ABSTRACT
Surgery is the most effective treatment option ever employed against breast cancer. Halsteds radical mastectomy (RM), which dates from the turn o f the century, revolutionized the local control o f the disease and demonstrated that a subset o f patients could be cured by surgery alone. Halsted viewed breast cancer as a principally local-regional disease that spread in a centrip etal fashion. Fifty years later, Bernard Fisher would hypothesize that breast cancer is primarily a systemic disease and state that the surgeons knife had little impact upon outcome. Today, we would argue that they are both right and both wrong - breast cancer begins as a local disease and, at some point in its evolution, becomes systemic. Local control cannot cure all patients, but no patients are cured without it. Surgery remains the mainstay o f local control at the turn o f the millennium, and recent trends towards earlier stage at diagnosis will undoubtedly increase its role.
