Karnofsky Memorial Lecture. Natural history of small breast cancers.

to occur in fits and starts, that is, there appear to be long periods of quiescence and then great bursts of insight into the etiology, natural history, and therapy of particular diseases. With breast cancer, the notion of the disease, its pathogenesis, and its treatment remained relatively static following the formulation of the Halsted paradigm for the disease and the acceptance of radical mastectomy as the logical therapeutic embodiment of this notion of disease spread.1,2 Fin de sidcle or end of the century is used to describe the last decade of the nineteenth century, when this opera-tion was described. It also connotes a time for reflection and taking stock. Since it has been just 100 years since the initial publication on this subject, it is appropriate to consider the state of the paradigm for breast cancer