Changing concepts in treating early breast cancer. An overview

Localized breast cancer is most effectively treated by operative resection. During the last 10 years, however, several new aspects of the disease have become evident and have had a direct influence on its management. There are indications that breast cancer is a systemic disease even in its early stages, and careful pathological observations have shown that breast cancer is a multifocal disease, although the clinical significance of this is not yet clear. The most important single prognostic factor is the status of the regional nodes. Tumor-induced immunosuppression in the host correlates with tumor burden. Removal of the primary tumor almost certainly accelerates the proliferation of residual tumor cells and so the "cell kill' of chemotherapeutic agents is increased. Several conclusions concerning therapy may be drawn from a consideration of these conceptual changes: a) local surgical control of the disease is frequently insufficient and has to be combined with systemic therapy b) for true staging, axillary node dissection has to be included with any treatment modality, and c) until proven otherwise, the whole breast has to be treated because of the multicentricity of the disease.