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Other doctors now concede that in some cases, radical mastectomy can be replaced by slightly less drastic operations. Happy Rockefeller's doctors performed a modified radical, removing her breast and lymph nodes but leaving some of the chest muscles. A report released a month ago by the National Cancer Institute suggests that "total mastectomy," or removal of the breast but no other tissues, may be as effective as radical surgery in treating cancers that doctors feel confident have not yet spread to the lymph nodes.
But there is little professional acceptance of the simpler procedures advocated by Crile and Peters, which most surgeons believe do not remove all the malignant cells and leave a woman vulnerable to a recurrence of cancer. Memorial's Robbins points out that most cancers have been growing for anywhere from six to eight years before they are discovered. By that time they may have spread to other parts of the breast as microscopic clusters of malignant cells that cannot be detected clinically. Studies of breast tissue removed during surgery have revealed that even when there was only one small identifiable lump in the breast, there were, in a majority of cases, micrometastases elsewhere in the breast, the lymph nodes of the armpit and the nodes beneath the pectoralis major, or major chest muscle.
This helps to explain the notable differences in survival rates achieved by the various surgical procedures. Of 53 women to undergo partial mastectomy at the Cleveland Clinic during a nine-year period, for example, only 18, or 34%, survived ten years. Of the 304 women who had radicals at New York's Memorial in 1960, 185, or 61%, were alive ten years later.*
The chances of a breast-cancer victim are markedly improved if the tumor is detected and a mastectomy performed before malignant cells spread to the lymph nodes. A study conducted by the American Cancer Society dramatically shows how earlier detection can be achieved. During the past year, doctors at 25 centers screened 75,000 women over the age of 35 for breast cancer. They used three techniques: physical examination, thermography (a method of measuring the heat given off by a tumor) and mammography. Of those women who underwent biopsies to determine if suspicious growths were in fact malignant, 289 were found to have cancer. But in 77% of these victims, the cancers had not yet spread to lymph nodes under the arms. However, self-examination remains the technique by which about 95% of all breast cancers are now found. In more than half such cases, the cancerous cells have already reached lymph nodes. Thus the early detection provided by professional screening can make a vital difference: a woman whose cancer has not reached the lymph nodes has at least an 85% chance of being alive five years after her operation; if the nodes are involved, her chances decrease by half.