The power of social change: the Women's Movement and breast cancer

Racial/ethnic differences in early detection of breast cancer: a study of 250,985 cases from the California Cancer Registry

AIMS

This study analyzed early breast cancer detection rates as a surrogate for breast cancer mortality rates. Stage at diagnosis was broken down by race/ethnicity and year of diagnosis for the cases of female breast cancer in the California Cancer Registry from 1988 to 2002.

METHODS

A quarter million cases of breast cancer in women > or =50 years of age recorded in the California Cancer Registry over the period 1988-2002 were classified as early (in situ and localized stages) or late (regional and distant stages). The increases in the percent of cases that were early were studied by 3-year periods over this interval. In addition to the total group, data were broken down by race/ethnicity. The 3-year periods were used to compensate for small numbers of cases in some of the nonwhite groups.

RESULTS

The proportion of early stage female breast cancers reached a plateau at 70% in the mid-1990s. African American and Hispanic women's screening rates reached a plateau at a considerably lower rate. Only Pacific Islander/Asian American women demonstrated a sustained rise in the percent of early breast cancers detected through 2002, eventually nearing the rate of early detection set by white women.

CONCLUSIONS

The plateaus observed suggest that focused interventions continue to be needed for all women, especially for African American and Hispanic women if the American Cancer Society's 2015 goals are to be achieved.

The History of Mastectomy

The mastectomy that is performed today is a procedure born from hundreds of years of discoveries, inventions, and amendments to existing surgical techniques. The reasons for performing this extreme surgery have changed as well, ranging from unilateral breast removal to allow greater upper limb functionality to bilateral removal of the breasts or breast tissue in individuals predisposed to breast cancer or in individuals who have already been diagnosed. The additions of surgical tools and anesthetics to the field of medicine further transformed the surgical field in general and had a large impact on the mastectomy. William Halsted's radical mastectomy served as the basis of most future breast removal techniques, and it the method recognized today as the “radical mastectomy.” Most radical surgeries are currently used for prophylaxis, whereas less invasive lumpectomies have eclipsed breast removal surgeries as of the latter half of the 20th century.

Breast surgery as a specialized practice

The interest in breast surgery as a specialized practice has expanded over the last decade as technology advances and medicine became more complex and specialized overall. There is evidence that breast cancers treated in high-volume centers and by specialists result in improved survival and that the demand for breast surgical oncologists will increase with the aging population. Breast specialists of the future are more likely to be trained in oncoplastic techniques, thereby providing more comprehensive care.