Evolution of Radiation in Early Breast Cancer

Breast cancer is the most common cancer among females across the globe and in India, with an incidence of nearly 40 per 100,000 population. Mastectomy has been extensively described as a surgical treatment option since the previous century. In 1894, Halsted introduced the concept of radical mastectomy which comprises en-bloc removal of the breast, overlying skin, pectoralis major, pectoralis minor and level I, II, and III lymph nodes. Nearly, three-quarters of patients in the series of Halsted’s had axillary lymph node metastases. Instead of such advanced disease, he reported only 6% local recurrence and an impressive 3-year survival rate of 38–42%. In 1948, Patey reported no added benefit of removal of the pectoralis major and described a technique known as modified radical mastectomy (MRM), which was further modified by Auchincloss and Madden by preserving both the pectoralis major and the pectoralis minor muscles. This paradigm shift was intending less mutilating surgery without compromising survival outcomes. As a result, by 1980, nearly 70% of all breast cancer surgeries were MRM.