Changing concepts in breast cancer

The First National Conference on Breast Cancer was held under the auspices of the American Cancer Society and the Public Health Service in 1969. Since then, there have been many changes in our basic concepts regarding this malignancy. Ten years ago we were concerned primarily with the quantity of life; today we are also concerned with the quality of life. New trends and ideas include such diverse subjects as biologic tumor markers, role of retinoids, diet and disease, interferon, anti‐estrogen therapy, hyperthermia, targeted antibodies, the self‐help movement, mind and cancer, ambulatory out‐patient surgery, aspiration biopsy, thymidine labeling index, informed consent, and many others. However, I would consider certain specific changing concepts as being most important and having the greatest pragmatic value. The direction of these trends during the past ten years which are of major significance are as follows:1 1. Benefits of low‐dose mammography. 2 2. Recognition and treatment of minimal or subclinical breast cancer. 3 3. Trend toward more conservative breast surgery for breast cancer including modified mastectomy and partial mastectomy plus primary radiation therapy. 4 4. Notable results of adjuvant combined chemotherapy. Improved local control of breast cancer and systemic control of micrometastases and disseminated disease. 5 5. Importance of hormone receptors in predicting response to endocrine therapy and as an index of prognosis in breast cancer. 6 6. New operative techniques of breast reconstruction and programs for rehabilitation after mastectomy. 7 7. Oncology team concept of breast cancer treatment—surgery complemented by radiotherapy, hormone therapy, chemotherapy and immunotherapy.Thus, today's changing concepts had their beginnings ten years ago. Tomorrow's are already on their way.