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53
any other organ. It occurs at any period of adult
life, and with increasing frequency as age advances.
The deaths over the age of 45 years are a very serious
factor in the total mortality.
The right and left breasts are affected approximately
with equal frequency, but certain portions of
each breast are more liable to be attacked; thus the
upper and outer quarter is the most common situation
and the central part around the nipple comes next.
Since, however, cancer may affect any portion of the
breast the essential consideration is that whenever a
lump in the breast of a woman of any age is in question
the possibility of its being malignant should not be
lost sight of.
Natural Course.—The growth consists of a hard
lump which in the early stages is usually unattended
by pain. It grows and causes contraction of the
surrounding tissues, retraction of the nipple and
alteration of its position. The glands in the armpit
become enlarged, usually within a few months from
the time of the local mass being recognised. The mass
extends to the surrounding tissues and secondary
growths or metastases appear in the chest, liver and
other organs, and in the bones in some cases. This
extension occurs by way of the lymphatics or the blood
stream. The average natural duration of cancer of
the breast appears to be a little over three years;
some cases, however, run an acute, others a chronic
course. Cancer probably takes on the whole a more
rapid course in the young than in the old and during
pregnancy or lactation the course may be abnormally
rapid.
Antecedent Conditions.—It is often remarked that
cancer attacks a diseased rather than a normal organ,
and the memorandum refers to the local conditions
which frequently precede cancer of the breast, such as
chronic inflammation, acute transient inflammation,
and deformity or abnormality of the breast. A history
of injury to the breast is a frequent antecedent of