Seminars in Surgical Oncology 7:245-246 (1991)

BREAST CANCER MANAGEMENT AT MEMORIAL SLOAN-KETTERING CANCER CENTER

Guest Editors

DAVID W. KINNE, MD ARTHUR I. HOLLEB, MD Dr. Kinne is Chief of the Breast Service at Memorial Sloan-Kettering Cancer Center, New York, New York. Dr. Holleb is a Consultant for Cancer Control of the American Cancer Society.

Foreword

A quarter of a century ago, breast cancer was the most fatal cancer in women; it was the most feared, the most self-discovered, the cancer for which the most biopsies were done and x-ray examinations per- formed, the most controversially treated cancer, and the cancer for which the most radiation therapy, hor- mone therapy and chemotherapy were given.

In 1991 some of these statements remain true, yet significant changes have taken place. Breast cancer is no longer the No. 1 cancer killer of women. That fatal

distinction now belongs to lung cancer. Also, there have been revolutionary changes in the treatment of breast cancer-from the extended radical mastectomy with internal mammary node resection to breast con- servation surgical approaches.

Today there is a better understanding of the biologi- cal behavior of in situ breast cancer; minimally inva- sive breast cancer; and the standard, readily palpable, invasive breast cancer. Refinements in marnmographic techniques using a minimum of radiation exposure

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enable us to detect breast cancer about 2-3 years before it becomes palpable.

Controlled clinical trials have clarified the role of simple local excision of a breast cancer followed by radiation therapy to the breast and by chemotherapy when axillary lymph nodes are involved. Today, if a mastectomy is necessary, we can offer highly success- ful plastic surgical reconstructive techniques that promptly restore the breast contour with most satis- factory cosmesis.

The articles presented in this issue of Seniinars in Surgical Oncology represent the approach of the Breast Service of the Memorial Sloan-Kettering Can- cer Center to the detection, diagnosis, treatment, and rehabilitation of patients with breast cancer. Cancer of the breast in the male is also discussed. recognizing that its occurrence in the male constitutes less than 1% of all breast cancer.

Breast cancer is a timely subject. We are seeing an increasing incidence of the disease and we do not know why. The lifetime risk of developing breast can- cer is now 1 :9 for American newborn girls.

Breast cancer detection has entered the legislative arena resulting in some health care systems providing funds for mammographic screening of asymptomatic women. Not many years ago, it was the sole responsi- bility of the individual woman to cover the costs of early detection efforts. Prevention of breast cancer, possibly by means of dietary modification, has re- cently become a prominent medical issue as a potential large scale clinical trial.

Despite improved diagnosis and treatment, there is an enormous psychosocial impact when the diagnosis of breast cancer is first made and when therapy, albeit conservative, is instituted. The major role of rehabili- tation is to have the patient look upon breast cancer as any other illness-not as a social stigma, a punish- ment (“why me?” or “why has God done this to me?”), or a loss of femininity or sexual attractiveness.

The last scientific word about breast cancer has yet to be written. The medical scene changes from month to month. The articles in this issue represent the views of one highly experienced major comprehensive can- cer center and my alma mater. It is hoped that this special review and update will serve the reader well in our collective aim of improving the care of all patients with breast cancer.

Dr. David W. Kinne, co-editor of this issue of Seminars in Surgical Oncology, and chief of the Breast Service at Memorial Sloan-Kettering Cancer Center, deserves considerable credit for agreeing to the concept of a special issue dealing with breast can- cer, for organizing and collating the scientific content and for follow-up of promised deadlines, in which he had the diligent administrative assistance of Jose- phine Girardi, RN. During his tenure as chief, Dr. Kinne has made remarkable contributions to breast cancer control, particularly in the area of surgical management.

Arthur I. Holleb, M D Larchmont. New York