Carcinoma of the breast.

Abstract

The possibility that breast cancer spreads via lymphatics as well as through the blood stream at an early stage has led to investigations con cerning metastases. It is postulated that if malignant cells can gain access to the blood stream there must be a high mortality rate there to yield such frequency of cure. Of the 250 of the authors patients 75 are alive and well at 15 years and a further 5 alive with recurrence (a 32% 15-year survival rate). 1000 patients had conservative radical mastectomies in which biopsies were performed to determine whether radiotherapy was indicated. The overall internal mammary invasion rate was 22.5%. 69% of 500 patients with no nodes are alive after 10 years although 5% have had recurrences. Only 10% of those with both sets of nodes invaded are alive 5% of whom have had recurrence. 3 factors - position of the primary its size and what has happened in the axillary nodes - determine whether or not internal mammary nodes are likely to be involved. Surgeons and radiotherapists although they deal with lymphatic spread only are still useful.