Joseph H. Farrow

Clinical and pathologic correlation with mammographic findings in lobular carcinoma in situ

The authors review the records of 61 patients who had clinical mammographic examination and histologic lobular carcinoma in situ in at least one breast. An analysis was done to determine the tissue counterpart of positive mammographic findings as well as the accuracy and usefulness of mammography as an adjunct in the diagnosis of in situ lobular carcinoma.

Intrapleural chemotherapy for effusion from metastatic breast carcinoma

Efficacy of thoracentesis with the instillation of nitrogen mustard or thio‐TEPA for malignant pleural effusions due to metastatic mammary carcinoma is investigated. One hundred and thirty‐eight patients were evaluated, of whom 93 were treated by aspiration or intercostal tube drainage of the effusion followed by instillation of a cytotoxic agent. The remaining 45 patients received similar intrapleural chemotherapy and subsequent systemic cytotoxic agents several months later. Thirty‐eight (27.5%) of the total patients in this study demonstrated an objective response with an average duration of 8.8 months. Subjective improvement was observed in 73 (53%). Rate and duration of response to instillation of nitrogen mustard and thio‐TEPA were similar. The use of a recently devised weighted intercostal tube with the same alkylating agents significantly improved the results.

Simple excision or biopsy plus radiation therapy as the primary treatment for potentially curable cancer of the breast

This retrospective study compares in detail the pretreatment clinical findings and therapeutic results following initial treatment of 77 patients by various types of biopsy and major radiation therapy with those in a similar number having only radical surgery and a second group treated by radical mastectomy and postoperative irradiation. Of the 77 having biopsies, 27 had an aspiration, 33 incisional and 17 exeisional biopsy or what may be considered a simple excision. The amount of primary irradiation delivered to these patients varied considerably but the best results were obtained following a total dosage of 6,000 rads or more. While none of these methods of treating primary operable and infiltrating carcinoma of the breast cured all the patients, there were significant differences in therapeutic results. Those subjected to a radical mastectomy with or without postoperative irradiation had a longer clinically free interval, a lower incidence of local recurrence, and a higher total survival rate than the patients treated by various biopsies and primary irradiation. The physical intolerance to a radical breast operation has greatly decreased, but there is now an increased emphasis on limited surgery by a few doctors so as to preserve feminine appearance. While this is desirable, there remains an essential need for more accurate and reliable means to select patients for such treatment in order to obtain therapeutic results equally good as those which follow radical mastectomy.

Malignant pericardial effusion secondary to metastatic breast carcinoma: A case of long-term remission

This is a case report concerning a spontaneous 5‐year remission of malignant pericardial effusion secondary to metastatic breast carcinoma. The patient received no specific therapy for the pericardial effusion other than one pericardiocentesis. The authors are unable to explain the failure of recurrence of the pericardial effusion especially in the presence of progressive metastatic breast carcinoma in other areas. A review of the literature has not revealed any case of malignant pericardial effusion secondary to metastatic breast carcinoma surviving 5 years.

Systemic chemotherapy for advanced breast cancer.

During a 20‐year period, 377 women with primary advanced or metastatic breast cancer were treated systemically by various chemotherapeutic agents and were considered suitable for a detailed analysis of therapeutic results. Fifty‐five (15%) of these patients experienced objective remission of palpable or demonstrable disease for 2 months and 10% for 6 months, but 19.6% died within one month after the initiation of treatment. It should be noted that 271 of the total patients in this study had been previously treated by additive or ablative hormone therapy and, at the time chemotherapy was given, a majority had multiple metastases and, in some instances, involvement of vital organs. Regardless of the type of chemotherapy, as well as the initial maintenance or total dosage, the poorest therapeutic results were obtained when the metastases were located in the bones, brain, or lungs with lymphangiectatic involvement and the liver with jaundice or abdominal ascites. The best results were observed when the cancer was located in nonvital soft tissues as well as nodular pulmonary metastases and the liver without associated functional complications. While there are controversial opinions regarding the need for toxic side effects in order to produce objective remissions, in our observations, dosages just below the level of toxicity in most instances produced almost equal therapeutic results. If there were failures to subtoxic doses, better results were obtained by using a different cytotoxic agent rather than increasing the amount of the initial drug. In this review, very few patients received simultaneously multiple anticancer drugs, and whether or not this would produce better results than successive use of single cytotoxic agents remains to be evaluated. The determination of which chemotherapeutic agent is most effective regarding the anatomical site of the breast cancer cells remains an unsolved problem. In this nonrandomized study, comparative results suggested that objective responses declined in the following order: methotrexate, Leukeran, Thio‐TEPA, Velban, 5‐fluorouracil, Cytoxan, and nitrogen mustard. It should be noted that the number of patients treated by each of these compounds varied considerably, and this may in part account for the differences in response rates. When chemotherapy was combined simultaneously with other palliative measures, the results in the chemotherapy group were improved but infrequently exceeded the response rates of those following the use of additive or ablative hormone therapy alone. While chemotherapy has contributed to the symptomatic and objective palliation of many patients with advanced breast cancers, our observations suggest that with few exceptions it should be used to supplement rather than to replace other measures. The exceptions apply to those patients who would be unable to tolerate other palliative procedures because of physical conditions from anatomical sites of metastases, advanced age, or unrelated complications.

Antiquity of breast cancer

Records of breast cancer date back as far as several thousand years B.C. with the Egyptians. More records have been found around 500 B.C. with the Greeks and Romans. The 1st noteworthy contribution to cancer diagnosis did not come however until the 17th and 18th centuries when van Leeuwenhoek developed the microscope. The 19th century brought about anesthesia X-ray and the development of the radical mastectomy procedure. During the 1st 1/2 of the present century great progress was made in radiation therapy. Detection of operable breast cancer has been enhanced. A cure for breast cancer has yet to be found.