The complete roster
The register
Twenty-eight entries, six sections. Each one is a single thing that was established, with the people and the institution that established it named in the entry.
The disease
Section 01 →| No. | Entry | What it establishes |
|---|---|---|
| 01.1 | Ducts and lobules | The tissue is a branching system of ducts ending in lobules, and almost everything that follows depends on which part a growth started in. |
| 01.2 | Carcinoma in situ | Cells confined within the duct wall are classified separately from those that have crossed it, and that boundary is the whole basis of staging. |
| 01.3 | Invasive carcinoma | Once the basement membrane is breached the classification changes and so does everything downstream of it. |
| 01.4 | Grade and stage | Grade describes how the cells look and stage describes how far they have gone; the two are routinely confused and mean different things. |
| 01.5 | How spread was explained | The nineteenth-century account had the disease moving outward in an orderly way, and it dictated surgical practice for eighty years. |
Receptors and genes
Section 02 →| No. | Entry | What it establishes |
|---|---|---|
| 02.1 | The oestrogen receptor | Elwood Jensen identified the receptor that made hormonal treatment possible and made the disease something that could be sorted into kinds. |
| 02.2 | HER2 | A marker of worse outcomes became a target, which is a rare direction of travel in medicine. |
| 02.3 | BRCA1 on chromosome 17 | Mary-Claire King located the gene by linkage in 1990, when a great many people in the field doubted a single gene would be found at all. |
| 02.4 | Molecular subtypes | Expression profiling divided one diagnosis into several with different behaviour, which changed what the word meant. |
Detection
Section 03 →| No. | Entry | What it establishes |
|---|---|---|
| 03.1 | Mammographic technique | Robert Egan standardised exposure and positioning in the late 1950s, which is what turned an unreliable picture into a usable one. |
| 03.2 | Film to digital | Replacing film with a detector changed the dose, the storage and what could be done to the image afterwards. |
| 03.3 | Ultrasound and MRI | One reads echoes and the other listens to atoms in a magnetic field; neither casts a shadow, which is why they see different things. |
| 03.4 | The pathology slide | The final answer is a piece of tissue on glass, stained, and looked at by a person. |
| 03.5 | The screening argument | Whether population screening does more good than harm is genuinely contested, and the disagreement is about overdiagnosis rather than about whether the machine works. |
Surgery
Section 04 →| No. | Entry | What it establishes |
|---|---|---|
| 04.1 | The radical mastectomy | William Halsted formalised the operation in the 1890s and it remained standard for roughly eighty years. |
| 04.2 | Halsted's theory of spread | The operation followed from a theory about how the disease travelled, and when the theory turned out to be wrong the operation went with it. |
| 04.3 | Conserving surgery | Removing less tissue was resisted for a long time and then shown to give the same result, which took trials rather than argument. |
| 04.4 | The axilla | How much of the armpit to remove was its own long argument, with real consequences for the arm afterwards. |
The trials
Section 05 →| No. | Entry | What it establishes |
|---|---|---|
| 05.1 | NSABP B-04 | The trial that tested whether the radical operation actually helped, by comparing it with less. |
| 05.2 | NSABP B-06 | The trial that established breast-conserving surgery with radiotherapy as an equivalent option. |
| 05.3 | Milan I | The Italian trial that reached the same conclusion by a different route, which is why the conclusion stuck. |
| 05.4 | Randomisation as evidence | Allocating treatment by chance is what makes two groups comparable, and it is the reason a trial can overturn a century of conviction. |
| 05.5 | The Oxford overviews | Pooling every trial's individual data periodically produced answers no single trial was big enough to give. |
Treatment
Section 06 →| No. | Entry | What it establishes |
|---|---|---|
| 06.1 | Radiotherapy | Directed radiation after surgery reduces local recurrence, and the planning of it is a geometry problem. |
| 06.2 | Cytotoxic chemotherapy | Combination regimens came out of trial programmes rather than from any single laboratory insight. |
| 06.3 | Tamoxifen | A compound developed for something else entirely became the long-running hormonal treatment, and the receptor work is what explained why it worked. |
| 06.4 | Aromatase inhibitors | Blocking the enzyme rather than the receptor is a different mechanism with different consequences. |
| 06.5 | Trastuzumab | An antibody aimed at a specific receptor, and the first widely used treatment chosen by a test rather than by the diagnosis alone. |