Greek Surgeon Pavlos Ioannou's Possible Influence on William Halsted's Famous Radical Mastectomy.

Pavlos Ioannou performed an innovative surgical operation for breast cancer in Vienna University Hospital in 1861. A few years later, after his return to Greece, an operation performed on his closest friend's child, which led to fatal complications, led him to retire from surgical practice. William Halsted travelled to Europe in order to master European surgery, including at Vienna University, and about 20 years later he published his famous method for radical mastectomy, which appears to be identical to Ioannou's operation. This article debates whether Halsted studied Ioannou's method in the archives of Vienna University (and was encouraged by Ioannou's retirement to develop this technique), whether he learned about it through his peers, or whether this was simply a historical coincidence.

'No ordinary meeting': Robert McWhirter and the decline of radical mastectomy.

On 7 January 1948, a meeting was held at the Royal Society of Medicine in London. Its purpose was to settle a controversy. Robert McWhirter, an Edinburgh-based radiotherapist, had been invited to defend the scandalous position advocated by Geoffrey Keynes ten years previously: that radical mastectomy offered no survival advantage when compared to simple mastectomy plus local radiotherapy. The negative publicity surrounding the meeting proved overwhelming for Keynes and he abandoned his research. Indeed, the events of the meeting may have been quietly buried were it not for McWhirter who, over the following decade, pursued Keynes' research. He refined his technique, sparing patients the disfiguring and painful radical mastectomy without compromising overall survival. Later, he garnered support from other researchers, which led to a series of papers confirming his original findings. Towards the end of his career, he also made contributions to service organisation and hormone therapy, eventually holding the Presidency of the Faculty of Radiologists. By keeping the controversy alive, McWhirter was instrumental in overturning 60 years of surgical dogma. He remains a pivotal figure in the history of breast cancer.

"Entrenched practices and other biases": unpacking the historical, economic, professional, and social resistance to de-implementation.

BACKGROUND: In their article on "Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices," Prasad and Ioannidis (IS 9:1, 2014) referred to extra-scientific "entrenched practices and other biases" that hinder evidence-based de-implementation. DISCUSSION: Using the case example of the de-implementation of radical mastectomy, we disaggregated "entrenched practices and other biases" and analyzed the historical, economic, professional, and social forces that presented resistance to de-implementation. We found that these extra-scientific factors operated to sustain a commitment to radical mastectomy, even after the evidence slated the procedure for de-implementation, because the factors holding radical mastectomy in place were beyond the control of individual clinicians. We propose to expand de-implementation theory through the inclusion of extra-scientific factors. If the outcome to which we aim is appropriate and timely de-implementation, social scientific analysis will illuminate the context within which the healthcare practitioner practices and, in doing so, facilitate de-implementation by pointing to avenues that lead to systems change. The implications of our analysis lead us to contend that intervening in the broader context in which clinicians work--the social, political, and economic realms--rather than focusing on healthcare professionals' behavior, may indeed be a fruitful approach to effect change.

[The Bulletin du cancer: the years before the First World War]. / Le Bulletin de l'Association française pour l'étude du cancer de 1909 à 1914 : le Bulletin du cancer dans sa première période.

Three years after its founding in 1909, the Association française pour l'étude du cancer is a major scientific society developing transdisciplinary debates particularly on innovative therapeutics in cancer, such as the developing use of radium. The Association at that time assembles together all the French medical elite. Reading the Bulletin offers a clear view of the brilliant monthly debates. First World War stopped the life of the Association for four years. After this break, the set up of dedicated centers for cancer treatment was responsible for a major turn in the Association's life.

History of mastectomy before and after Halsted.

The operation described by Halsted, in 1894 and called radical mastectomy, represents a milestone in the treatment of breast cancer. It consisted of removal of the breast, muscles and axillary lymph nodes. The pre-Halsted era saw attitudes ranging from the willful abstention to brutal treatments by cauterization or amputation. The introduction of anesthesia and asepsis enabled more advanced surgical attempts. The stratification of patients into operable and nonoperable categories has improved surgical outcome. After attempts to extend Halsted procedure (by extended or super-radical mastectomies) proved to be of little benefit, a minimally-invasive trend emerged gradually. It started with modified radical mastectomy that spares the muscles and was then followed by breast conservative surgery that leaves breast tissue behind. Then sentinel lymph node mapping was introduced with the hope of reducing the extent of axillary dissection. Finally, skin sparing mastectomy appeared in order to conserve skin and facilitate breast reconstruction.

The origins of radical mastectomy.

William halsted is the 19th century surgeon whose name is most frequently associated with the radical mastectomy procedure; however, this type of surgery actually has been performed since the 16th century. The development of radical mastectomy was a long process, and many surgeons over time have contributed valuable insights and alterations to this fundamental treatment for breast cancer. This procedure may be most commonly associated with Halsted because he promoted a meticulous operative technique, synthesized the best points in the techniques suggested by the most famous surgeons of the 19th century, and provided a scientific basis for the performance of radical mastectomy.

History of surgery for breast cancer: radical to the sublime.

The historic milestones that have brought the surgical management of breast cancer to its current state are recounted. The Halsted radical mastectomy, once considered the ideal cancer operation, no longer has a place in the routine management of patients with breast cancer. Breast conservation in the form of segmental mastectomy, axillary node dissection, and radiation is often chosen over the modified radical mastectomy, popular in the 1980s. Axillary lymphadenectomy, shown to be of questionable therapeutic value in breast cancer, is certainly of prognostic significance. Studies are ongoing to establish the validity of the less-invasive sentinel node biopsy in determining axillary nodal status. Perhaps the most significant change in today's approach to breast cancer is the reliance on well-controlled prospective studies to evaluate outcome and determine the appropriate surgical procedure.

Sobrevida con mastectomía radical en cáncer de mama invasor / Survival in radical mastectomy for invasive breast cancer

Objetivos: Comparar las tasas de sobrevida a largo plazo según diversas factores clínico-patológicos y terapéuticos y determinar las tasas de sobrevida y recurrencia decenal luego de mastectomía radical clásica (MRC) y mastectomía radical modificada (MRM). Material y métodos: Revisamos retrospectivamente las historias clínicas de 72 pacientes con carcinoma de mama invasor operable con axila negativa (n igual 38) o positiva (n igual 34), tratadas con MRC (n igual 57) o MRM (n igual 15) en el Hospital Belén, Trujillo, Perú, desde el 1º de enero de 1966 al 31 de diciembre de 1995. Resultados: La edad media fue 47,6 más menos 9,5 años (límites, 30 a 70 años). El tiempo medio de enfermedad fue 9 meses (límites, 0,3 a 156 meses). Los síntomas o signos más frecuentes fueron presencia del tumor (100 por ciento) y dolor mamario (37,5 por ciento). Las tasas de sobrevida decenal en las pacientes tratadas con MRC y MRM, según el método actuarial de Kaplan-Meier, fueron 58 por ciento y 54 por ciento, respectivamente (p igual NS). No Hubo diferencia significativa en la tasa de sobrevida decenal entre el grupo de MRC y MRM al considerar el tamaño tumoral, número de ganglios regionales positivos, nivel axilar comprometido, estadio patológico y tipo de tratamiento. En las pacientes con ganglios axilares negativos hubo una mejora significativa en la sobrevida decenal cuando fueron tratadas con MRC que con MRM (68 por ciento contra 38 por ciento, p menor 0,05). Las tasas decenales de recurrencia local, regional y a distancia en el grupo de MRC, fueron 21 por ciento y 24,6 por ciento, respectivamente, mientras que el grupo de MRM las tasas decenales de recurrencia local, regional y a distancia fueron 13,3 por ciento 10 por ciento y 26,7 por ciento, respectivamente (p igual NS). Conclusiones: En pacientes con carcinoma de mama operable, la sobrevida decenal es similar cuando éstas son tratadas con MRC y MRM; sin embargo en las pacientes con ganglios axilares negativos, la sobrevida decenal es influida favorablemente por la MRC.

[Development of surgery for breast carcinoma by Joseph Rotter]. / Die Entwicklung der Chirurgie des Mammakarzinoms durch Joseph Rotter.

Hundred years ago Joseph Rotter published his new method of operation for breast cancer, by which the rate of local recurrences significant was decreased. This radical mastectomy performed similarly by Halsted in Baltimore (USA) was the surgical standard of the breast cancer therapy for a long time and is still used in local advanced carcinoma until today.