[Growth velocity of breast carcinoma and radiographic "early diagnoses"]

Between 1960 and 1975, 53 mammary carcinomas have been observed in a collective of 15000 women a part of whom, comprising finally 80 per cent, was free from troubles (annual prophylactic examination for breast cancer). Of these 53 cases were available two up to eleven preceding mammographic series made within an observation period of 0.2 to eleven years. A "mean growth curve" was obtained empirically, based on 163 mammographic tumor measurements with tumor sizes between 2 mm and 60 mm. In the course of a development period between two and eleven years, 33 per cent of the carcinomas were seen to accelerate their further growth in comparison with the initial value; 66 per cent revealed an increasing slow-down of growth, and all tumors showed considerable changes in their growth rates. Mammary carcinomas altogether continually decelerated their growth as measured by the duplication time of the tumor volume from Tv = 309 days on the average up to an average of Tv = 381 days after two through eleven years. The mean growth curve exhibited an exponential shape which was completed by biomathematical methods and can be described by means of a Power function. It corresponds well to the rate of incidence of the mammary carcinoma which shows an identical rise in relation to increased old age. The medium growth time from a primary cancerous cell with ten micron in size up to the tumor 2 mm in diameter may be estimated biomathematically only and amounts to ten or twenty years with 23 duplication periods. The further average growth rate between the tumor sizes of two and ten millimeter, stages which can be diagnosed roentgenologically, was empirically six years; the most quickly growing tumor needed almost two years. For the purpose of early cancer detection (tumor size below 10 mm, lymph nodes histologically free from metastases), the serial mammography to be performed every 18 months or two years is the only technique which provides utilizable early recognition marks and besides does allow a simple judgement. Solely the symptoms "suspect desification, partly spiculated" in sixty per cent and "typical cancerous microcalcification" in forty per cent have been observed as the earliest signs. The reliability ("certainty") of mammography is frequently overestimated (false negative rate: 7 to 18%) and should be quoted only for collectives where control mammographies have been made over a period of five or ten years. Roentgenological controls of alterations below three millimeter in size and without an indication for biopsy ought to be performed within six months, and still sooner in case of larger alterations. It is not possible earlier than after five or ten years to judge of the radicality of a therapy, as spread cancerous cells, on he average, reveal similar growth rates as does the primary tumor.