The gynecologist and breast disease.

The designation of the obstetrician-gynecologist as a principal physician for women may impose new responsibilities on them, but in reality it merely reaffirms what most obstetrician-gynecologists have long regarded as standard practice. The gynecologist has always insisted that breast examination is an integral part of the evaluation of every patient and the basic knowledge of breast disease is certainly as essential as any understanding of obstetric and gynecologic problems. The obstetrician-gynecologist should follow certain guidelines that will help achieve in making an early diagnosis. These include: Integrate breast examination into the routine gynecologic examination of all patients. Instruct patients in the technique of life-long, periodic breast self-examination. Develop proper ambulatory surgical facilities suitable for performing breast biopsies. Perform biopsy for all true, solid, three-dimensional masses. The final diagnosis of pathologic condition rests on a careful histologic examination of a biopsy specimen. Encourage research, both basic and clinical, and etiology, diagnosis and treatment of breast lesions including innovative screening programs for high risk patients. Include obstetric and gynecologic residency programs with specific instructions in early breast cancer detection techniques. Previously, breast cancer was viewed as a stereotype disease that progressed from the breast to the nodes to the systemic area. This has changed. Breast cancer is now viewed as a systemic disease, which spreads to local and distant sites at the same time. Breast cancer is best viewed as occultly metastatic at the time of presentation. Therefore, dissemination of tumor cells has occurred by the time of surgery in many patients, and it is not surprising that radical mastectomy and local irradiation do not prevent metastatic disease.