Surgery for Breast Cancer: Less May Be as Good as More

This issue of the Journal contains some results of two multicenter studies by the National Surgical Adjuvant Breast and Bowel Project, 1 , 2 which go far toward defining a new rationale for surgical management of potentially curable breast cancer. Historically, radical mastectomy, first proposed around 1900, was used for women with large tumors. Its results were measured by short-term survival, and the operation was justified by subsequent investigations that showed permeation of the lymphatics leading from the primary tumor to axillary nodes. It was the general consensus that cancer started as a local disease, extended both by direct invasion and lymphatic permeation, . . .