Paradigmatic Shifts in the Management of Breast Cancer

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Abstract
It has been almost exactly 100 years since William Halsted published his seminal report on the use of radical mastectomy “for the cure of cancer of the breast,”1 and it is fitting that this issue of the Journal includes the long-term results of two randomized trials evaluating treatment for breast cancer that might be cured with mastectomy alone.2,3 Halsted's ideas and his operation dominated our thinking about the treatment of breast cancer until approximately 25 years ago, when a major paradigmatic shift began. The premises underlying the Halsted approach were that metastases occurred by centrifugal and contiguous spread from . . .