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 Breast Cancer: Revisiting Accepted Wisdom in the Management of Breast Cancer - Part 1 

Halsted's lack of interest in his patients as people was reminiscent of the heroic Virchow. He was scrupulous and painstaking in the surgery itself, yet harbored an aversion for interaction as a form of caring for his patients. At the same time, he fashioned himself as their savior. Most significantly, the complicated radical mastectomy launched surgeons on a trajectory of prestigious professional accomplishment. Because of the anatomical and technical prowess required, in 1898 surgeon Frederick Gerrish'6 said of Halsted's radical mastectomy: "We now have an operation which should be regarded as unjustifiable for the general practitioner."

Virchow and Halsted were uncommonly devoted medical scholars and sleuths. Hooked on deciphering pathological mysteries, the interest of science was their priority. Surgery afforded the chance for live dissection, an occasion immensely more instructive than the scrutiny of cadavers. Throughout surgical history, peeking within the pulsing inner sanctum yielded scholarly returns, even when there appeared to be no profit for the patient.

Advances in knowledge sometimes occur in the absence of therapeutic gain--the interests of clinicians and researchers are interdependent, but not necessarily identical. Lithographs of Halsted's early mastectomies illustrate exceptional textbook learning opportunities, showing the skin vividly peeled back from the chest wall, exposing the vast web of glands and vessels. On the other hand, women were left with a large, open chest wound thick with clots that sometimes took months to heal. Halsted defined success by the tissue samples gleaned and the perfection of the technique employed. Ultimately, however, contrary to concurrent insights, he believed in Virchow's notion that cancer spread to muscles via lymph.

As late as 1907, in a follow-up paper titled "The Results of Radical Operations for the Cure of Cancer of the Breast," Halsted17 echoed Virchow's flawed theory, writing:

    I recall ... cases ... in which general metastasis was believed, erroneously, I think, to have occurred by way of the bloodvessels [sic].... We believe, with Handley, that cancer of the breast, in spreading centrifugally ... before involving the viscera may become widely diffused along surface planes.... It permeates to the bone rather than metastasizes to it, and, by way of the Iymphatics, along facial planes ... the liver may be invaded by way of the deep fascia ... the brain by the Iymphatics accompanying the middle meningeal artery.... Though the area of disease extends from cranium to knee, breast cancer in the broad sense is a local affection ... invariably by process of Iymphatic permeation, and not embolic by way of the blood. If extension, the most rapid, takes place beneath the skin along the fascial planes, we must remove not only a very large amount of skin and a much larger area of subcutaneous fat and fascia, but also strip the sheaths from the upper part of the rectus, the serratus magnus, the subscapularis, and, at times, from parts of the latissimus dorsi and the teres major. Both pectoral muscles are, of course, removed. A part of the chest wall should, I believe, be excised in certain cases, the surgeon bearing in mind always that he is dealing with Lymphatic, and not blood, metastases.... It must be our endeavor to trace more definitely the routes traveled in the metastases to bone, particularly to the humerus, for it is even possible in case of involvement of this bone that amputation of the shoulderjoint, plus a proper removal of the soft parts, might eradicate this disease.... So, too ... amputation at the hipjoint may seem indicated.
(Excerpted from Alternative Therapies in Health and Medicine)
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 About The Author
Harriet Beinfield LAcHarriet Beinfield, L.Ac. and Efrem Korngold, L.Ac., O.M.D. have pioneered the practice of Chinese medicine in America for the last 28 years as educators, writers, and practitioners. They are the co-authors of the......more
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