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Treatment of cancer of the breast

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Abstract

Historical background

THERE was a great calm in the surgical world, which lasted from the turn of the century until McWhirter1 reported the results of simple mastectomy and radiation therapy. During the period of calm there were a few stubborn renegades like Sir Geoffrey Keynes in London,2 and McNealy3 in Chicago, who quietly continued to do simple operations for cancer of the breast and seemed content with their results. But such practices were generally frowned upon. In some hospitals in the United States, a surgeon had to justify the performance of a simple mastectomy or be threatened with loss of surgical privileges. During the period of relative complacency, many papers on cancer included a phrase of such as—“just as the Halsted radical mastectomy embodies the principles of cancer surgery so. . . .” The place of radical mastectomy seemed secure.

Then, almost simultaneously the position of the conventional radical mastectomy was attacked from two sides: on one by the work of Handley,4 on involvement of internal mammary lymph nodes, with the result that ultra-radical mastectomy was advocated, and on the other, by the clinical studies of McWhirter,5 which showed the value of simple mastectomy and radiation therapy. Williams, Murley, and Curwen6 next reported that the results of the simple operations or radium implants done by Sir Geoffrey Keynes at St. Bartholomew’s Hospital were as good as those after radical mastectomy.

Under the influence of McWhirter, who had demonstrated so clearly the value of radiation in controlling metastases in axillary . . .


 

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