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October 7, 1974, Vol 230, No. 1 >
ARTICLE | October 7, 1974

Management of Breast Cancer: Limited Mastectomy FREE

George Crile, Jr., MD
[+] Author Affiliations

Reprint requests to the Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44106 (Dr. Crile).


JAMA. 1974;230(1):95-98. doi:10.1001/jama.1974.03240010061039
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References

MY stand on the treatment of breast cancer has been widely misunderstood. Many surgeons believe that I advocate what the British call "lumpectomy" and irradiation. Nothing could be further from the truth. I do, however, stand firmly against the traditional radical mastectomy. I consider it to be archaic, and I believe that it has no place in the modern treatment of breast cancer.

I strongly support modified radical mastectomy. It is primarily indicated for a patient who, at the time of operation, has palpable involvement of a few low or central axillary nodes. If the involvement is extensive, however, and particularly if the nodes at the apex are palpably involved, I agree with Haagenson that the axilla should not be dissected. It is better to rely on irradiation to control the cancer in the apical, supraclavicular, and internal mammary nodes.

In patients who at the time of operation have no

REFERENCES

1 +
Crile G Jr:  How much surgery for breast cancer? Mod Med 41:32-38, 1973;.
2 +
Halsted WS:  The results of operations for the cure of cancer of the breast performed at Johns Hopkins Hospital from June 1889 to January 1894 . Ann Surg 20:497-550, 1894.
3 +
Crile G Jr:  Rationale for cutting thick skin flaps and not grafting skin in operations for cancer of the breast . Cancer 18:795-799, 1965;.
4 +
Crile G Jr, Schofield PF:  Effect of lymphatic obstruction on the growth and metastasis of tumors . Surg Gynecol Obstet 128:1042-1046, 1969;.
5 +
Matas R, in discussion, Halsted WS:  Operative treatment of carcinoma of breast . JAMA 30:1106, 1898;.
6 +
Williams IG, Murley RS, Curwen MP:  Carcinoma of female breast: conservative and radical surgery . Br Med J 2:787-796, 1953;.
7 +
Fisher B:  Cooperative clinical trials in primary breast cancer: A critical appraisal . Cancer 31:1271-1286, 1973;.
8 +
Atkins, Sir Hedlet, et al:  Treatment of early breast cancer . Br Med J 2:423-429, 1972;.
9 +
Wise L, Mason AY, Ackerman LV:  Local excision and irradiation: An alternative method for the treatment of early mammary cancer . Ann Surg 174:392-399, 1971;.
10 +
Crile G Jr, et al:  Partial mastectomy for carcinoma of the breast . Surg Gynecol Obstet 136:929-933, 1973;.
11 +
Taylor H, et al:  Sector mastectomy in selected cases of breast cancer . Br J Surg 58:161-163, 1971;.
12 +
Rissanen PM:  A comparison of conservative and radical surgery combined with radiotherapy in the treatment of stage I carcinoma of the breast . Br J Radiol 42:423-426, 1969;.
13 +
Bond WH:  The treatment of carcinoma of the breast , in Jarrett AS (ed): Symposium on the Treatment of Carcinoma of the Breast. Cambridge, Mass, Exerpta Medica Foundation, 1968 .
14 +
Porritt A:  Early carcinoma of breast . Br J Surg 51:214-216, 1964;.
15 +
Peters MV:  Wedge resection and irradiation: An effective treatment in early breast cancer . JAMA 200:134-135, 1967;.
16 +
Adair FE:  The role of surgery and irradiation in cancer of the breast . JAMA 121:553-559, 1943;.
17 +
Auchincloss H:  Modified radical mastectomy: Why not? Am J Surg 119:506-509, 1970;.
18 +
End Results in Cancer . Bethesda, Md, National Cancer Institute, 1972;, vol 4.
19 +
Crile G Jr:  How much surgery for breast cancer? Mod Med 41:32-38, 1973;.
20 +
McWhirter R:  Recent advances in cancer and radiotherapeutics , in Hallen KE (ed): Clinical Oncology . Edinburgh, Churchill Livingstone, 1972;.
21 +
Crile G Jr:  Results of simple mastectomy without irradiation in the treatment of operative stage I cancer of the breast . Ann Surg 168:330-336, 1968;.
22 +
Crile G Jr:  Possible role of uninvolved regional nodes in preventing metastasis from breast cancer . Cancer 24:1283-1285, 1969;.
23 +
Crile G Jr:  Biological consideration in the treatment of cancer . Cleve Clin Q 39:145-152, 1972;.
24 +
Fisher B, Fisher ER:  Studies concerning the regional lymph nodes in cancer: II. Maintenance of immunity . Cancer 29:1496-1501, 1972;.
25 +
Crile G Jr:  Rationale of simple mastectomy without radiation for clinical stage I cancer of the breast . Surg Gynecol Obstet 120:975-982, 1965;.
26 +
Sandison AT: Autopsy study of the adult human breast . Monograph No. 8, Bethesda, Maryland, National Cancer Institute, 1961;.
27 +
Robbins GF, Berg JM:  Bilateral primary breast cancers: A prospective clinicopathological study . Cancer 17:1501-1527, 1964;.
28 +
Slack NH, et al:  Experiences with bilateral primary carcinoma of the breast . Surg Gynecol Obstet 136:433-440, 1973;.

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1 +
Crile G Jr:  How much surgery for breast cancer? Mod Med 41:32-38, 1973;.
2 +
Halsted WS:  The results of operations for the cure of cancer of the breast performed at Johns Hopkins Hospital from June 1889 to January 1894 . Ann Surg 20:497-550, 1894.
3 +
Crile G Jr:  Rationale for cutting thick skin flaps and not grafting skin in operations for cancer of the breast . Cancer 18:795-799, 1965;.
4 +
Crile G Jr, Schofield PF:  Effect of lymphatic obstruction on the growth and metastasis of tumors . Surg Gynecol Obstet 128:1042-1046, 1969;.
5 +
Matas R, in discussion, Halsted WS:  Operative treatment of carcinoma of breast . JAMA 30:1106, 1898;.
6 +
Williams IG, Murley RS, Curwen MP:  Carcinoma of female breast: conservative and radical surgery . Br Med J 2:787-796, 1953;.
7 +
Fisher B:  Cooperative clinical trials in primary breast cancer: A critical appraisal . Cancer 31:1271-1286, 1973;.
8 +
Atkins, Sir Hedlet, et al:  Treatment of early breast cancer . Br Med J 2:423-429, 1972;.
9 +
Wise L, Mason AY, Ackerman LV:  Local excision and irradiation: An alternative method for the treatment of early mammary cancer . Ann Surg 174:392-399, 1971;.
10 +
Crile G Jr, et al:  Partial mastectomy for carcinoma of the breast . Surg Gynecol Obstet 136:929-933, 1973;.
11 +
Taylor H, et al:  Sector mastectomy in selected cases of breast cancer . Br J Surg 58:161-163, 1971;.
12 +
Rissanen PM:  A comparison of conservative and radical surgery combined with radiotherapy in the treatment of stage I carcinoma of the breast . Br J Radiol 42:423-426, 1969;.
13 +
Bond WH:  The treatment of carcinoma of the breast , in Jarrett AS (ed): Symposium on the Treatment of Carcinoma of the Breast. Cambridge, Mass, Exerpta Medica Foundation, 1968 .
14 +
Porritt A:  Early carcinoma of breast . Br J Surg 51:214-216, 1964;.
15 +
Peters MV:  Wedge resection and irradiation: An effective treatment in early breast cancer . JAMA 200:134-135, 1967;.
16 +
Adair FE:  The role of surgery and irradiation in cancer of the breast . JAMA 121:553-559, 1943;.
17 +
Auchincloss H:  Modified radical mastectomy: Why not? Am J Surg 119:506-509, 1970;.
18 +
End Results in Cancer . Bethesda, Md, National Cancer Institute, 1972;, vol 4.
19 +
Crile G Jr:  How much surgery for breast cancer? Mod Med 41:32-38, 1973;.
20 +
McWhirter R:  Recent advances in cancer and radiotherapeutics , in Hallen KE (ed): Clinical Oncology . Edinburgh, Churchill Livingstone, 1972;.
21 +
Crile G Jr:  Results of simple mastectomy without irradiation in the treatment of operative stage I cancer of the breast . Ann Surg 168:330-336, 1968;.
22 +
Crile G Jr:  Possible role of uninvolved regional nodes in preventing metastasis from breast cancer . Cancer 24:1283-1285, 1969;.
23 +
Crile G Jr:  Biological consideration in the treatment of cancer . Cleve Clin Q 39:145-152, 1972;.
24 +
Fisher B, Fisher ER:  Studies concerning the regional lymph nodes in cancer: II. Maintenance of immunity . Cancer 29:1496-1501, 1972;.
25 +
Crile G Jr:  Rationale of simple mastectomy without radiation for clinical stage I cancer of the breast . Surg Gynecol Obstet 120:975-982, 1965;.
26 +
Sandison AT: Autopsy study of the adult human breast . Monograph No. 8, Bethesda, Maryland, National Cancer Institute, 1961;.
27 +
Robbins GF, Berg JM:  Bilateral primary breast cancers: A prospective clinicopathological study . Cancer 17:1501-1527, 1964;.
28 +
Slack NH, et al:  Experiences with bilateral primary carcinoma of the breast . Surg Gynecol Obstet 136:433-440, 1973;.

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