Word: veronesi
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Dates: during 1980-1989
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Until recently, such breast-sparing techniques were universally considered to be inadequate and dangerous. Today, the evidence is to the contrary. Last month, at a meeting at the National Cancer Institute in Bethesda, Md., noted Italian Oncologist Umberto Veronesi presented the results of a landmark ten-year study comparing survival after a mastectomy with survival following a less disfiguring operation called quadrectomy (see diagram). His conclusion: "There is absolutely no difference...
...Veronesi, who heads Milan's respected National Cancer Institute, bases his conclusion on the treatment and follow-up of 700 Italian patients. Half were treated with a mastectomy and half with a quadrectomy, plus radiation if the malignancy extended to lymph nodes under the arm. All of the women in the study had a very early stage of breast cancer, with tumors measuring less than three-quarters of an inch in diameter. A decade after treatment, 96% of the women in both groups were alive and apparently healthy. Significantly, the study defied the longstanding dictum that anything short...
...treatment. According to Dr. Samuel Hellman, physician in chief of New York's Memorial Sloan-Kettering Cancer Center, even patients with tumors as large as two inches in diameter may require nothing more than a lumpectomy followed by radiation. Though this approach involves removing even less tissue than Veronesi's method does, the results with some 350 patients seem to be just as good. Moreover, Hellman notes, the physical appearance of the treated breast is "good to excellent" in four out of five patients...
Many physicians have resisted the new techniques because they fear that without mastectomy cancer will be more likely to recur and more patients will die. The ten-year Italian results may convert the skeptics, although Veronesi warns, "Next the surgeons are going to want to see the 15-year outcome, and then...
...recurrence. For women with a small degree of spreading (measured by counting the number of malignant lymph nodes), radiation treatment is strongly recommended. Women with more extensive spreading may also be candidates for a lumpectomy, but for these patients chemotherapy might be used as an added safeguard. According to Veronesi's colleague, Dr. Gianni Bonadonna, a leading authority on chemotherapy, there is really only one reason for a complete mastectomy: when the tumor is so large that it fills one-third or more of the breast. In that case, he asks, "What would you be leaving behind...