Utilizing the Columbia Clinical Classification and a logical size criterion for the primary cancer, a treatment scheme for primary operable breast cancer has been adopted at the Lahey Clinic Foundation. Treatment aggressiveness is scaled to tumor aggressiveness based on sound clinical criteria of size, nodal involvement, and location. Total mastectomy with partial axillary dissection is the standard surgical procedure for stages A and B. Radiation therapy is restricted to those cases where local recurrence would be frequent. It is suggested that the accent on survival as a measure of treatment success diminish, and that concern for local recurrence and regional nodal spread be viewed in terms of their uncommon contribution to survival and their clear relationship to stage of disease. The earlier stages of disease now seen in American treatment facilities enable such an approach to be adopted with assurance.
Cady B. Modern Management of Breast CancerA Point of View. Arch Surg. 1972;104(3):270-275. doi:10.1001/archsurg.1972.04180030018007