Cost-effective preoperative evaluation, operative treatment, and postoperative follow-up in the breast cancer patient.

Although medical criteria based on retrospective and prospective studies form the basic foundation for the strategies enunciated in this article, efficiency in management and cost effectiveness follow because of the simplification that has been found to be appropriate by analyzing reports over the past decade and using common sense. In addition, the realization of the effectiveness of mammographic screening programs should encourage all surgeons to promote and practice yearly mammographic screening in appropriately aged women. At present, this means women between the ages of 50 and 75, but there is increasing evidence that women between the ages of 40 and 49 may benefit. A compromise would suggest women over 45 years of age as appropriate, recognizing the controversy now raging over the effectiveness of screening in women 40 to 49 years old. Wide appreciation of the major gains in breast cancer detection by use of mammographic screening programs needs to be emphasized. We have predicted that within a decade the median maximum diameter of all invasive breast cancer in the United States will be only 1 cm if mammographic screening programs are widespread. If this occurs, there would be extraordinary gains in reduced patient morbidity and cost savings and undoubtedly changes will occur in the previously unyielding age-adjusted mortality rate. The goal of entirely outpatient management in the vast majority of breast cancer patients can be achieved by such mammographic screening as well as by the adaptation of induction chemotherapy and breast conservation in the majority of advanced primary breast cancer patients that still appear.