Breast cancer management: the road to today

When Cancer began publishing in 1948, 1 of the first articles to appear was a review of sex hormones and advanced carcinoma of the breast. Because little was then known about the biology of breast cancer, standard treatment was characterized by radical and disfiguring surgery, often with only a limited effect on long-term outcomes. Several pivotal developments in the ensuing 60 years changed this picture dramatically. The large tumors that were common at initial presentation in 1948 became increasingly uncommon with the growing use of screening mammography. It was soon suggested that these smaller tumors could be successfully treated with more conservative surgery, especially with the addition of multidrug chemotherapy and hormonal therapy as adjuvant treatments. These revolutionary developments, which have allowed many women to remain free of disease for extended periods of time, were chronicled in landmark papers that appeared in Cancer: the first clinical trial to determine whether screening mammography would improve outcomes, the early small trials comparing less invasive surgery with Halsted's radical mastectomy, the initial National Surgical Adjuvant Breast Project trial testing the efficacy of triethylenethiophosphoramide in combination with radical surgery, and the first antiestrogen trials. These articles are extraordinary not only for breaking new ground in their respective technical areas, but also for the keen insights shown by the authors into what would become important in the future.