Efficacy of breast cancer screening by age.Cancer 75:2507–2517, 1995.

    Article  PubMed  CAS  Google Scholar 

  8. Kerikowske K, Grady D, Rubin SM,et al: Efficacy of screening mammography.JAMA 273:149–154, 1995.

    Article  Google Scholar 

  9. DeKoning HJ, Boer R, Warmerdam PG,et al: Quantitative interpretation of age-specific mortality reduction from the Swedish breast cancer-screening trials.J Natl Cancer Inst 87:1217–1223, 1995.

    Article  CAS  Google Scholar 

  10. Shapiro S, Venet W, Strax P,et al: Ten to fourteen years effects of breast cancer screening on mortality.JNCI 69:349–353, 1982.

    PubMed  CAS  Google Scholar 

  11. Verbeek ALM, Hendriks JHCL, Holland R,et al: Reduction in breast cancer mortality thru mass screening with modern mammography: First results of the Nijmegen project 1975-1981.Lancet 1:1222–1224, 1984.

    Article  PubMed  CAS  Google Scholar 

  12. Tabar L, Gad A, Holmberg LH,et al: Reduction in mortality from breast cancer after mass screening with mammography.Lancet 1:829–832, 1985.

    Article  PubMed  CAS  Google Scholar 

  13. Fisher B: The surgical dilemma in the primary therapy of invasive breast cancer: A critical appraisal. In: Current Problems in Surgery. Year Book Medical Pub., Inc., Chicago, pp4–53, 1970.

    Google Scholar 

  14. Haybittle J: The evidence for cure in female breast cancer.Comment Res Breast Dis 3:181, 1983.

    Google Scholar 

  15. Brinkley D, Haybittle J: Long-term survival of women with breast cancer.Lancet 1:1118, 1984.

    Article  PubMed  CAS  Google Scholar 

  16. Hibberd A, Harwood L, Well J: Long-term prognosis of women with breast cancer in New Zealand: study of survival to 30 years.BMJ 286:1777, 1983.

    PubMed  CAS  Google Scholar 

  17. Rutqvist L, Wallgren A: Long-term survival of 458 young breast cancer patients.Cancer 55:658, 1985.

    Article  PubMed  CAS  Google Scholar 

  18. Rosen P, Groshen S, Siago P,et al: A long-term follow-up study of survival in stage I (T1N0M0) and stage II (T1N1M0) breast carcinoma.J Clin Oncol 7:355, 1989.

    PubMed  CAS  Google Scholar 

  19. Fisher B, Fisher ER: Studies concerning the regional lymph nodes in cancer. I. Initiation of Immunity.Cancer 27:1001–1004, 1971.

    Article  PubMed  CAS  Google Scholar 

  20. Fisher B, Fisher ER: Experimental evidence in support of the dormant tumor cell.Science 130:918–919, 1959.

    Article  PubMed  CAS  Google Scholar 

  21. Borgstein P, Meijer S: Historical perspective of lymphatic tumour spread and the emergence of the sentinel node concept.Eur J Surg Oncol 24:85–95, 1998.

    Article  PubMed  CAS  Google Scholar 

  22. Haigb PI, Brennan MB, Giuliano AE: Surgery for diagnosis and treatment: sentinel lymph node biopsy in breast cancer.Cancer Control 6:301–306, 1999.

    Google Scholar 

  23. Zeidman I, Buss JM: Experimental studies on the spread of cancer in the lymphatic system -I. Effectiveness of the lymph node as a barrier to the passage of embolic tumor cells.Cancer Res 14:403–405, 1954.

    PubMed  CAS  Google Scholar 

  24. Gilchrist RK: Fundamental factors governing lymphatic spread of carcinoma.Ann Surg 111:630–639, 1940.

    Article  PubMed  CAS  Google Scholar 

  25. Tachibana T, Yoshida K: Role of the regional lymph node in cancer metastasis.Cancer Metastasis Rev 5:55–66, 1986.

    Article  PubMed  CAS  Google Scholar 

  26. Fisher B, Fisher ER: Barrier functions of lymph node to tumor cells and erythrocytes.Cancer 20:1907–1913, 1967.

    Article  PubMed  CAS  Google Scholar 

  27. Fisher B, Fisher ER: The inter-relationship of hematogenous and lymphatic tumor cell dissemination.Surg Gynecol Obstet 122:791–798, 1966.

    PubMed  CAS  Google Scholar 

  28. Weiss L: The pathophysiology of metastasis within the lymphatic systems. In: Weiss L, Gilbert HA, Ballon SC eds, Lymphatic System Metastases, GK Hall, Boston, pp2–40, 1980.

    Google Scholar 

  29. Pressman JJ, Simon MB, Hank K,et al: Passage of fluids, cells, and bacteria via direct communications between lymph nodes and veins.Surg Gynecol Obstet 115:207–214, 1962.

    Google Scholar 

  30. Edwards JM, Kinmonth JB: Lymphovenous shunts in men.Br J Med 4:579–581, 1969.

    CAS  Google Scholar 

  31. Cady B: Lymph node metastases. Indicators, but not governors of survival.Arch Surg 119:1067–1072, 1984.

    PubMed  CAS  Google Scholar 

  32. Liotta LA, Stetler-Stevenson WG: Principles of molecular cell biology of cancer: Cancer metastases. In: De Vita VT, Hellman S, Rosenberg SA eds, Cancer; Principles and Practice of Oncology, JB Lippincott, Philadelphia, pp98–115, 1989.

    Google Scholar 

  33. Fisher B, Fisher ER: Studies concerning the regional lymph node in cancer. II. Maintenance of immunity.Cancer 29:1496, 1972.

    Article  PubMed  CAS  Google Scholar 

  34. Fisher B, Saffer E, Fisher ER: Studies concerning the regional lymph nodes in cancer. IV. Tumor inhibition by regional lymph node cells.Cancer 33:631, 1974.

    Article  PubMed  CAS  Google Scholar 

  35. Fisher B, Montague E, Redmond C,et al: Comparison of radical mastectomy with alternative treatments for primary breast cancer: A first report of results from a prospective randomized clinical trial.Cancer 39:2827–2839, 1980.

    Article  Google Scholar 

  36. Fisher B, Redmond C, Fisher ER,et al: Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation.N Engl J Med 312:674–681, 1985.

    PubMed  CAS  Google Scholar 

  37. Veronesi U, Valagussa P: Inefficacy of internal mammary node dissection in breast cancer surgery.Cancer 47:170–175, 1981.

    Article  PubMed  CAS  Google Scholar 

  38. Veronesi U, Marubini E, Mariani L,et al: The dissection of internal mammary nodes does not improve the survival of breast cancer patients. 30-year results of a randomized trial.Eur J Cancer 35:1320–1325, 1999.

    Article  PubMed  CAS  Google Scholar 

  39. Yoshimoto K: Personal communication, 1997.

  40. Fisher B: Breast cancer management: alternative to radical mastectomy.N Engl J Med 301:326–328, 1979.

    PubMed  CAS  Google Scholar 

  41. McNeil C: Four large studies aim to resolve sentinel node debate.JNCI 90:729, 1998.

    Google Scholar 

  42. Giuliano AE: Mapping a pathway for axillary staging. A personal perspective on the current status of sentinel lymph node dissection for breast cancer.Arch Surg 134:195–199, 1999.

    Article  PubMed  CAS  Google Scholar 

  43. Cote RJ, Rosen PP, Old LJ,et al: Detection of bone marrow micrometastases in patients with early-stage breast cancer.Diagn Oncol 1:37–42, 1991.

    Google Scholar 

  44. Menard S, Squicciarini P, Luini A,et al: Immunodetection of bone marrow micrometastases in breast carcinoma patients and its correlation with primary tumor prognostic features.Br J Cancer 69:1126–1129, 1994.

    PubMed  CAS  Google Scholar 

  45. Harbeck N, Untch M, Pache L,et al: Tumor cell detection in the bone marrow of breast cancer patients at primary therapy: results of a 3-year median follow-up.Br J Cancer 69:566–571, 1994.

    PubMed  CAS  Google Scholar 

  46. Molino A, Pelosi G, Turazza M,et al: Bone marrow micrometastases in 109 breast cancer patients: correlations with clinical and pathological features and prognosis.Breast Cancer Res Treat 42:23–30, 1997.

    Article  PubMed  CAS  Google Scholar 

  47. Mansi JL, Easton D, Berger U,et al: Bone marrow micrometastases in primary breast cancer: Prognostic significance after 6 year’ s follow-up.Eur J Cancer 27:1552–1555, 1991.

    Article  PubMed  CAS  Google Scholar 

  48. Diel IJ, Kaufmann M, Goerner R,et al: Detection of tumor cells in bone marrow of patients with primary breast cancer: A prognostic factor for distant metastasis.J Clin Oncol 10:1534–1539, 1992.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Operation Center, Kanazawa University Hospital, School of Medicine, Kanazawa University, Japan

    Masakuni Noguchi

  2. Futaba Breast Clinics, Kanazawa, Japan

    Takao Taniya

Authors
  1. Masakuni Noguchi
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  2. Takao Taniya
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Noguchi, M., Taniya, T. Biology and surgical management of Breast Cancer. Breast Cancer 8, 16–22 (2001). https://doi.org/10.1007/BF02967474

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  • DOI: https://doi.org/10.1007/BF02967474

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