摘要:

Just as it is the aim of experimental cancer research to investigate conditions favouring orinimical to the origin and growth of cancer in animals, it is the task of statistical cancer research to study conditions under which the incidence of human cancer will increase or decrease. This study will naturally include the evaluation of results of treatment which, so far, has formed the bulk of cancer statistics.For all the interest of experimental cancer research, it may be doubted if complete understanding of chemical or virus carcinogenesis would place us in a much better position at the bedside of cancer patients than we are now in cases of heart failure, with all our knowledge of respiratory enzymes, etc. But whereas experimental cancer research aims at therapy, cancer statistics are directed towards prevention, and already show results in this field with regard to some forms of occupational cancer.However, it is true that statistics cannot provide proofs. They can find out if correlations exist, and in this way point to some possibilities and exclude others. But proofs with a bearing on pathological subjects must be provided by pathological means. For instance, it was by means of statistical examinations that the connection between syphilis and general paralysis was first suggested, but the proof of this suggestion had to be provided by bacteriological and immunological methods.

DOI:10.1259/0007-1285-21-252-583

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

A Brief Paper on “precancerous conditions” of the breast, introductory to a discussion of the surgical and radiotherapeutic aspects of mammary cancer, can touch only on a few points of a subject which is one of the most debatable in the whole of pathology. It is difficult, therefore, to avoid statements which may appear unqualified and dogmatic. In the following remarks, I limit the meaning of cancer to carcinoma.The term “precancer” needs definition. Cancer may be described as the end-stage of a long proliferative process which eventually produces a malignant tissue. Precancer, in the strict sense of a cause-effect relationship, implies the stages before actual malignancy emerges,i.e., a condition or conditions which will go on to cancer, even when the carcinogenic agent is withdrawn. We can point to no lesion in the breast, or indeed in any tissue and say, “this will inevitably become carcinoma”. In cancer, we are dealing not with one but with several unknowns—the carcinogenic agent itself, the mechanism by which it produces malignant cells, the stages through which the cells pass in this transformation, and the time factor; there is also, possibly, an ill-defined, genetic organ or tissue susceptibility. Is it, then, always a case of thetime, theplaceand theunloved oneall together? Thetimeis very important, whether considered as the age of the patient as she approaches the “cancer period” or the long time necessary for the production of actual malignant change; theplaceis an unstable tissue and one of the most frequent sites of cancer in women; and theunloved one, the carcinogenic agent itself, is still unknown.

DOI:10.1259/0007-1285-21-252-590

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

Since Broders (1921) first stressed the importance of histological de-differentiation as a factor in prognosis of carcinoma. numerous attempts have been made to correlate histological appearances with the subsequent course of the disease. The first to attempt this to any extent in the breast was Greenough (1925). On a small preliminary series of 50 cases of radical mastectomy, Patey and I (1928) showed that there was a definite correlation between histological appearances and clinical course in carcinoma of the breast (Table I). This work was confirmed by Handley and myself (1938) on a series of 172 cases (Table II). It was found that the main criteria of value were de-differentiation and evidence of rapid growth. Many criteria that formerly had been considered of ominous significance were found not to affect the prognosis appreciably; these included such factors as cellularity of the growth and young age of the patient. It was stressed that although grading was of importance it is obvious that the stage that the disease has reached is of much greater significance as far as ultimate prognosis is concerned. This does not rule out the importance of histological grading, because the presence of metastases depends to a considerable extent on the histological type of the growth, and it is more likely that growth of high malignancy will show a higher percentage of cases with secondary deposits in glands at the time of operation (Table III).

DOI:10.1259/0007-1285-21-252-594

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

To assess the efficacy of treatment it is important to consider the incidence and mortality of the disease. In cancer of the breast the incidence has risen consistently. Between 1935 and 1945 it has increased year by year, and in the total period (ten years) 76,430 women died of this disease in England and Wales; the number of deaths in 1945 was 7291, or over 20 per cent. of the total deaths from cancer in women (38,798).This increase in mortality and in incidence suggests that a review of the present-day methods of treatment is desirable. Such a review should correlate the natural history of the disease with the results of various methods of treatment.Cancer of the breast as a cause of death is registered in increasing numbers as age advances; the peak is reached in the five-year period 55 to 60 years of age and then declines slowly. I have, therefore, chosen 55 years as the age at which to consider expectation of life in connection with cancer of the breast. In comparison with all other sites of cancer (except skin), the breast is the most favourable; that is, the least rapidly lethal site—and this should affect seriously the method of treatment.Several authorities, both in this country and in the United States, have computed the expectation of life in untreated cases, of which there is unfortunately no lack.

DOI:10.1259/0007-1285-21-252-596

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

An account has been presented of the method of treatment at present in use in Edinburgh. It must be accepted as representing but one direction in which the survival rates of breast cancer may be improved. There may be other better methods.Considerable emphasis has been placed on the importance of assessing the true value of a method of treatment so that better methods may be recognised without undue delay. The view has been expressed that the publication of results of selected cases has greatly confused the issue and has tended to convey the impression that radical mastectomy is a highly successful method of treatment of breast cancer.When radical mastectomy is the only method of treatment available, and when all cases coming to a large general hospital are taken into account, the five year survival rate is unlikely to exceed 25 per cent.A brief account of the method of treatment by simple mastectomy and radiotherapy has been presented. The five year survival rate of all cases coming to the Royal Infirmary in the period 1941–45 is 43·7 per cent.The most important feature of this method is the substitution of radiotherapy for surgery in the treatment of the axilla. The decision to do so was taken because when the axilla is not involved by malignant cells it appears unnecessary to carry out an axillary dissection, and when the axilla is involved the results of surgical dissection are poor.The fact that a five year survival rate of 29 per cent. was obtained in the advanced cases without distant metastases indicates that radiotherapy, even in such adverse circumstances, is an effective method of treating the axilla. It is therefore not surprising that this same method of treatment in operable cases should be associated with a survival rate much higher than that obtained by radical mastectomy.A high standard of radiotherapy is essential and adequate dosage must be given.It is most important to appreciate that simple mastectomy and a low standard of radiotherapy will be associated with results poorer than those obtained by radical mastectomy without any radiotherapy.

DOI:10.1259/0007-1285-21-252-599

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

I Propose to review some of our findings in the treatment of cancer of the breast, over a period of ten years, from 1937 to 1946. It should be made clear at the outset that all the results of treatment submitted in this communication are based on a personal series of cases which have been under my care at the Royal Cancer Hospital, and have been treated by my colleague, Professor Smithers, and myself after close consultation. The views expressed are my own, based on previous experience taken in conjunction with the present series of 369 cases.It was at the beginning of 1937 that we instituted a system at the hospital whereby all new cases of cancer were seen in consultation by a radiotherapist and a surgeon, and a full discussion took place as to the plan of treatment to be employed.This teamwork has proved invaluable to me as a surgeon. It has stimulated keen interest in a thorough examination of each patient by all concerned and has resulted in a higher standard of case recording. It has led to a free exchange of views concerning the advantages and handicaps of surgery, radiotherapy, and other forms of treatment.In classifying this group of cases we have followed the classification which is shown in Chart I. This is based on Dr. Ralston Paterson's, with minor modifications.

DOI:10.1259/0007-1285-21-252-610

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

The Radium Commission owes a great deal to its first Chairman, Lord Lee of Fareham, and was very fortunate when, in 1933, Lord Donoughmore became his successor. He brought to its highly technical atmosphere, a fine intelligence, great administrative experience, and a humanity seasoned with humour, which at once secured him the entire confidence of the members and complete reliance on his judgement.

DOI:10.1259/0007-1285-21-252-617

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

Radiographs of the chests of healthy children in the first few years of life may show a sail-like, triangular projection from the mediastinum. This has been proved to be the shadow of the thymus and is not of pathological significance.

DOI:10.1259/0007-1285-21-252-618

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

Members are reminded that annual subscriptions become due on January 1, 1949.

DOI:10.1259/0007-1285-21-252-624-b

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY

摘要:

The return of large numbers of troops from military service in tropical climates has presented investigators in temperate zones with a further problem in diagnosis, namely the recognition of chronic amœbiasis of the colon.The diagnosis of this condition intimately affects the radiologist, as bacteriological examination of the stool for vegetative forms and cysts of Entamœba Hitolytica in chronic amœbiasis is notoriously unsatisfactory. Furthermore, many such cases are primarily referred for X-ray examination for the exclusion of other lesions such as diverticulitis or carcinoma of the colon. In such cases the radiologist can perform valuable service in indicating the possibility of chronic amœbic colitis and directing attention to a detailed examination of the stool.Undoubtedly all cases of chronic amœbiasis of the colon do not show radiological changes and figures of the incidence of radiological signs vary considerably. Browneet al.(1945) in a series of 141 cases of chronic amœbiasis investigated by barium enema found that 36 per cent. showed changes which radiologically were regarded as characteristic of chronic amœbiasis.Edson and others (1945), however, found that in a smaller series of twenty cases 80 per cent. showed positive radiological signs, whilst King (Bell, 1939) found that in a series of twelve cases all showed positive signs.The most recent figures are those of Nicholson and De Dominics (1947), who found that in sixty proved cases of chronic amœbiasis 32 per cent. had positive X-ray findings.

DOI:10.1259/0007-1285-21-252-625

出版商:The British Institute of Radiology    

年代:1948

数据来源: WILEY