A communication in this issue (p 96) reports improved results after an extended radical mastectomy of the Urban type. This extended operation resulted from the initial work of R. S. Handley in London, and clinical application by Urban and others. As recorded by Sugarbaker in this recent study, the 5-year survival rate of 160 patients after the extended radical mastectomy was 70% during the period between 1951 and 1957, compared to a survival rate of 55% in 95 patients having conventional radical mastectomy between 1947 and 1951. Due to lay and professional education, patients with cancer of the breast in the 1951-1957 period might be expected to have come to the physician earlier than those in the 1947-1951 period. However, the percentage of patients with positive axillary nodes was only slightly lower in the later period, 53% as compared with 55% between 1947 and 1951.
Though one surgeon performed all