Prognosis in carcinoma of the breast

Abstract

The controversy which exists as to the relative merits of the different methods of treatment for carcinoma of the breast has led to the present investigation, the prime object of which has been to establish a more accurate classification for this disease. Previous attempts at histological grading in breast cancer have been reviewed. Grading has been studied in a series of 470 cases of mammary carcinoma. It has been accomplished without technical difficulty, and a close parallel was found between the histological picture and the period of survival. The results of grading have been compared with those of clinical staging. Both methods, when employed separately, give comparable results. The grade of the tumour taken together with the state of the axillary lymph nodes gives a more accurate indication of outcome than either grading or staging alone. For example, 94 per cent of Grade I cases without glandular involvement were alive at five years compared with 16 per cent of Grade III with this complication. A clinico-pathological system for determining prognosis by linking stage and grade has been presented. This procedure casts light on some of the hitherto unexplained clinical problems of breast cancer. It offers an explanation for disasters in early cases, and also for remarkably good results obtained in advanced stages. In indicates that all is not necessarily lost if a patient presents with a Stage 2 or even a Stage 3 growth, provided it is of low grade histological malignancy. The five-year results achieved by surgical treatment both alone and in association with radiotherapy have been presented. Inferior results were obtained for the combined attack. It has been shown that in a given clinical stage or histological grade the cases treated by surgery alone are not strictly comparable to those subjected to surgery and radiotherapy. The latter were found to have additional unfavourable features. This fact has been invoked to explain the disappointing results of ancillary radiotherapy, case selection probably accounting for the superior results of surgical treatment alone. A classification of breast cancer based upon either a system of grading or staging separately brings about a grouping of cases which are not strictly similar in type. The comparison of such atypical groups may well be responsible for the wide variation in results obtained by different workers for identical methods of treatment. In addition this has probably also played a major part in bringing about the present-day confusion as to the relative merits of the various measures advanced for the control of the disease. Attention has been drawn to the possible prognostic and therapeutic importance of lymphatic spread to other glands than those in the axilla. Possible fallacies in grading and staging have been discussed. Brief reference has been made to the effects of treatment on prognosis. The good results of conservative surgical procedures have been noted. © 1950, The British Empire Cancer Campaign for Research. All rights reserved.