This is a resume of a Breast Cancer Survey carried out by the American College of Surgeons in 1978. Four hundred and ninety-eight hospitals in 47 states, Washington, D.C., and Puerto Rico participated, contributing a total of 24,136 female patients with histologically confirmed breast cancer. In these patients, five-year cure rates were 60.5% for clinically localized disease and 33.9% for regional disease. Five-year survival rates were 72.8% for localized disease and 49.1% for regional disease. From the 1960's into the early 1970's, there was a gradual shift away from radical mastectomy towards so-called modified radical mastectomy. In a group of patients treated by either radical or modified mastectomies, the axillary nodal status, size of the tumor, and location of the tumor were examined in relation to the prognosis. In the study of number of metastatic nodes in the axilla, there were reduced cure and survival rates in patients with one or more positive nodes as compared to those with negative axillary nodes. With the increase in the number of positive nodes, there was a continuing associated decline in survival and cure. The clinical size of the tumor also correlated well to the prognosis. With the increase in the size of the tumor, there was a gradual increase in the probability of axillary nodal involvement. However, in the group of patients with tumor size smaller than 1 cm, axillary metastasis occurred in 25%. When the axillary nodes were involved, the cure rate in those patients was not significantly better than the rates for those with larger primary tumors in this study. Tumors located in the medial half of the breast were associated with a slightly lower cure rate than those in the lateral half. Young women under 35 years of age had poorer survival and cure rates, although in women 35-44 years of age, the five-year results were comparable to the older group of patients. In blacks, breast cancer was diagnosed in a relatively more advanced stage than in whites. Survival and cure rates were generally lower for blacks, and such lower rates seem to be associated with the relatively advanced stage of the disease.
Experience with a group of 54 patients with adenoid cystic carcinoma of the head and neck is presented. The tumors are characterized by a high incidence of local recurrence and ultimate distant metastases after aggressive attempts at surgical excision. Radiation therapy, while not curative, has proved uniformly useful in promoting tumor regression and pain relief in locally advanced and metastatic tumors. Of 41 patients eligible for 5‐year follow‐up, 11 (26.8%) remain free of disease. A clinicopathologic review of the patients in this series indicated they could be divided into 2 groups on the basis of their behavior. A group of 9 patients had a fulminating course with early recurrence, metastasis, and a fatal outcome within 3 years of therapy. A larger group had a prolonged course with survival for many years in spite of recurrences and metastases. A solid histologic pattern with areas of necrosis was notable in many patients in the former group, which may be of value in predicting behavior of a given tumor.
As part of the national survey on the tumorigenesis of oral contraceptive drugs conducted by the American College of Surgeons' Commission on Cancer, a histologic study was made of 94 cases of liver tumors in users and non-users of oral contraceptives. Pathologic criteria were established and then the slides were studied; the results were tabulated to determine the significance of each of the criteria as related to the use of contraceptives. These criteria included tumor size, peliosis hepatis, hemorrhage, necrosis, fibrosis, thrombosis, and vascular alterations of the intima and media.Cases of focal nodular hyperplasia in pill users exhibited greater vascular alterations, fibrosis, peliosis, and tumor size as compared to focal nodular hyperplasia observed in non-pill users. In addition, hemorrhage, necrosis, and peliosis were much more common in hepatic cell adenoma than in focal nodular hyperplasia. fn the material reported in this series there were no hepatic cell adgaoma cases observed in non-pill users. Focal nodular hyperplasia cases exhjbited qp gverwhelmingly greater degree of vascular intimal and medial alterations than hepatic cell adenoma. The results suggest that the effects of oral esntraceptives on the liver may be primarily upon the vasculature.
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