Language
Country/Area
No result found
From radical mastectomy to modern treatments: What's stopping us from using this major surgery?
A radical mastectomy is a surgical procedure used to treat breast cancer by removing the entire breast and the underlying pectoral muscles (including the teres major and minor muscles) and the underarm lymph nodes. Breast cancer is the most common cancer in women. In the early 20th century, the disease was primarily treated surgically, and it was during this period that radical mastectomy was developed. However, as technology and surgical skills have improved, mastectomies have become less invasive in recent decades. As of 2016, a combination of radiation therapy and breast-conserving surgery is considered the optimal treatment option.
History of radical mastectomy
The successful results achieved by William Halsted and Willy Meyer, the pioneers of radical mastectomy, ushered in the modern era of surgical treatment of breast cancer. In 1894, Hastert published a clinical study of 50 radical mastectomies at the Johns Hopkins Hospital. Meyer published his radical mastectomy studies in New York patients in December 1894. This complete removal of breast tissue was initially called a Haastectomy, later renamed "total excision," and eventually became what is today known as a "radical mastectomy."
“Radical mastectomy is considered the first step in eliminating breast cancer, but its initiation is followed by a long and painful recovery process.”
Radical mastectomy was based on the medical belief at the time that breast cancer initially spreads locally, then invades surrounding tissue, and eventually spreads to the lymphatic sheath. As research continues, the medical community's understanding continues to evolve. Although Hastert's surgery has created a 3% postoperative recurrence rate, a 20% local recurrence rate, and a five-year survival rate of 40%, the high postoperative complication rate has affected the quality of life of many patients.
The transformation of surgery
As medical trends continue to change, the results of various clinical studies have gradually become popular since the 1950s, making doctors realize that not all breast cancer patients can benefit from radical mastectomy. In 1943, Haagensen and Stout reviewed more than 500 patients who underwent radical mastectomies and identified a group of patients who could not be cured by radical surgery and began to propose the relationship between operability and The concept of inoperability.
“With the advancement of medical technology, more and more doctors are beginning to question the necessity of radical mastectomy.”
This discovery promoted the development of a clinical staging system for breast cancer and laid the foundation for subsequent treatment design and research. This was further fueled by a 1977 study conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP) that showed no significant difference in survival or recurrence rates between radical mastectomy and less invasive procedures. Innovations in surgical methods.
The impact of extended radical mastectomy
Under the influence of the Hastert-Meyer theory, many surgeons believed that expanding the scope of surgery to remove more lymph nodes would improve the chance of cure. From the 1920s onwards, many surgeons further explored Bihaster's original surgery. Invasive surgery is also required. As research progressed, the medical community began to realize that these "extended radical mastectomies" were not very effective and that these massive, painful surgeries offered no significant advantage over standard radical mastectomies.
“The gradual decline in extended radical mastectomies demonstrates the important mission of modern surgery in improving patients’ quality of life.”
Nowadays, radical mastectomy is relatively rare among surgeons’ surgical options, replaced by more miniaturized and personalized treatments, such as breast-conserving strategies that combine local excision with radiation therapy. These changes not only make surgery more acceptable, but also effectively improve patients' quality of life.
In the future, how will the medical community further balance the effectiveness of cancer treatment with the quality of life of patients? Is this still a question worthy of our deep consideration?
