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Admission to hospital for biopsy was arranged within a few days of examination either at the screening clinic
or the outpatient clinic. Great importance was attached to arranging immediate investigation in an attempt to
prevent unnecessary anxiety. Cysts were aspirated by Mr. Abel at the screening clinic as well as at outpatients.
In every case the fluid was examined microscopically in the hospital pathology laboratory. The patients were
followed up at the outpatients sessions.
CASES OF CANCER
1. Patient born 1918
Attended 1968—a small tender lump was found at edge of breast tissue, laterally on right side. It was
difficult to find and on re-examination it was not confirmed and the patient was reappointed for the
following year's screening. In 1969 the lump was found again. It had not increased in size. The patient was
admitted for biopsy and carcinoma was diagnosed. She refused mastectomy and at her request was referred
to another hospital for radiotherapy.
2. Patient born 1924
Attended first in 1969—at the screening clinic a non-discrete mass was palpated in the upper outer quadrant
of the left breast. She was re-examined at the outpatient clinic after a month, when there was still no
discrete lump and she was discharged until the following year. In 1970 the lump was still present and she was
admitted for biopsy. An invasive scirrhous duct carcinoma was found and left radical mastectomy was
carried out.
3. Patient born 1919
Attended in 1968, 1969 and 1970 and no abnormality was discovered. She was referred back to Mr. Abel,
however, by the general practitioner in February, 1971. A radical mastectomy was carried out at that time for
breast carcinoma with gland involvement.
4. Patient born 1921
Attended in 1968 and 1969 and no abnormality was found. In 1970 a discrete mobile lump was found in
the lower inner quadrant of the left breast. She was admitted for biopsy and an infiltrating scirrhous
lobular and duct carcinoma was found. She was advised radical mastectomy but refused.
5. Patient born 1921
Attended in 1968 and a lump was found which was not confirmed at the follow-up clinic. No lumps
were found in 1969 or 1970. In 1971, however, a lump, which proved on biopsy to be an invasive scirrhous
carcinoma, was discovered. She had a left radical mastectomy. The lymph nodes were free from carcinoma.
6. Patient born 1928
Attended 1968, 1969, 1970 and 1971. Chronic mastitis was noted but she was not referred for further
investigation. In 1972 a hard lump was found on the right outer edge of the right breast. She was admitted
immediately for biopsy. A scirrhous carcinoma was found and radical mastectomy was carried out.
7. Patient born 1921
Attended 1968, 1969, 1970 and 1971 when no abnormality was found. In 1972 a lump was found almost
under the nipple in the upper outer quadrant of the left breast. Biopsy revealed extensive intra-duct carcinoma
and left radical mastectomy was done.
An eighth patient who does not appear in the figures is known to have had carcinoma. She attended the screening
clinic in 1968 when no abnormality was found. In 1969 a diffuse lump was found in the inner upper quadrant of
the right breast. It was slightly tender. It was not thought to be significant and she was asked to come back to
the screening clinic the following year. However, she sent a letter then to say she had had her breast removed in
March 1970 atanother hospital. A report was obtained and she had had a fairly well differentiated-adenocarcinoma,
for which she was treated by simple mastectomy and radiotherapy.
Conclusion
We are well aware that examination of the breasts by palpation only is not adequate, that cases will be missed,
and that it is still presumption that earlier detection means more cures. We would rather use better methods such
as mammography or thermography, but until we have the resources for these we feel convinced that it is worth
using palpation backed up by education in self examination. We have found that by the expenditure of a little
effort and almost no money, several very small cancers have been found and it should be appreciated that this is
not a statistical random sample but a group of women who had already selected themselves for the cervical
smear test. 1,000 women is a small number but we all agree it is enough for one team as we have described. Had
we to do these sessions more than four or five times a year they would be exhausting and efficiency could fall
off from monotony and fatigue. The technique of palpation definitely needs practice and skill increases with
experience.
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