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To the Editor.—
I read with great pleasure Dr Ralph Johnson's letter to the editor (230:1387, 1974). Dr Johnson has very accurately stated the case for considered judgment and thoughtful procrastination in the physician management of early, operable breast cancer.Since most clinically detected breast cancers have been present in occult or semioccult form for many months, the helter-skelter approach from biopsy to mastectomy is not only unnecessary but in many cases harmful.Until recent years the policy at one of our greatest midwestern surgical clinics, was to operate on all patients with a histologic diagnosis of breast cancer—regardless of stage, provided the patient could withstand the anesthesia and the operation. Thankfully, that period is past, but from the failure of radical operations in advanced stages of breast cancer, we have learned a great deal that we now put to good use.Unfortunately, in many areas throughout the United States,
Sanders GB. Management of Breast Cancer. JAMA. 1975;233(12):1259. doi:10.1001/jama.1975.03260120021008