A review of 146 cases of carcinoma of the breast operated on between 1930 and 1943.

Abstract

IN 1948, the writer together with Dyson published an article analysing the results in a personal series of 118 cases of carcinoma of the breast, operated on in the Middlesex Hospital between 1930 and 1943 and followed up until the end of 1946 (Patey and Dyson, 1948). In 1966 it was thought that it might be of interest to determine the long term results in this same series of cases. The histological records of the Bland Sutton Institute of Pathology were examined, and all cases of carcinoma of the breast operated on during these years from the general wards, either by the writer or by one of his assistants, noted. Excluding cases in which biopsy was the only procedure, records of 146 cases were found. It is not possible at this long interval of time to account for the difference between the present figure of 146 and the figure in the 1948 paper of 118, since the case references of the earlier paper are no longer available. The writer has the strong impression, however, that the earlier paper included only cases operated on by him personally. On the other hand, it became clear when the two series were compared in detail that some cases referred to in the earlier paper did not have a counterpart in the present series. Some may be among records which are unfortunately missing. It is also possible that a few private cases were inadvertently included in the earlier series.The present paper is therefore a follow up of a slightly different, slightly larger, group of cases, which includes however most of the cases in the 1948 series. In calculating length of survival after operation, only calendar years have been taken into account. Thus, a patient operated on any time in 1930 and dying in 1940 is counted as surviving 10 years. The few patients who died within twelve months of operation have been counted as surviving one year. Selection of Cases and Types of OperationDuring the years when these operations were performed, the general attitude of surgeons towards carcinoma of the breast was that operation was indicated in all cases in which surgery was technically feasible. In addition, there was general agreement that " radical mastectomy ". according to the principles laid down by Halsted and by Handley, was the correct operative procedure. Against this background, there developed in Britain in the 1930's a questioning of the almost automatic performance of " radical mastectomy " for carcinoma of the breast. such questioning however being confined to a small minority. There were three major influences leading to this new attitude. The first and most important was the development and organization of radiotherapy. The second was the growing

Erfolge und Komplikationen der brusterhaltenden Mammakarzinomtherapie - Ergebnisse einer Langzeitbeobachtung

“…Jahrhunderts versuchten die damaligen Chirurgen daher mit stark verstümmelnden Methoden wie der ¹Radikalen Mastektomie nach Rotter-Halstedtª durch komplette Entfernung der Mamma mitsamt des Musculus pectoralis major eine systemische Progression zu verhindern [45]. Durch die in den 30er Jahren von Patey entwickelte ± auch heute in gewissen Fällen noch nötigen ± ¹Modifiziert radikalen Mastektomieª sollte unter Schonung des genannten Muskels eine Generalisierung unterbunden werden, was gerade in den damals vorherrschenden fortgeschritteneren Stadien nur selten gelang [32].…”

Changes in mastectomy rates at a Brazilian public hospital over 20 years (1989 to 2008)

“…[1][2][3][4] During the first half of the 20 th century, Halsted's radical mastectomy and some variations of the procedure were used to treat the disease. [5][6][7][8] In the 1970s, Fisher's group in the United States and Veronesi's group in Italy started comparing the prognoses of patients who had undergone breast-conserving surgery (BCS;…”

Interpectoral approach to dissection of the Axillary Apex: An elegant and effective approach

“…The Halstedian radical mastectomy was the goldstandard for the surgical treatment of breast cancer till the 1950's [1]. With a better understanding of the biology of the disease and recognition of the fact that it is possible to satisfy oncologic principles while maintaining cosmesis, there has been a paradigm shift from radical mastectomy to modified radical and then onto breast conserving procedures; involving lumpectomy and axillary dissection through a separate incision.…”