(IN)CURABILITY OF BREAST-CANCER - A 30-YEAR REPORT OF A SERIES OF 3933 CASES

The aim was to compare mortality in a consecutive series of women with breast cancer to that of an age-matched cohort of the Scottish popula tion. An analysis of outcome has been performed in a retrospective ser ies of 3933 women with breast cancer diagnosed between 1954 and 1964 a nd followed for between 30 and 40 years (median 32 years). The ratio o f observed to expected mortality (O:E) was calculated by quinquennia f or the group as a whole and for subsets defined by clinical prognostic criteria. O:E mortality remained significantly greater than unity for at least 25 years following diagnosis and treatment, indicating a fai lure to demonstrate cure of the disease in a statistical sense, i.e. b y the elimination of the excess hazard of death in the study group. Cl inical prognostic factors, such as tumour size, palpability of axillar y nodes and their combination in clinical stages, significantly discri minate for survival for the first 10 years only. These data confirm ot her long-term follow-up studies of women with breast cancer. For pract ical purposes, the disease should be considered to be incurable. The i mplications of this concept for the development of clinical research a re discussed briefly.