V. The Value of Simple Mastectomy and Radiotherapy in the Treatment of Cancer of the Breast

An account has been presented of the method of treatment at present in use in Edinburgh. It must be accepted as representing but one direction in which the survival rates of breast cancer may be improved. There may be other better methods. Considerable emphasis has been placed on the importance of assessing the true value of a method of treatment so that better methods may be recognised without undue delay. The view has been expressed that the publication of results of selected cases has greatly confused the issue and has tended to convey the impression that radical mastectomy is a highly successful method of treatment of breast cancer. When radical mastectomy is the only method of treatment available, and when all cases coming to a large general hospital are taken into account, the five year survival rate is unlikely to exceed 25 per cent. A brief account of the method of treatment by simple mastectomy and radiotherapy has been presented. The five year survival rate of all cases coming to the Royal Infirmary in the period 1941–45 is 43·7 per cent. The most important feature of this method is the substitution of radiotherapy for surgery in the treatment of the axilla. The decision to do so was taken because when the axilla is not involved by malignant cells it appears unnecessary to carry out an axillary dissection, and when the axilla is involved the results of surgical dissection are poor. The fact that a five year survival rate of 29 per cent. was obtained in the advanced cases without distant metastases indicates that radiotherapy, even in such adverse circumstances, is an effective method of treating the axilla. It is therefore not surprising that this same method of treatment in operable cases should be associated with a survival rate much higher than that obtained by radical mastectomy. A high standard of radiotherapy is essential and adequate dosage must be given. It is most important to appreciate that simple mastectomy and a low standard of radiotherapy will be associated with results poorer than those obtained by radical mastectomy without any radiotherapy.