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54
malignant disease. There is no evidence that disturbances
of the menstrual period or menopause have
any influence as predisposing causes.
Diagnosis.—"It is most important to the success
of treatment that the diagnosis should be made at
the earliest possible stage. In view of what has
already been said in regard to conditions precursory
to cancer several of which also give rise to a mass in
the organ, it will be obvious that, on first recognition
of a lump in the breast, the difficulty frequently becomes
one of distinguishing between an early cancer
and a non-malignant condition. It is at this early
stage of the disease, before invasion of the axillary
glands (i.e., the glands in the armpits) has taken place,
that diagnosis is of such great importance and may
be attended with such difficulty."
Treatment.—"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 any 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.
"The patient views the entire operation (including
the anaesthetic) with repugnance, and as a proceeding
which, even if completely successful in a surgical sense,
is an evil of no little magnitude. These obstacles
naturally do not carry equal weight in all cases, but
in some degree they influence patients and must be
given their due weight. Sometimes patients assert
that they have not noticed a mass in the breast until
it is so extensive that no surgical measures are possible.
When this is so, no more can be said; but often the
patient has recognised the condition some time previously,
but from reluctance to submit to operation,