What shall we teach our students about breast cancer? A personal view

The incidence of breast cancer in Australia is as high as in most parts of the world. The usual presentation is with a breast lump. Invasive and preinvasive malignant changes may be identified in both duct and lobular epithelia. There are clinical features of malignancy, but histological proof is necessary. Aspiration of cysts and reexamination of clinically benign lumps are acceptable in certain circumstances, but a tissue diagnosis should be made by needle or open biopsy. Earlier diagnosis is possible by radiological screening of asymptomatic patients, but the cost is high. Total excision of the breast (simple mastectomy) is the minimum treatment advisable for infiltrating cancer; If there is a high chance that the draining lymph nodes will contain tumor, they should be treated by surgical excision or radiotherapy. Early chemotherapy does reduce the incidence of systemic metastases after mastectomy, but its precise place in management is not yet clear. The social impact of mastectomy is considerable and deserves more attention than has been paid to it in the past. Clinical trials of treatment should continue, as they are beginning to answer some fundamental questions.