(In)curability of breast cancer: a 30-year report of a series of 3933 cases

The aim was to compare mortality in a consecutive series of women with breast cancer to that of an age-matched cohort of the Scottish population. An analysis of outcome has been performed in a retrospective series of 3933 women with breast cancer diagnosed between 1954 and 1964 and followed for between 30 and 40 years (median 32 years). The ratio of observed to expected mortality (O:E) was calculated by quinquennia for the group as a whole and for subsets defined by clinical prognostic criteria. O:E mortality remained significantly greater than unity for at least 25 years following diagnosis and treatment, indicating a failure to demonstrate cure of the disease in a statistical sense, i.e. by the elimination of the excess hazard of death in the study group. Clinical prognostic factors, such as tumour size, palpability of axillary nodes and their combination in clinical stages, significantly discriminate for survival for the first 10 years only. These data confirm other long-term follow-up studies of women with breast cancer. For practical purposes, the disease should be considered to be incurable. The implications of this concept for the development of clinical research are discussed briefly.