[Role of surgical treatment in multidisciplinary therapeutic strategy: breast cancer]

In 1894, Halsted originated the standard radical mastectomy consisting of en bloc resection of the breast and axillary lymph nodes as a treatment for breast cancer. His approach was based on the theory that breast cancer was an essentially localized disease and progressed gradually through the lymphatic chains to the distant organs. His theory had been considered as a standard not only in the field of breast cancer, but also for most of the solid malignancies for a long time. Since the 70 s, the increase of early stage breast cancer and the trend to Quality-of-Life oriented treatment have led us to evaluate the modification of the extent of surgery. The results of several prospective randomized trials proved that breast conserving treatment was safe and popularized the idea that breast cancer was essentially a systemic disease. Based on the new theory, all effective treatments, including surgery, radiotherapy and medical treatment, are now used for patients with not only early stage but advanced or recurrent breast cancer. Nowadays surgeons should change the idea that they are leaders in cancer treatment to that of members of cancer treating teams. In this situation, there are many problems and much confusion. This paper was presented at the 8th Conference of the Japanese Clinical Oncology Meeting and concerned role of surgical treatment in multidisciplinary therapeutic strategy from the standpoint of the breast surgeon.