The surgical treatment of breast cancer

Controversy regarding the efficacy of surgical treatment of breast cancer has persisted since the earliest descriptions of this disease in the first and second centuries AD. It has been acknowledged for many years that patients with untreated breast cancer survive for a surprisingly predictable period of 5 yr. Hence, in recommending extensive surgical procedures, the surgeon must recognize the unique biology of breast cancer and the need for long-term follow-up. In spite of a voluminous body of literature concerning the treatment of breast cancer, the distention and contention still continue. However, there is now increasing support for conservative treatment, including the less radical modified mastectomy, and in selected cases, wide local excision, axillary dissection and radiotherapy. As knowledge accumulates, it is clear that the treatment of breast cancer requires a multidisciplinary approach reflecting our understanding of the biology of this disease.