Reprints on Axillary Masses in Breast Cancer: A Review

In 1986, John Swales, the Editor of English for Specific Purposes, researched on the worldwide traffic in the reprint request (RR) and wrote about me as “the only active researcher that I have traced in the RR area” [1]. Perhaps, a sequel to this honor is to use the dozen reprints which I collected during the 1980-1989 period to expatiate on the intriguing phenomenon of how the axillary lymph nodes have been featuring so much in breast cancer cases [2-13].


Introduction
In 1986, John Swales, the Editor of English for Specific Purposes, researched on the worldwide traffic in the reprint request (RR) and wrote about me as "the only active researcher that I have traced in the RR area" [1]. Perhaps, a sequel to this honor is to use the dozen reprints which I collected during the 1980-1989 period to expatiate on the intriguing phenomenon of how the axillary lymph nodes have been featuring so much in breast cancer cases [2][3][4][5][6][7][8][9][10][11][12][13].

Method
These reprints have been analyzed from several angles. A starting point is the array of the cited Journals, namely, Cancer [2,3,12], Journal of Surgical Oncology [4,11]. Annals of Surgery [5,8], American Journal of Surgical Pathology [6], Histopathology [7], Breast Cancer Research and Treatment [9]. The American Surgeon [10], Surgery [12], and Human Pathology [13]. Another point is the country of origin. Certainly, USA super abounded. Incidentally, I had previously demonstrated the premier position of USA in the reprint's traffic [14]. Next, Canada, Norway, Italy and Israel also featured.

Results
A case report came from Canada while 2 cases were presented from USA [10]. The rest totaled 2,542 cases. With regard to the single case report, there was eventually no evidence of a primary lesion in the breast called "occult" breast cancer, this was defined as "nonpalpable breast carcinoma presenting as an axillary mass" [10]. Following the study of 48 such patients carried out in New York for at least 5 years, it was concluded thus: "the actual pathologic stage, which takes tumor size into consideration, determines prognosis rather than the apparent clinical stage described when the patient is first examined" [13]. This was confirmed years later [6].
"Skip" metastasis was also considered [5,8]. It was defined as "involvement of lymph nodes (which) occurs in a stepwise continuous fashion from the periphery of the axilla medially." However, it was concluded that the risk is not great and "should not be a major consideration in therapeutic decisions" [8].
The sinuses of the axillary lymph nodes were also studied in Norway [7]. Apparently, they depended on Halsted's observation in 1898, and were purely mechanical. Likewise, fatty changes came into view, but it was concluded that "the presence of fat in axillary lymph nodes does not influence implantation of tumor cells from a primary carcinoma of the breast and has to be reported as an anatomic variant" [11]. Another question arose. An Italian group tackled it. They concluded thus: "When the nodes at the first level are positive, the chances that metastases are also present at the higher levels are of the order of 40.0%" [12]. Another Italian group took up xeroradiography [9]. They lamented thus: "Xeroradiography does not appear to have improved our ability to identify axillary lymph node metastases in patients with breast cancer". Light elecronmicroscopic examination was carried out in USA. The conclusion ran thus: "The finding of carcinoma that appears histologically to be entirely preinvasive, whether duct or lobular in type, in a breast biopsy specimen does not entirely preclude the possibility of metastases in axillary lymph nodes." What of sampling procedures? The question boiled down to "an axillary sampling instead of a complete axillary dissection". The answer was as follows: "the possibility exists that node "sampling" understages patients who would otherwise have received adjuvant chemotherapy to improve their chances for cure." Perhaps, the answer is that of Patel's group, namely, "carcinoma found in an axillary node should be treated as a breast cancer, even in the absence of the breast tumor."

Discussion
The above data have dealt with Reprints in the field of reproductive medicine. In fact, these reprints are the old champions in the Communication Sciences. What of the reigning Internet? In this context, what of combining the old and the new? I did so with the 2004 work published on the doleful disease of gestosis. It was Chappell who lamented that gestosis contributed "to at least 40 000 to 60 000 of these deaths worldwide each year" [14]. Fortunately, I had received 3 reprints concerning gestosis during the 1980/1981 period [15][16][17][18]. Using them, I hypothesized that, since gestosis was appreciated thrice as being linked with "new father," "new partner," and "different consort," the "women at risk ought to be so educated as to be aware of the known repercussions associated with change in paternity". As I concluded, "in all probability, the gloom of gestosis can give way smoothly to that bloom of placid parturition which must naturally follow the above enumerated enlightened sexual behavior." In particular, the Allied Health Professionals should be involved because this is not a question of prestige but of cooperation [20]. If they do so with the obstetricians, the 40 000 to 60 000 deaths worldwide would become history.