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19
be fixed with any degree of accuracy; (2) amongst cases
of cancer, even in women of the same age and of the
same habit of body, some run an acute, others a
chronic, course; and (3) the age at which the patient
becomes affected appears to exert an important influence
upon the natural course of the disease; cancer takes
on the whole, a more rapid course in the young person
than in the old. It should also be added that if cancer
of the breast supervenes during pregnancy or lactation,
the course of the disease may be abnormally rapid.
While subject to these variations, the average natural
duration of a case of cancer of the breast appears
to be a little over three years."
That there is a close relationship between chronic
inflammatory conditions of the breast and the onset
of malignant disease is emphasised, and " there is no
doubt that microscopical examination frequently shows
a concomitant condition of cancer and chronic inflammation,
or that breasts which are the seat of such chronic
inflammation may pass into cancer by imperceptible
stages."
Turning next to treatment of cancer of the breast,
the memorandum states, Whatever may be the result
of future investigations and whatever may be the
case with cancer in other regions, it is beyond question
that, at the present time, early surgical operation
affords the one chance for a patient suffering from
cancer of the breast. Cases of cancer treated only with
internal medicines, or external applications, or by
dietetic methods are not being effectually treated.
This does not mean that such agents as radium and
X-rays cannot be usefully employed as aids to surgery,
or in cases in which surgical operation is impossible.
We now come to the most important point of all, viz.,
the measure of the success of surgical treatment. We
have seen that the average duration of life in patients
whose disease has followed a 'natural' course is
little more than three years. This average figure has
been obtained by noting the duration of life in a large
number of women whose history is known from the
time of coming under skilled observation until death.
No precisely comparable figure for patients who have