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One Giant Leap for Mankind

Bernard Fisher, MD
JAMA. 1973;225(10):1246. doi:10.1001/jama.1973.03220380058019.
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To the Editor.—  As difficult as it may be for some to accept, it has not been unequivocally demonstrated that total (simple) mastectomy is a procedure that should or should not supplant radical mastectomy.1 From the total clinical evidence available, there is no more justification for condemning total (simple) mastectomy than there is for recommending its use to the exclusion of other procedures. It is a simple fact that there has never been a comparison made of the two operations by randomly performing one or the other on a single, well-defined population of patients. Halsted indeed demonstrated that radical mastectomy reduced the incidence of local recurrence in his patients as compared to that observed by other surgeons of that era, but to the best of my knowledge, he never presented information to indicate that the operation actually enhanced survival. Biological considerations are even more compelling than clinical ones (which

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