Revisiting accepted wisdom in the management of breast cancer.

Misconceptions and illusions prevail in the management of breast cancer. Historical review reminds us that medical practice is commonly rooted in tradition rather than proof. The Halsted mastectomy inadvertently served the burgeoning profession of surgery in the early 20th century more than it has benefited women with breast cancer, yet 100 years later the operation continues to thrive. Despite evidence that mastectomy, radiation following lumpectomy, axillary node dissection, or intensive follow-up surveillance have little impact on survival, these practices are adhered to tenaciously. The extent to which current treatment for breast cancer succeeds in prolonging life remains open to question. Many accepted ideas and interventions are perilously disconnected from their true merit. The imperative for doctors to do something sometimes contradicts their pledge to do no harm. Reflection on what is known should guide future action.