Non-disseminated Breast Cancer: Controversial Issues In Management (medical Radiology)

In the last two decades, there has been a major increase in the actual numbers of women diagnosed with breast cancer (from 65000 new cases 20 years ago in the United States to 183000 in 1993). Concomitant with this has been a shift toward making the diagnosis earlier and toward diagnosing an earlier stage ofthe disease (more than 70% of diagnoses were of advanced-stage disease two decades ago, whereas more than 70% of diagnoses are now earlier-stage disease in 1992). These changes are clearly related to the woman's greater sensitivity to abnormalities in the breast and her seeking medical care, to the physician's greater awareness of the potential diagnosis of cancer, and to the major and important impact of mammographic screening. These changes have had a major impact on the questions of appropriate treatment, thereby contributing to the controversies in the disease. What is the role of surgery? What are the respective advantages of radical mastectomy, modified radical mastectomy, and conservation surgery with and without supplementary treatment? What is the role of radiation therapy? When should radiation therapy be performed after mastectomy, and what volumes should be irradiated post mastectomy? Where is radiation therapy indicated after conservation surgery, and when is radiation therapy an effective palliative treatment measure? When should chemotherapy and/or hormonal therapy be used as an adjuvant to primary treatment and when as an effective palliative treatment? This book by Levitt and Fletcher addresses these critical and important issues. Front Matter....Pages I-XIV Is Breast Cancer Curable?....Pages 1-3 Criteria of Operability in Advanced Breast Cancer....Pages 5-9 Postoperative Radiotherapy and the Pattern of Distant Spread in Breast Cancer....Pages 11-26 How Much of the Axilla Should Be Dissected?....Pages 27-34 How Much of the Effect of Chemotherapy Is Due to Hormonal Manipulation?....Pages 35-42 Chemotherapy for Node-Negative Breast Cancer....Pages 43-56 Treatment of the Peripheral Lymphatics: Rationale, Indications, and Techniques....Pages 57-72 What Is the Value of Clinical Trials?....Pages 73-81 What Have We Learned from the Stockholm Trials on Adjuvant Radiation Therapy in Early-Stage Breast Cancer?....Pages 83-92 Pathologic Factors Predictive of Local Recurrence in Patients with Invasive Breast Cancer Treated by Conservative Surgery and Radiation Therapy....Pages 93-104 What Is the Optimal Technique of Irradiation in Breast-Conserving Treatment?....Pages 105-115 Which Patients Should Be Treated by Breast Conservation Surgery and Which by Modified Radical Mastectomy....Pages 117-128 What Is the Role of Adjuvant Chemotherapy in Postmenopausal Women with Operable Breast Cancer?....Pages 129-142 How Should We Treat Ductal Carcinoma In Situ?....Pages 143-154 How Successful Is Breast Reconstruction?....Pages 155-160 Back Matter....Pages 161-168 The latest controversies about how to treat breast cancer are examined and analyzed from various viewpoints by recognized experts. The focus is on breast cancer that has presumably not yet spread, where there are many different avenues of treatment open and, consequently, ample disagreement as to the best course of action. The viewpoints presented here help clarify the issues for all oncologists dealing with breast cancer