In
those patients who respond well by three months but still have large
tumors in a number of those you would end by six months being able
to operate them and do the surgery you want.
Also,
some patients are still reluctant about surgery, and part of being
a doctor is to treat patients as an individual and some patients
come not wanting surgery at all. They take the drugs, by three months
their tumor is smaller, they come around by six months they say,
"Well, it has gotten much smaller. Yes, okay. Now, you can
operate now and that’s fine." It’s part of building
a relationship with the patient so that they trust you. I think
one of the very important issues and there’s a 1% percent mortality
in most published series have been mastectomy and axillary dissection
on women over the age 70. It’s not because the surgeons kill
a patient. It’s because the surgery is pretty stressful, it’s
a longer operation and there’s potential for more complications.
So, by doing less surgery, you have less chance of the patient dying
of MI, stroke and getting complications such as hematomas. I think
there’s another issue really – the morbidity of having
a slightly bigger and longer operation.
