Locoregional treatment for breast cancerBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7423.1062 (Published 06 November 2003) Cite this as: BMJ 2003;327:1062
- D Dodwell, consultant in clinical oncology,
- K Horgan, consultant surgeon
- Breast Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds LS1 3EX
Local recurrence also affects mortality, and appropriate treatment is important
Breast cancer is a common and diverse disease that is seen in many areas of clinical practice. Central to the development of a coherent strategy for its management and to define research priorities is an understanding of its natural history and the relation between the risks of locoregional and systemic recurrence.
The Halstedian view of breast cancer as a disease characterised by stepwise locoregional progression, which is therefore amenable to radical surgery and radiotherapy, came under question when randomised trials of more aggressive local treatment (mostly entailing the application of radiotherapy after mastectomy) improved local control but not overall survival.1 The perception that mortality from breast cancer was related to systemic rather than local recurrence led to the notion of biological predeterminism, and the role of local treatment was relegated to the prevention of local recurrence and its attendant morbidity rather than influencing mortality.2
One effect of this transition in understanding was the development of less radical locoregional treatment and specifically the introduction of breast conserving surgery with breast irradiation. The long term …