Management of Locally Advanced Breast Cancer

In 1962, Bloom and colleagues described the natural history of locally advanced breast cancer.[1] (For the purposes of this manuscript, we will define locally advamced breast cancer as tumors that measure more than 5 cm, tumors that extend to the chest wall or skin, and tumors with fixed ipsilateral nodes or ipsilateral internal mammary nodes. These characteristics therefore correspond to operable disease stage IIIA (T3, N1 or any N2) and to initially inoperable stage IIIB (any N3 or any T4) disease.[2]) Bloom et al retrospectively analyzed data from 250 untreated patients with locally advanced breast cancer (97.6% of whom had T3 or T4 disease) who were hospitalized in the Middlesex Hospital in London between 1805 and 1933. The patients, who were in the hospital for at least 6 months, died in the hospital and were autopsied. Mean survival time was 2.7 years (range, 3 months to 18 years).