fits of extensive preoperative scanning and radiologie tests in patients with bone pain. But they are also aware that these tests, as measured by today's limita¬ tions of method, are not contributory, timely, economical, or even reasonably indicated in all patients with probable breast malignancy. Too, they are aware that a separate biopsy specimen taken days or weeks prior to definitive surgery may erroneously sample the breast, may produce errors in clinical staging, may cause multiple periods of patient anxiety, and may allow occasional serious therapy delay through patient misunderstanding, her seeking of multiple professional or nonprofessional opinions, or her simple flight from a threatening situation. It must not be forgotten that while detection of malig¬ nancy is the role of the clinician, the diagnosis of malig¬ nancy is still based on the pathologist's interpretation of the submitted sample. Similarly, it must not be forgotten that benignancy of one sample is never a substitute for proper therapy of a suspicious mass. Excision, where benignancy is likely, is the preferred method of biopsy, as it provides adequate tissue for study, avoids sampling error, allows uncontaminated surgical restoration of breast continuity, and prevents the problem of persisting abnor¬ mality postbiopsy. Needle or drill biopsy at the operating table is an acceptable alternate if malignancy is likely, provided that excisional biopsy is done immediately where malignancy is not found. The diagnostic process of breast biopsy in the operating room followed by immediate appropriate therapy still remains the standard against which all other management plans must be measured. Moreover, when the pathologist is a real person rather than a written report, when he shares with the other operating room members not only a rapid report, but a valued perspective, a bit of knowledge, advice, or a friendly word, then all involved will again recognize that the teamwork of medicine is still human and concerned and functioning for the benefit of the individual

screening

A Perspective popular plans We variety management therapy patients

confronted in the medical and press by of to establish a diagnosis and then to initiate for with breast masses suggestive of malignancy. Some of these plans are rational and appropriate to certain types of surgical practices. Some suggestions are meant simply to be useful reports of small aspects of the overall care of patients who may have a frightening and dangerous disease. Each may tend to confuse the busy surgical practitioner. It is reassuring to remember that surgery already has a method of one-stage tissue diagnosis-operative therapy that has been perfected by surgeons and pathologists over the course of many years. Fresh-frozen or rapid hisopathologic diagnosis from needle or excisional biopsy material submitted from the operating room has clearly been successful, feasible, and desirable, if not nearly ideal. Surgeons who are at ease in the use of this method also understand the individuality of each patient with possible breast malignancy. Their surgical consultation is an empathie explanation of the proposed management of the whole patient, the need for diagnosis without imprudent delay, the risks of the disease and the surgery, and the anticipated result. Utilizing and understanding today's sensitive detection measures, most of these surgeons can predict with considerable accuracy the eventual diagnosis of most detected breast masses, even though these masses may be impalpable. This prediction skill, together with an understanding of the overall health status of the patient, facilitates the planning for surgery at the earliest possible time. Most surgeons who utilize the one-stage surgical biopsytherapy plan are realistic. They know the potential beneare

a

The Archives in

JOHN S.

WELCH, MD Rochester, Minn

of Surgery

the winter of 1975, the American Medical Association, an understandable mood of tightening its financial three management firms to examine the of its operation publications. Among the recommendations emerging from their reports was a suggestion that the AMA might examine employing an outside publisher to handle the specialty journals under AMA supervision. Several publishing firms made offers. The offers were carefully studied. The Board of Trustees and the House of Delegates have now judged that that part of the Ama's educational mission which the journals represent will be better served by maintaining the present method of distributing them.

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patient.

Since

have been abroad that the state of the was unsettled, that of some\p=m-\the Archives of Surgery particularly\p=m-\moreso than others, we are happy to report to our readers that for the foreseeable future there will be no change. No change, that is, in the manner in which they may arrange to receive the journal, whether by benefit of AMA dues or by subscrip¬ tion. The Editors are, of course, continually reappraising the content and format, with a view to maintaining an upward curve of improvement. RICHARD WARREN, MD Chief Editor rumors

specialty journals

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