Cancer of the breast in philadelphia hospitals 1951‐1964

9003 patients were enrolled in a registry for cancer of the breast maintained by the Philadelphia County Medical Society from 1951 through 1964. This is an analysis of a 10 percent random sample of cases. Information on survival status was obtained for more than 95 percent and the registry encompassed about 85 percent to 90 percent of all mammary cancer cases in Philadelphia during the study periods. The yearly average was 800 of whom 600 were area residents. 90 percent of the tumors were diagnosed by the patient herself. A mass in the breast was the presenting symptom in almost all cases. Approximately 25 percent were 2 cm or less in diameter; 40 percent were localized at the time of diagnosis; 6 percent were dissemenated. Approximately 3 or 4 were treated by radical mastectomy involving removal of axillary contents and pectoralis muscles with the breast with or without postoperative radiation. Analysis of the 10 percent random sample indicates that the series resembles other large registers in average age symptomatology frequency of delay and 5-year survival. Groups showing a relatively high proportion of delay were older patients non-Caucasians men pregnant women and patients with simultaneous bilateral carcinoma. Delay was considered to have occurred if 1 month or more elapsed between the first sign or symptom and diagnosis or treatment. About 40% came to diagnosis and treatment without reported delay. Most of the delay was due to delay by patients but in a fifth of cases physician delay was noted. As the extent of delay increased 5-year survival decreased from 64% of those diagnosed promptly to 41% for those with 1 year or more of delay. In almost a fifth of cases disseminated at the time of diagnosis no apparent delay had occurred. The professional-technical group reported symptoms earlier. The overall relative 5-year survival was 63%. For stage 1 it was 83% for stage 2 it was 52% and for stage 3 it was 8%. Among patients whose stage of disease was not determined the 5-year survival rate was 50%. Size of tumor was not related to survival in stage 1 but large tumors in stage 2 had a poorer prognosis. Survival was less for women under age 35. The main determinant of survival was stage at diagnosis. However several histologic subtypes particularly the colloid intraductal and lobular carcinoma showed an advantage in 5-year-survival. Unspecified types were 88%. 473 patients were pregnant or within a 6-month postpartum period. Negro patients constituted 35.6% of these. There had been a disproportionate number of delayed diagnosed cases among them. Those in stage 1 had a similar 5-year survival rate as the whole registry but those in state 2 had a very poor survival rate 22% reaching 5 years. Enrolled were 85 patients (about 1%) with simultaneous bilateral mammary carcinomas. Their mean age was 59.5 years and their survival was poorer than the group as a whole. However half of these subjected to radical mastectomy survived 5 years. 72 men had mammary cancers. Their mean age was 64 compared with 56.1 for women. Delay in diagnosis was appreciably greater although the proportion of localized tumors was higher. Relative survival rates were similar. Major advances will depend on greater understanding of etiological factors and an ability to diagnose patients earlier. X-ray mammography xerography and thermography may lead to important advances.