I have spent most of my academic career studying the diagnosis and treatment of breast cancer. I have no doubt about the most important innovation in my field over the last 200 years. It was not a surgical technique, it was not the discovery of radiotherapy or a new drug but a paradigm shift about the nature of the disease. Until the late 1970s breast cancer was considered as an anatomical challenge to be defeated by the skills of the surgeon alone until a group of revolutionaries, lead by Dr. Bernard Fisher of Pittsburgh PA, described an alternative model that better explained some enigmatic features of the disease.
We now accept that in the majority of cases we are dealing with a systemic disorder with the primary tumour as the tip of an iceberg. The therapeutic consequences of this conceptual revolution have been better survival following the early exhibition of chemotherapy regimens and tamoxifen, together with less mutilating surgery combined with modern radiotherapeutic techniques, that have preserved the breast and improved quality of life for the survivors.
Since 1980, mortality from breast cancer has fallen by more than 30 per cent in the UK alone as a result of the new technologies being harnessed to a new conceptual framework.
Michael Baum is emeritus professor of surgery and visiting professor of medical humanities at University College London, chair of the Psychosocial Oncology Committee at the National Cancer Research Institute and editor-in-chief of the International Journal of Surgery.