The Evolving Treatment of Breast Cancer

To the Editor.—  Surgical and medical treatment of the patient with breast cancer has changed dramatically in the past two decades. The Halsted radical mastectomy has been replaced by the modified radical mastectomy, and, more recently, evidence has appeared supporting segmental mastectomy as an acceptable alternative when combined with axillary dissection and postoperative radiation therapy.The National Surgical Adjuvant Breast Project has performed numerous studies attempting to resolve the dilemma surrounding the various treatments. One such study, protocol B-04, compared radical mastectomy and total mastectomy with and without radiation therapy. The results showed no significant difference in overall survival when comparing the three treatment arms.¹ Of equal importance, the data indicated that surgical removal of the axillary lymph nodes was useful for staging but did not benefit survival, supporting the theory that breast cancer is a systemic disease and that involved axillary nodes serve only as a marker of