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Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century?

      To fully grasp how so many smart, right-minded people could get it so wrong, it might help to start with a quick review of medical history. Take the radical mastectomy, conceived by William Halsted
      • Halsted W.S.
      The results of operations for the cure of cancer of the breast performed at the John Hopkins Hospital from June 1889 to January 1894.
      in the late 19th century. The procedure was intended to remove all cancer cells of the breast, the overlying skin, the underlying muscle, and regional lymph nodes (Figure 1). It was mutilating, permanently disfiguring, and no more effective than less radical, less disfiguring procedures. Still, because of the prestige and respect Halsted commanded as a teacher of surgeons, his disciples defended and taught the radical mastectomy at the most revered medical colleges. His extreme surgery was perpetuated for almost a century, until challenges by courageous physicians in Europe
      • McWhirter R.
      The value of simple mastectomy and radiotherapy in the treatment of cancer of the breast.
      • Hayward J.
      Conservative surgery in the treatment of early breast cancer.
      and America,
      • Crile Jr, G.
      Results of conservative treatment of breast cancer at ten and 15 years.
      along with a prospective randomized study by Dr. Bernard Fisher,
      • Fisher B.
      • Redmond C.
      • Fisher E.R.
      • Bauer M.
      • Wolmark N.
      • Wickerham D.L.
      • Deutsch M.
      • Montague E.
      • Margolese R.
      • Foster R.
      Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation.
      finally sounded the death knell of this standardized surgical error of the century.
      Figure thumbnail gr1
      Figure 1The Halstead radical mastectomy.
      Reprinted from Cotlar AM, Dubose JJ, Rose DM. History of surgery for breast cancer: radical to the sublime. Curr Surg 2003;60:329–337.
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