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Otto Saphir, M.D.
JAMA. 1952;150(9):859-861. doi:10.1001/jama.1952.63680090007009a.
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When the physician is confronted with a patient having the textbook signs of carcinoma of the breast, it is usually too late to initiate even such radical curative measures as radical mastectomy. Retraction of the nipple or skin overlying the tumor, fixation of the tumor, peau d'orange discoloration of the skin, and axillary metastases signify advanced carcinoma. Numerous observations of so-called premalignant or precancerous lesions in the breast have accumulated in the literature. If such a condition really exists, it may be possible by its elimination to prevent the occurrence of cancer; however, many of these so-called precancerous lesions never become cancerous, and if cancer develops in such a breast it does not mean that cancer originated in the precancerous lesion. There probably are a number of factors, most of which are unknown and not discernable morphologically, that govern the growth of a malignant lesion in such a breast. The


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