Problem of Carcinoma of the Breast

Kunath, Carl A.

doi:10.1001/archsurg.1940.01210010069005

Cited by 7 publications

(2 citation statements)

References 7 publications

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“…The absence of evidence has sometimes led to dramatic reversals when high-quality evidence finally becomes available. 13 For example, the radical mastectomy, pioneered by William Halsted in the 1880s, 14 was practiced for nearly a century before a controlled trial, published in 1981, showed no advantage over less disfiguring approaches. 15 More recently, studies have shown no clear advantage to common procedures for back pain, 16 meniscus tears, 17 or the prevention of venous thromboembolism.…”

Section: Inadequate Evidence Undermines Patient Carementioning

confidence: 99%

Evidence Supporting the Value of Surgical Procedures: Can We Do Better?

Darrow

Robertson

Kasoff

2020

The American Surgeon™

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There is an acknowledged need for higher-quality evidence to quantify the benefit of surgical procedures, yet not enough has been done to improve the evidence base. This lack of evidence can prevent fully informed decision-making, lead to unnecessary or even harmful treatment, and contribute to wasteful expenditures of scare health care resources. Barriers to evidence generation include not only the long-recognized technical difficulties and ethical challenges of conducting randomized surgical trials, but also legal challenges that limit incentives to conduct surgical research as well as market-based challenges that make it difficult for those funding surgical research to recoup investment costs. These legal and market dynamics differ substantially from those surrounding new drug or device development. Nevertheless, obstacles could be overcome and overall expenditures could be reduced if a share of federal health care agency budgets were reallocated to generating randomized trial data, standardizing outcome measures, and conducting observational studies analogous to those that have been facilitated for drugs via the Food and Drug Administration’s Sentinel Initiative. Until better quality evidence is available, ethical principles require adequate disclosure of the limited evidence base supporting current surgical procedures.

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Section: Inadequate Evidence Undermines Patient Carementioning

confidence: 99%

Evidence Supporting the Value of Surgical Procedures: Can We Do Better?

Darrow

Robertson

Kasoff

2020

The American Surgeon™

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“…Most probably this holds good also for the Grade I and Grade III tumours, only that the time factors are so long or so short that their significance is obscured under the usual clinical conditions. When Kunath (1940) says: "Size and ma88.-An analysis of this point failed to reveal that a larger tumour carries any more serious a prognosis than does a small one ", and Hoopes and McGraw (1942) likewise conclude: " No correlation was found between the post-operative duration of life and the size of the tumour removed ", these findings are not necessarily in contradiction to the opposite conclusions, mentioned above. The explanation may be a different composition of the groups of tumours, as regard number of representatives of the different grades of malignancy.…”

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confidence: 96%

The Prognostic Significance of Small Size in Breast Cancer

Kreyberg¹,

Christiansen²

1953

Br J Cancer

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The pathology of invasive breast cancerA Syllabus Derived from Findings of the National Surgical Adjuvant Breast Project (Protocol No. 4)

Fisher

Gregorio²,

Fisher³

et al. 1975

Cancer

717

140

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The inter-relationships of 32 pathologic and 7 clinical parameters encountered in the study of 1000 examples of invasive breast carcinoma have been presented. In some instances the biological significance of these associations is at present unclear. In others it is to be noted that there is no information provided as to the rank of their significance. Nevertheless, the associations that were encountered not only help further characterize the various forms of breast cancer but also provide information regarding the possible biological significance of some of their features. Although it is not our intention to minimize the possible significance of the inter-relationships of pathologic parameters, most emphasis in the summarizing statements which follow has been placed upon those correlations which may relate to prognosis. In this regard reference has been made to short-term treatment failure, vis a vis local recurrence and/or metastases, which may not necessarily accurately reflect patient survival, although generally such a relationship exists. Information in this regard as well as to the rank of the significance of these pathologic features shall be forthcoming when sufficient time has elapsed since the inception of this study to allow for such conclusions, i.e. survival or long-term treatment failure rates. Lastly, it becomes evident that the guidelines followed in the examination of these specimens appear to represent at least the minimum requirements necessary for a meaningful pathologic evaluation of breast carcinoma.

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Problem of Carcinoma of the Breast

Cited by 7 publications

References 7 publications

Evidence Supporting the Value of Surgical Procedures: Can We Do Better?

Evidence Supporting the Value of Surgical Procedures: Can We Do Better?

The Prognostic Significance of Small Size in Breast Cancer

The pathology of invasive breast cancerA Syllabus Derived from Findings of the National Surgical Adjuvant Breast Project (Protocol No. 4)

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