Murray M. Copeland

REPRODUCIBILITY OF THE TECHNIC OF MAMMOGRAPHY (EGAN) FOR CANCER OF THE BREAST.

Summary The findings of the reproducibility study indicate that the technic of mammography developed by Egan can be learned by other radiologists, that films of acceptable quality can be produced, and that the interpretations provide information which is useful in the clinical management of breast disease.

Primary malignant tumors of bone. Evaluation of current diagnosis and treatment

The authors experience in the diagnosis and treatment of primary malignant bone tumors (700 cases) is reviewed, together with the experience of the staff at The University of Texas M. D. Anderson Hospital and Tumor Institute, to evaluate various approaches to diagnosis and treatment, and to determine whether progress has been made in treating bone sarcoma. The survival rates remain fairly constant and continue to be largely influenced by the adequacy of the surgery performed. Radiation therapy, while largely palliative, plays a role in adjunctive and definitive treatment (especially in reticulum cell sarcoma of bone). High energy forms of radiation therapy prove superior to ortho‐voltage treatment. The clinical achievements of chemotherapy present scant evidence that it plays more than an adjunctive palliative role in the majority of cases treated. There is evidence that in some cases it may play an adjunctive role in successful treatment when used with radiation and/or surgery.

The treatment of mammary dysplasia with special reference to microcystic and macrocystic disease of the breast

Abstract There are three forms of mammary dysplasia: 1. 1. Mastodynia (simple mammary nodosity with pain) is the most common and least serious. One case of carcinoma, only, was found in 350 patients with this disease. 2. 2. Macrocystic disease is the next most common form of mammary dysplasia. In 445 patients, followed for five years or more, only five cases (1 per cent) of carcinoma ultimately occurred in the group. 3. 3. Microcystic disease (adenosis) of the breast is, fortunately, the least common form of mammary dysplasia, since it is the most serious in many of its aspects. In 150 patients with microcystic disease (adenosis), adequately followed, the incidence of cancer was 3 per cent. In a control population, the chance that in a white women between the age of thirty-five and forty-four years cancer will develop, lies between 2.8 and 5.5 cases per 1,000 women [69]. Breast changes due to mammary dysplasia are intimately related to the function of the ovaries, and result from an imbalance between the activities of the follicle hormone complex and the corpus luteum hormone. One of the promoting factors, namely estrogen, in bringing about mammary dysplasia is directly concerned with the progression of certain breast cancers. The following observations were pointed out to indicate a possible relationship between the changes in the breast associated with mammary dysplasia and the development of cancer: (1) In many cases, breasts removed because of cancer show the changes of some form of chronic cystic mastitis (breast dysplasia); (2) suggestive transitional stages between breast dysplasia and carcinoma have been traced by some investigators; (3) while experimental production of mammary cancer following cystic disease and adenosis is not possible, to date, in the higher order of mammalia, it has been accomplished in rats and mice by using estrogenic hormones; and (4) among patients treated conservatively for microcystic disease (adenosis), in 3 per cent mammary cancer has developed subsequently. This was seven times the expected rate. Forms of treatment were discussed. If cancer is found on exploration of the breast, radical mastectomy is the treatment of choice. Simple mastectomy rarely is the treatment of choice for breast dysplasia and should not be used for removing cancer of the breast unless extenuating circumstances of health or palliation supervene.

Part III: Malignant bone tumors: Primary and metastatic

Metastasis to Bone Secondary bone deposits from pri mary malignant tumors are not rare and present a wide variety of bone changes.27 The distribution of osseous involvement may appear roentgeno graphically as multiple or single lesions totally destructive or reflecting mixed osteolytic and/or sclerosing reaction. The most frequent sites of the primary growths are: cancer of the breast, prostate, lung, thyroid, kidney, female genital organs and gastrointestinal tract. Roentgenographically, solitary or multiple metastases are often found in the spine, upper end of the humerus, femur and/or skull. They are extremely rare below the elbow or knee. A cen tral area of bone destruction may in crease and destroy the cortex with little bone expansion. Osteoplastic changes usually occur with prostatic carcinoma metastases (Figs. 1A and 1B), occa sionally with breast carcinoma, four per cent (Fig. 2), and malignant mela noma; both absorption of bone as well as proliferation of irregular spic ules of new bone are observed. Bone invasion from neuroblastoma may show radiological changes suggesting Ewings sarcoma or reticulum cell sar coma of bone. Disability from pain is a prominent feature of metastatic bone cancer, and severe anemia is often noted. Pathologic fracture of weight bearing bones or ribs is common.

Introductory statement on the progress of the national large bowel cancer project. Its goals, objectives, and program

The introductory lecture updates the state of the art bearing on cancer of the large bowel. Topics discussed include etiological factors, the pathology of the disease, the role of animal models, the early diagnosis of the disease, including biochemical markers, with emphasis on immunology, and finally therapy, including surgery, radiotherapy, chemotherapy, and the immunological approaches to therapy as identified in the ongoing activities of the National Large Bowel Cancer Project. Interesting aspects of complementing the traditional ways of treating colorectal disease are noted in the discussion of new approaches to chemotherapeutic treatment based on rational developments obtained through the study of cell kinetics and cell turnover. It is pointed out that this and other interrelationships considered in the multidisciplinary experimental and clinical approaches provide important leads toward the understanding of the mechanisms of disease, discovery of causes and means of prevention, methods of earlier diagnosis, improved rational modalities of treatment, and, one hopes, more successful management.

Clinical staging system for cancer and end results reporting

important concept in staging tumors for purposes of treatment. The basic difficulty in the staging of any malig nant tumor is human variation in de scribing the lesion on examination. Ad ditional factors become most important from the standpoint of end results re porting. To bring a uniform standard of staging classification to fruition is fraught with difficulty, due to varying shades of opinion as to what factors should be used. Within the scope of de bate are such factors as age, duration of the disease, size and accessibility of the tumor, and histologic type of dis ease. The necessity of some or all of these factors being included is evident in the continuing efforts to effect further diagnostic techniques and, in deed, to develop new methodologies in diagnosis. As there are many forms of cancer, we must have detailed diagnostic cri teria expressed in definitive terms, which are understood and agreed to by all concerned. We do not have a univer sally applicable form of therapy for all tumors, thus it is necessary to delineate and explore the effect of specific forms of therapy on specific forms of cancer, in specific stages of advancement. Rec ords containing such complete data will offer a means of providing exchange of experience among investigators with comparable diagnostic criteria. Historically, the practice of dividing cancer cases into groups according to so-called stages arose from the fact

THE AMERICAN JOINT COMMITTEE ON CANCER STAGING AND END RESULTS REPORTING.

Dr. Copeland describes the development of The American Joint Committee on Cancer Staging and End Results Reporting, its objectives, and the steps in the preparation of the clinical classifications. Emphasis is on simplicity, practicability and credibility. The TNM (tumor, nodes, metastasis) system is utilized where possible.

Mammography: A progress report

Abstract 1. 1. Mammography is becoming an important adjunct to diagnosis of early cancer of the breast, as well as an aid in differentiating between benign and malignant lesions of the breast. 2. 2. Mammography has definite limitations and does not in any circumstance replace the advantages of surgical biopsy. Biopsy is imperative if the mammogram reveals a significant shadow. 3. 3. Mammography should be reserved as an aid in the management for those patients with specific indications of breast disorder. 4. 4. If the mammograms give negative or inconclusive results, surgical exploration and biopsy are necessarily predicated upon the clinical evaluation of the affected breast. 5. 5. If mammography is to gain wide acceptance and succeed in hospitals around the country, the team approach must be used. Such a team is composed of the surgeon, radiologist, and pathologist. The radiologist, of course, is the key to a successful program through his efforts and ability to give good service and to give reports of meaningful value. Mammography is not just the taking and reporting of films. 6. 6. Mammography has become a permanent diagnostic aid, and through continued improvement in technics, films and x-ray equipment, complemented by the team approach, it gives every indication of adding to the control of cancer of the breast.