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. 1979 Nov 17;2(6200):1247–1251. doi: 10.1136/bmj.2.6200.1247

Long-term survival of patients with breast cancer: a study of the curability of the disease.

A O Langlands, S J Pocock, G R Kerr, S M Gore
PMCID: PMC1596940  PMID: 519399

Abstract

A retrospective analysis was made of 3878 cases of breast carcinoma first seen in Edinburgh from 1954 to 1964. During this time there was a policy to treat breast cancer by simple mastectomy and x-ray therapy, and over 90% of cases classified as international stages I and II were so treated. The mortality in these women was compared with that in an equivalent normal population using Scottish national age-specific death rates. For every year of follow-up within 20 years of initial treatment there was an excess mortality from all causes. There was an overall excess mortality of 58% among patients with breast cancer 15-20 years after initial treatment, and 20 times more deaths occurred in this period from breast cancer than in a normal population. For patients disease-free after 15 years there was still a 28% excess mortality from all causes. Factors known to be of major prognostic significance for five-year survivorship had less influence than might have been expected when the ratio of observed to expected deaths was considered for longer periods of follow-up. The effect of clinical staging (I, II, or III), though initially marked, largely disappeared by the 10th year of follow-up, and after allowing for age there was no evidence beyond 10 years of an effect on survival of the original stage of the disease. Similarly, the effect of tumour size on survival disappeared after 10 years. Women who were premenopausal at presentation still had a significant excess of deaths in the fourth quinquennium of follow-up. In the menopausal and postmenopausal groups combined there was still a small non-significant excess of deaths from all causes after 15 years but this almost disappeared when patients who had already relapsed were excluded. In terms of overall mortality only patients who have undergone the menopause before presentation and who are disease-free 15 years after primary treatment may prove to be cured by conventional techniques such as simple mastectomy and postoperative radiotherapy.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Brinkley D., Haybittle J. L. The curability of breast cancer. World J Surg. 1977 May;1(3):287–289. doi: 10.1007/BF01556839. [DOI] [PubMed] [Google Scholar]
  2. Campos J. L. Observations on the mortality from carcinoma of the breast. Br J Radiol. 1972 Jan;45(529):31–38. doi: 10.1259/0007-1285-45-529-31. [DOI] [PubMed] [Google Scholar]
  3. Cutler S. J., Asire A. J., Taylor S. G., 3rd An evaluation of ovarian status as a prognostic factor in disseminated cancer of the breast. Cancer. 1970 Oct;26(4):938–943. doi: 10.1002/1097-0142(197010)26:4<938::aid-cncr2820260431>3.0.co;2-k. [DOI] [PubMed] [Google Scholar]
  4. Cutler S. J., Axtell L. M., Schottenfeld D. Adjustment of long-term survival rates for deaths due to intercurrent disease. J Chronic Dis. 1969 Dec;22(6):485–491. doi: 10.1016/0021-9681(69)90010-1. [DOI] [PubMed] [Google Scholar]
  5. Duncan W., Kerr G. R. The curability of breast cancer. Br Med J. 1976 Oct 2;2(6039):781–783. doi: 10.1136/bmj.2.6039.781. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Fisher B., Slack N. H., Bross I. D. Cancer of the breast: size of neoplasm and prognosis. Cancer. 1969 Nov;24(5):1071–1080. doi: 10.1002/1097-0142(196911)24:5<1071::aid-cncr2820240533>3.0.co;2-h. [DOI] [PubMed] [Google Scholar]
  7. Langlands A. O., Kerr G. R. Prognosis in breast cancer: the relevance of clinical staging. Clin Radiol. 1978 Nov;29(6):599–606. doi: 10.1016/s0009-9260(78)80177-9. [DOI] [PubMed] [Google Scholar]
  8. MCKENZIE A. Cancer of the female breast, mortality, and the menopause. Lancet. 1955 Nov 26;269(6900):1129–1130. doi: 10.1016/s0140-6736(55)92964-0. [DOI] [PubMed] [Google Scholar]
  9. McWHIRTER R. Simple mastectomy and radiotherapy in the treatment of breast cancer. Br J Radiol. 1955 Mar;28(327):128–139. doi: 10.1259/0007-1285-28-327-128. [DOI] [PubMed] [Google Scholar]
  10. Mueller C. B., Ames F., Anderson G. D. Breast cancer in 3,558 women: age as a significant determinant in the rate of dying and causes of death. Surgery. 1978 Feb;83(2):123–132. [PubMed] [Google Scholar]
  11. Mueller C. B., Jeffries W. Cancer of the breast: Its outcome as measured by the rate of dying and causes of death. Ann Surg. 1975 Sep;182(3):334–341. doi: 10.1097/00000658-197509000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Myers M. H., Axtell L. M., Zelen M. The use of prognostic factors in predicting survival for breast cancer patients. J Chronic Dis. 1966 Aug;19(8):923–933. doi: 10.1016/0021-9681(66)90008-7. [DOI] [PubMed] [Google Scholar]
  13. Stewart H. J. Controlled trials in the treatment of "early" breast cancer: a review of published results. World J Surg. 1977 May;1(3):309–313. doi: 10.1007/BF01556845. [DOI] [PubMed] [Google Scholar]
  14. Stoll B. A. Does the malignancy of breast cnacer vary with age? Clin Oncol. 1976 Mar;2(1):73–80. [PubMed] [Google Scholar]
  15. Tough I. C. The menopause and prognosis in breast cancer. J R Coll Surg Edinb. 1969 Nov;14(6):337–339. [PubMed] [Google Scholar]

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