Primary chemotherapy in breast cancer: The beginning of the end or the end of the beginning for the surgical oncologist?

For the last 2000 years surgery has been the primary treatment for patients with breast cancer. During this period, surgical procedures for breast cancer became more extensive and culminated in the radical mastectomy as described by Halstead. Such extensive surgery was fuelled, and perpetuated, by the widespread acceptance of the Halsteadian concept of tumour biology and tumour spread. As a result of this, radical mastectomy dominated surgical practice for breast cancer for almost 100 years [1]. However, with advances in our understanding of tumour biology, these Halsteadian concepts were challenged. As a result, novel, and less extensive, approaches to the surgical treatment of breast cancer were initiated and evaluated in a scientific manner.