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mortality. The disease occurs with approximately
equal frequency in either of the breasts, but sometimes,
if the case runs a slow course, the other organ becomes
affected towards the end of the disease. The various
portions of the breast show differences in their liability
to attack, for there is reason to believe that the upper
and outer quarter is the commonest situation in which
cancer appears, while the nipple is the rarest. The
other portions occupy intermediate positions in this
respect, without noteworthy differences between them.
The matter is important because the severity of the
disease bears a relation to the portion of the breast
affected.
The growth itself consists in a localised hard mass
or swelling which may, for a time, pass unrecognised
owing to the fact that in its early stages, cancer is
usually unattended by pain. This mass grows, leads to
contraction of the tissues in its neighbourhood with
coincident retraction of the nipple, and alteration of its
position. The subsequent course of cases varies within
wide limits. Usually but little time elapses between
the recognition of the local mass and the discovery of
enlarged glands in the armpit. After a longer or shorter
period the skin over the mass in the breast may give
way and an ulcer result. At the same time, extension
from the primary mass may have taken place in other
directions, by way of the lymphatics or of the blood
stream, so that secondary nodules are formed in the
chest, the liver and other internal organs, the skin and,
in some cases, certain of the bones. These bring in
their train other symptoms, amongst which pain is
important, and ultimately the patient dies, death
frequently being determined by some intercurrent
disease, which, in the lowered condition of her vitality,
she is no longer able to resist. There is no evidence
that child bearing or suckling is a predisposing cause
of cancer of the breast. Statistics show that after the
change of life cancer of the breast causes relatively a
larger number of deaths among the unmarried than
among married women. For many reasons the natural
duration of cancer of the breast is difficult to state
with precision. Thus (1) the onset frequently cannot