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and all that it may entail, or owing to aversion from
what she regards as mutilation, she puts off the decision
until pain or ulceration or her fears render
concealment no longer possible. Though it is impossible
to withhold sympathy from the patient in
such a case, it is certain that she has deprived herself
of her best chance. How good this chance is, if the
cancer be adequately treated by operation in an early
stage, will appear in succeeding paragraphs."
Results of Operation.—"Under modern conditions
deaths directly attributable to the operation, if performed
by skilful surgeons and in well-equipped institutions,
have been reduced in the case of breast
operations to a fraction of one per cent. Operations
performed at a late stage of the disease involve, as
would be expected, a greater risk than those at an
early stage."
A comparison between the average duration of life
in patients whose disease has followed a "natural"
course with that of patients treated by operation
clearly shows the value of surgical treatment. We
have seen that the average in cases which have followed
a " natural " course is little more than three years.
"Recently, by means of a special investigation, it has
been possible to ascertain the results in a considerable
number of patients suffering from undoubted cancer
of the breast, confirmed by microscopical examination,
at varying intervals up to ten years after operation.
They show that, with the modern complete operation,
52 per cent. are alive and well after a three-years'
interval, 39 per cent. after five years, and 30 per cent.
after ten years. These statistics, however, relate to
patients who at the time of operation were in
various stages of the disease, some in such a condition
that, although the surgeon could be reasonably sure
that operation would afford relief and might eradicate
the disease altogether, he could have little confidence
that the disease would not recur.
When, however, the results were examined according
to the stage (early, middle or late) the disease had