INTERDISCIPLINARYBREAST CENTERS 1055-3207/00 $15.00 + .OO A NEW ERA IN THE DIAGNOSIS OF BREAST CANCER LBsz10 Tabar, MD, Peter B. Dean, MD, Cary S. Kaufman, MD, Stephen W. Duffy, MSc, and Hsiu-Hsi Chen, PhD Physicians traditionally have fought a losing battle against breast can- cer, because the disease often was far advanced by the time of treatment. Most breast cancers treated during the twentieth century were detected by palpation, and often the tumors had been palpable long before they were brought to medical attention. The outcome of these advanced cancers was equally poor, regardless of the method of therapy chosen. As recently as the National Surgical Adjuvant Breast and Bowel Project (NSABP) B-06 clinical trial, the choice of therapy (mastectomyversus lumpectomy versus lumpectomy and postoperative irradiation) given to women with palpable breast cancer had essentially no influence on their long-term sur- vival. The outcome was generally unfavorable, because 40%of the women died from breast cancer during 12 years of follow-up (Fig. Advanced stage disease is often fatal, because it has progressed to a systemic disease with viable metastases at the time of diagnosis and treat- ment. Because the incidence of advanced breast cancers in a population is directly correlated with the rate of breast cancer death, advanced stage disease is the primary impediment to better breast cancer contr01.~~,~~,6~ Thus the search for new ways to combat the disease has concentrated around the following two approaches: (1)to develop combinationsof ther- apeutic regimens effective at all stages of the disease, particularly ad- From the Department of Radiology, University of Uppsala Faculty of Medicine; and the Department of Mammography, Falun Central Hospital, Falun, Sweden (LT); the De- partment of Diagnostic Radiology, University of Turku Faculty of Medicine; and the Medical Imaging Center, Turku University Central Hospital, Turku, Finland (PBD); the Department of Surgery, University of Washington; and the Bellingham Breast Center, Bellingham, Washington (CSK); the Medical Research Council Biostatistics Unit, Insti- tute of Public Health, Cambridge, United Kingdom (SWD); and the Department of Epi- demiology, Taiwan University College of Public Health, Taipei, Taiwan (HHC) SURGICAL ONCOLOGY CLINICS OF NORTH AMERICA VOLUME 9 NUMBER 2. APRIL 2000 233