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1967 1968
No. of sessions during the year 105 152
No. of new patients 344 962
Total visits made by new and old patients 1,582 2,636
No. of new City patients included above 23 16
No. of cervical smears taken 162 451
Cytology Clinic — Mammography Survey
The following report has been submitted by R.A. Kemp Harper Esq., M.D., M.B., Ch.B.,
D.R., F.R.C.P., F.F.R., F.R.F.P.S.:-
"As a result of the generosity of the Council of the City of London a radiographic survey
of the breasts of all women attending the above Clinic was commenced in August, 1964. As,
however, the Clinic is held on one afternoon only, it was found that the special X-ray tube necessary
for this type of examination was over heating as a result of so many X-ray exposures during the
course of the afternoon. The examination was therefore limited to patients aged 40 years or over
and by July, 1969, 2,000 patients had been examined, this being considered as a suitable number
on which to report on the results of the survey.
The apparatus was sited in the Women's Out-patient Department where the Cytology Clinic
is held, as a result of which all women asked to co-operate by having this additional examination
agreed to do so.
The apparatus was also used to examine women with known or suspected pathology in the
breast whenever requested to do so by a clinician and over 400 patients in this category were also
examined.
The results of these surveys are as follows:—
Cytology' Clinic Survey
Patients examined 2,000
Proved cancer found 2
One recent case as yet unproved
2 cases = .1%
3 cases would = .15%
(The latter figure is in accord with the results from the Mayo Clinic over a series of 5,000
similar cases.)
Benign tumour found 140 = 7%
Re-examination was requested in 2.3% in all of which patients no malignant tumour was found
with one exception.
On a basis of Ministry of Health statistics on costing of work done in X-Ray Departments,
the cost of finding one cancer in presumed healthy subjects was £4,500, if the third case is proved,
and £6,750 if only two have been found. Of patients with known or suspected lesions in the
breast, the statistics are as follows:—
Number of patients examined = 600
Number of malignant tumours found = 166
Number of benign tumours found = 163
% Accuracy in malignant tumours = 84.2%
% Accuracy in benign tumours = 88.6%
Overall accuracy = 86.4%
The number of malignant tumours found in the survey is fairly similar to those in the few
recorded surveys carried out elsewhere, mostly in the United States of America, and it is apparent
that the cost of and time which has to be devoted to these surveys gives an inadequate reward
for the energy expended. The time and money would be better utilised in examining at regular
intervals, those women who have already had a cancer of one breast, as the probability of a
tumour developing in the other breast is about 7 — 10%.
I am of the opinion that the survey be discontinued but that the apparatus be used for the
purpose I suggest and for the examination of women with known or suspected tumours.
Since the project was started in 1964, more sophisticated equipment giving much less radiation
dose to the patient and withmuch improvement in thequality of the radiographs has been developed.
This new equipment costing just over £5,000 would be ideal for detecting early malignancy in the
other breast of a patient who has already had a cancer of one breast. No such survey has so far
been undertaken in this country and very few elsewhere, so that this would be an extremely
valuable field of investigation in the early detection of cancer.
I am extremely grateful to the Council for the interest taken in providing the equipment for
this project and to them I wish to convey my sincere thanks and appreciation."
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