G White

Breast cancer survival among women under age 50: is mammography detrimental?

Great uncertainty exists about the benefit of detecting breast cancer by mammography in women under 50 years of age. We have reviewed the survival of patients aged 49 years or less whose cancers were detected by mammography alone. 117 women under the age of 50 years were diagnosed with breast cancer between 1978 and 1991 based only on an abnormal mammogram. Ductal carcinoma in-situ (DCIS) was found in 47 (40%) of these women, whilst 70 (60%) had infiltrating ductal or infiltrating lobular carcinomas. During the same interval, 928 women in this age group presented with palpable breast cancer. DCIS was diagnosed in 82 (9%) of these women, whilst 846 (91%) had infiltrating carcinoma. Among the infiltrating cancers detected by mammography alone, 50% were stage I, whilst only 30% of the women with palpable cancers were stage I. Five-year survival for all mammographically detected cancer patients was 95%, whereas for women with palpable cancers the survival was 74% (p < 0.00005). If DCIS is not included, the corresponding survivals are 91% for mammographically detected infiltrating cancers and 72% for palpable infiltrating cancers. Only 1 woman who died among those with palpable cancer had had a mammogram before diagnosis. Our data contradict the suggestion that women under 50 are put at a survival disadvantage by undergoing mammography. We believe that investigators who have reported negative results in this age group must examine other causes for their results.

Improved control of advanced oral cancer with massive roentgen therapy.

The cancers of the mouth covered by the title of this paper comprise extensive local lesions and those which have spread from the original site to involve contiguous structures. One hundred and thirty-seven patients with such cancers were treated at Pondville Hospital between 1944 and 1951. This small number precludes any statistical subdivision as to site and we have therefore massed all cases in one main group, intra-oral carcinoma. The primary sites were the tongue, floor of the mouth, tonsillar fossa, buccal mucosa, and palate (Table I). Inoperability was usually due to the location and extent of the disease, though there were a few instances of systemic contraindications to surgery. Some of the patients more recently seen were eligible for radical surgical procedures, but roentgen therapy was elected as the treatment of choice. Most of the patients were in the advanced age group (Table II). Prior to 1946, the results following roentgen therapy of intra-oral carcinoma at Pondville Hospital were disapp...