The Selective Treatment of “Early” Carcinoma of the Breast by Lumpectomy, Level I Axillary Dissection, and Radiation Therapy

Abstract

Considering the choice of treatment for “early” breast cancer controversial might be likened to calling a monsoon a small rainfall. Enthusiastic and vocal advocates of widely disparate forms of therapy resemble carnival barkers hawking their games, promising a prize with each toss. At one extreme are those who believe that no one any longer must submit to mastectomy, and at the other end are those who refuse to consider anything but mastectomy. In the middle of this maelstrom of rhetoric stands the all-but forgotten patient, who, quite understandably, feels that half of her is being pulled inexorably toward the linear accelerator while the other half is being drawn into the operating room. Not only is this decision between mastectomy and radiation therapy thrust upon the patient when she is most vulnerable, but the patient is all too often made to feel that the decision must be made immediately, any delay between biopsy and therapy jeopardizing the ultimate chances of survival.