In 1985 about 38,000 women died of breast cancer. Although the number of new cases of breast cancer has risen over the last two decades, the mortality rate has not changed markedly in the last fifty years. This does not mean, however, that there have not been considerable advances in the diagnosis and treatment of breast cancer. Regular breast self-examination and periodic mammography have become important tools in the early detection of breast cancer, while it is in its most curable stage. Better understanding of the different types of breast cancer has led to a more individualized approach to treatment, which now may include a combination of therapies.
There is also increased emphasis today on the quality of life following treatment of breast cancer. Only a few years ago, little attention was paid to the emotional aspects of breast cancer; indeed, many women went to great lengths to hide the fact that they had been treated for it. This began to change in the 1970s when a number of prominent women Betty Ford, Margaretta (Happy) Rockefeller, Marvella Bayh, Betty Rollin, among others—talked publicly about their struggles with breast cancer. Their openness encouraged other women to share their experiences with the disease, and has helped remove much of the stigma so wrongly associated with breast cancer in the past.
As women are becoming better informed about the disease, they are participating more in decisions regarding their treatment. Volunteer organizations, particularly the American Cancer Society’s Reach to Recovery program, have taken on new importance in helping women and their loved ones cope with the problems, both emotional and physical, associated with breast cancer. Breast reconstruction has become an increasingly important aspect of overall treatment, an important factor for women who fear the disfigurement of a mastectomy.
The broadened treatment options, the deep-seated emotional and cultural factors surrounding breast surgery, and the increased patient participation in treatment decisions make this one of the most controversial areas of cancer therapy. No longer is there a single “best” approach that applies to all women with breast cancer. Even the experts are not in full agreement as to how breast cancer should be treated. In this chapter, authorities representing different aspects of breast cancer diagnosis and treatment have collaborated to present an objective discussion of current approaches to breast cancer. Not all physicians and patients may agree with their viewpoints, as is to be expected in any area of medicine in which definitive treatment protocols are still being developed.