Changing attitudes in the management of cancer of the breast.

Opportunity to assess changes in the management of cancer of the breast over the past 7 years was afforded by analysis of responses to questionnaires that were part of an annual questionnaire course. Comparison of responses to questionnaires conducted in 1971 and 1977 identified important features of approaches to this disease and indicated the way in which changes have occurred. Diagnostic needle aspiration increased from 24% (1971) to 54% (1977). In both surveys surgeons reported employing mammography infrequently. Use of modified radical mastectomy increased from 15% (1971) to 60% (1977). Employment of classical radical mastectomy decreased from 83% (1971) to 37% (1977). Surgeons considering biopsy of the contralateral breast to be unnecessary decreased from 47% (1971) to 14% (1977). Skin grafting, after a mastectomy, decreased from 40% (1971) to 24% (1977). Though oophorectomy is still the preferred initial treatment for premenopausal patients with advanced disease, preference for chemotherapy in postmenopausal patients increased from 5% (1971) to 23% (1977). Surgeons approving of reconstruction with implants after mastectomy for carcinoma increased from 30% (1971) to 49% (1977). Following mastectomy in patients with positive axillary nodes, 58% of our respondents employ chemotherapy with several drugs and 34% prefer irradiation.