Over the past few decades, changes in the treatment of breast cancer amount to a revolution in patient care. And it’s not over yet. There was a time when the standard approach was a radicalmastectomy, which involved removal of not just the breast, but all the lymph nodes in the armpit and underlying muscles in the chest wall. This approach has been replaced by less extensive surgery that, through decades of clinical trials, has proved to be equally effective at treating patients, as well as safer and less disfiguring. Even simple mastectomies, in which most nodes and the muscles were left intact, have become far less common. Dr. J. Dirk Iglehart, director of the Susan F. Smith Center for Women’s Cancers at Dana-Farber Cancer Institute in Boston, estimated that he now performs a tenth of the number of mastectomies than when he entered the field in the 1970s.
Currently, most women with early-stage breast cancer have alumpectomy; only the tumor and a small margin of surrounding normal tissue are removed, along with a few lymph nodes. Patients then receive localized radiation therapy and often drug therapy to head off a recurrence.
Even though this approach is less aggressive, breast cancer death rates have dropped steadily since 1990, a combined result of earlier diagnosis and medical therapies developed largely through a major national investment in cancer research, according to Dr. Clifford A. Hudis, chief of breast cancer medicine service at Memorial Sloan Kettering Cancer Center in New York.
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