Recent trends in the treatment of primary breast cancer

In response to the continuing controversy over the treatment of primary breast cancer, a review of treatment practices in Metropolitan Detroit for the years 1973 through 1976 has been undertaken to determine what effect, if any, this controversy has had on clinical practice. The study population comprised 6132 females first diagnosed as having breast cancer during this period. Three treatment modalities—mastectomy alone, mastectomy plus radiotherapy alone, and mastectomy plus chemotherapy alone, comprising 96.8% of treated cases—were studied. The data indicate that significant changes occurred in surgical treatment and adjuvant therapy during this period. The proportion of patients receiving partial and modified radical mastectomy rose, while the use of the simple and radical procedures fell in each year. The use of chemotherapy increased throughout the study period while utilization of radiotherapy appeared to be on the decline, after peaking in 1975. In 1976, about 18% of all cases had received adjuvant chemotherapy, compared to 2% in 1973. By 1976, this modality was on an equal footing with radiotherapy as an adjuvant therapy. These changes were a function of both stage of disease and age of the patient at diagnosis. Adjuvant chemotherapy was most frequently used for disease staged as regional (30% of cases) and remote (45% of cases). The study shows that, at a time when there is dissatisfaction about the treatment of primary breast cancer, physician attitudes are very sensitive and react quite rapidly to new recommendations.