Epilogue: The Diseased Breast Lobe in the Context of X-Chromosome Inactivation and Differentiation Waves

摘要: The debate over whether cancer starts in a single cell (Hahn and Weinberg 2002) or is multifocal disease (the latter variously referred to as the multicellular model [Attolini Michor 2009] field theory [Soto et al. 2008]) has long history. This book, Breast Cancer: A Lobar Disease, may be stepping stone toward trying resolve this long-standing issue. My own work on breast detection been based assumption, at first sight contrary Tibor Tot’s sick lobe hypothesis, that targeting small lesion will halt cancer, epidemiological evidence would seem point way. And yet, can seen by dialogue with Tot Vincent Vinh-Hung end of my chapter (Gordon 2010), more subtle considerations let us see both ways, i.e., they are not mutually exclusive. It one could either stop recurrence for an extended time ablating tumor, remainder women’s life removing whole lobe, difficult outcomes distinguish. As total mastectomy versus lumpectomy (Lerner 2001), prove clinically equivalent terms prolongation life. At least, lobectomy less disfiguring than mastectomy, so passions need run high. Much remains ahead determine outcome debate, though we what tease out retrospective data (Vinh-Hung 2010).