Breast cancer surgery: an historical narrative. Part II. 18th and 19th centuries.

During the 18th and 19th centuries, management of breast cancer was greatly improved. The humoral theory of Galen, which dominated for centuries, was fallen into disfavour. Axillary nodal involvement was recognised as an adverse prognostic factor, while LeDran, in the middle of the 18th century, proposed the theory of lymphatic spread of breast cancer; he also favoured the idea that breast cancer at its earliest stage was a local disease, which could be effectively treated by surgery. The need to excise enlarged axillary lymph nodes was recognised by other surgeons of the 18th century, including Petit, who proposed a procedure very similar to radical mastectomy. During the 19th century, significant advances were noted, including the development of anaesthesia and antisepsis, a better understanding of the biology of cancer and the introduction of microscopic examination. Radical mastectomy was widely used in clinical practice by Halsted. However, this radical procedure was used by other surgeons of that time, including Meyer. Halsted was able to report a very low local recurrence rates (approximately 6%), a very important achievement given the advanced stages of the breast cancer when diagnosed in women at that time.