Fox M S
JAMA. 1979 Feb 2;241(5):489-94.
Randomized trials comparing surgical treatments of breast cancer show that radical mastectomy offers no greater benefit than simple mastectomy followed by radiotherapy. Furthermore, in terms of survival, radical mastectomy seems to be no better than wide excision followed by radiotherapy when the disease is clinically diagnosed as stage 1. The incidence of diagnosed breast cancer showed an 18% increase between 1935 and 1965 and a 50% increase between 1965 and 1975. However, breast cancer mortality has remained unchanged for at least the past 40 years. Analysis of survival curves of women with breast cancer suggests that two or more populations exist, with about 40% suffering fatal outcome unaffected by treatment. The remaining 60% exhibit a relative mortality only modestly different from that of women of similar ages without evidence of disease. Increasing detection of an entity that is histologically defined as malignant but biologically relatively benign could account for the observed increase in incidence.
比较乳腺癌手术治疗方法的随机试验表明，根治性乳房切除术并不比单纯乳房切除术加放疗更具优势。此外，就生存率而言，当临床诊断疾病为1期时，根治性乳房切除术似乎并不比广泛切除加放疗更好。1935年至1965年间，确诊乳腺癌的发病率上升了18%，1965年至1975年间上升了50%。然而，至少在过去40年里，乳腺癌死亡率一直保持不变。对乳腺癌女性生存曲线的分析表明，存在两个或更多群体，约40%的人遭受不受治疗影响的致命结局。其余60%的人表现出的相对死亡率与无疾病证据的同龄女性相比仅略有不同。对一种组织学上定义为恶性但生物学上相对良性的实体的检测增加，可能解释了观察到的发病率上升。
