Louis Venet

Mammography and clinical examination in mass screening for cancer of the breast

Periodic screening for cancer of the breast using mammography as well as clinical examination is being conducted by the Health Insurance Plan in a large random sample of women aged 40 to 64 years. A similar group of women has been assigned as controls. The long term objective is to determine whether the screening program results in lowering of mortality from mammary cancer. From the first screening examination among 20,211 women, the following observations can be made: 1. Screening has resulted in substantial detection of cancer; mammary cancer is detectable through screening an average of 21 months sooner than usual. 2. A higher proportion of cancers has been detected in the screened group (65%) in an early stage (as shown by the absence of axillary node involvement) than in the control group (41%). 3. Both mammography and clinical examination contribute to the early detection of cancer in mass screening. 4. Mammography and clinical examination are complimentary in detection. 5. Under different conditions of age, breast type and lesion characteristics, the two procedures have different rates of accuracy. 6. Mammography does comparatively well when the woman is older than 50, when the breasts are mostly fatty in type and when the lesion is in the lower half of the breast; clinical examinations do comparatively well when the woman is younger than 50, when the breasts are small and when the breasts are of the glandular type.

Quantitative thermography as a predictor of breast cancer

The lack of specific, consistent diagnostic criteria has lessened the value of thermography in the diagnosis of mammary cancer. In an effort to improve the diagnostic accuracy of this technique, a numerical procedure was devised based on the evaluation of four features of the breast thermogram. Each was shown to be a statistically valid indicator of malignancy. In combination, as a diagnostic score, they were even more reliable. The development of a color technique provided a simple means for quantitating three of these features. Normal patients and patients with proven breast tumors were thermographed and scored. Optimal weighting, by linear discriminant analysis, did not improve the results significantly. Three sets of weights for the four diagnostic criteria were used in the multiple logistic function in order to generate probability tables which related all possible diagnostic scores to the chance of having cancer. The observed results, in this small series, compared favorably with those predicted by the model.

Direct Observation of Massive Arterial Hemorrhage From a Diverticulum of the Hepatic Flexure

Summary A case is reported in which massive colonic bleeding was observed at laparotomy to arise from an artery at the ostium of a diverticulum of the hepatic flexure. The site of hemorrhage was localized by applying clamps segmentally on the bowel, and the bleeding was controlled.

Twelve years' experience with irradiation as the primary treatment for breast cancer.

Abstract Ninety patients received comprehensive, high-dose, supervoltage teletherapy as the primary treatment for carcinoma of the breast, following a biopsy or a segmental resection. The tumor doses delivered to the breast ranged between 5600 and 7000 rod in six to mine weeks; the draining lymph nodes received tumor doses of 5000 to 7000 rod in six to eight weeks. In five cases, Iridium-192 implants were employed to boost the radiation dose to the breast, and in seven instances a “toilette” mastectomy was performed for residual cancer. Satisfactory local control and cosmetic results were achieved in 86 patients. The patients were followed for 2 1 2 to 12 1 2 years. The local control rates were: Stage I, 100%; Stage II, 95%; Stage III, 100%; Stage IV (M-0), 89%; Stage IV (M-1), 100%. The overall disease-free survival figures were. Stage I, 85%; Stage II, 48%; Stage III, 50%; and Stage IV (M-0), 29%. We feel that this approach to the initial management of breast cancer is a practical, useful, and successful substitute for mastectomy when medical or surgical contraindications exist, or when the patient refuses a mastectomy.

Self-examination and clinical examination of the breast.

The techniques of self breast examination and the clinical examination of the breasts are described briefly. The potential value and the limitations of these tests in screening for breast cancer are reviewed. In a Cancer Society Monograph in 1958, Haagensen said, “It is probable that, from the point of view of the greatest possible gain in early diagnosis, teaching women how to examine their own breasts is more important than teaching the technique of breast examination to physicians, for we must keep in mind the fact that at least 98 percent of the women who develop breast carcinoma discover their tumors themselves.” Unfortunately, this is still true today. There is urgent need to focus research on methods to detect breast cancer in its early stages. Caution is emphasized in widespread advocacy of breast self examination without adequate supporting evidence of its efficacy. There is need for a well‐designed, prospective study of breast self examination with full attention to a rigorous research design and methodology.

Breast Cancer Found on Repetitive Examination in Mass Screening

Both clinical examination and mammography remain important in repetitive screening. If either modality had been omitted, a substantial number of cancers would have been undetected. Absence of axillary nodal involvement remains substantially higher in the screened group than in the control. In subsequent screening, overall figures for lack of gland involvement have reached 75% as compared to 44% in the control group. On initial examination, the clinician was more successful in the small glandular breast and in the under-50 age group. In subsequent screening, the differences remained but a narrowing of the gap was apparent.