When Bernard Fisher of National Surgical Adjuvant Breast and Bowel Project and George Crile Jr of the Cleveland Clinic initiated the conversation about breast cancer patients opting for breast preservation over radical surgery and achieving the same outcomes as those who opted for mastectomy, it was a game-changing concept. They were considered pariahs by their surgical peers, the dominating Halstedian surgeons. But when Fisher and his colleagues published fndings1 that showed equal efficacy for lumpectomy and mastectomy, the world took notice. Surgeons and patients were quick embrace the evidence, and that dramatic change in the approach to treatment continued until 2004, when we started seeing a steady increase in the mastectomy rate, and especially prophylactic mastectomy.
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