Mammary cancer is the greatest cancer killer in the United States; yet many physicians are confused as to the best method of therapy even for early lesions. Opinions and practice range from a limited excision, usually simple mammectomy—with or without radiotherapy, through the classic procedure of radical mastectomy to the "extended" operation that includes intercostal node resection and/or supraclavicular dissection. Before evaluating any method of therapy one must, of course, know the natural history of the disease without treatment. Shimkin1 plotted the survival curve of three groups of such patients. The findings were uniform and can be expressed as an average overall 20% five-year survival from the time the tumor was first noted. Summary of another group of 777 observations by Tomlinson and Eckert2 was expressed as average survivals of 38.5 months, with a range of 30.2 to 40.5 months.
Going back to a review3 of the earliest
Elman R. TREATMENT OF EARLY MAMMARY CANCERGUEST EDITORIAL. JAMA. 1956;161(10):972–973. doi:10.1001/jama.1956.02970100038011
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