In the large majority of cases, except those who had been surgically operated on, the diagnosis was clinical only, as it is an accepted fact that it is very unwise to make a biopsy, even before surgical removal, and manifestly improper where this is not undertaken; but in most of the cases there was the independent diagnosis of one or more other medical men, and many of the patients came to me on account of threatened operations by prominent surgeons, and even after these had been arranged for; in 27 cases there had been previous surgical removal with recurrence, and in several cases more than one operation, with again recurrence.
The exact duration of cancer before coming under observation is always an uncertain item, for undoubtedly a tumor starts in an individual cell or group of cells, and has probably been forming some time before being noticed by the patient or attracting attention in any way. The average stated duration of the disease was 1.6 years before coming under observation.
Surgeons are fully agreed that the earlier a tumor is recognized and removed the better the prospect of ultimate success, and this is eminently true in regard to remedial measures other than surgical: for as we have seen, after a cancerous process is well under way its cells secrete a something which hastens the general depravement of the system, and quickens the growth of the neoplasm, and naturally greatly increases the difficulty of overcoming the dyscrasia.
Thus in the effort to get at and remove all possible or prospective cancerous lesions, many innocent or non-malignant adenomata, etc., are operated on, which are afterwards found to be such microscopically. In the same way it is quite possible that some of the small breast tumors which have disappeared under the dietetic and medical measures here described were still non-malignant, and should not be grouped with carcinoma.
It is fair to say, therefore, that among my notes are also 22 cases of breast tumors which have been excluded from the carcinoma list, and entered with other titles, such as abscess, cyst, chronic mastitis, adenoma, etc. But I claim that even if some of these also disappear under the measures we are considering, as they frequently have done, it is a better and more desirable result than if they had been removed by the knife: for in the former case the cause which induced the unnatural growth has been overcome, whereas by surgery only the obnoxious mass has been dislodged, and perhaps with it adjoining tissue and glands, but nothing has been accomplished toward checking the cause producing the offending lesion. But the very fact of the frequent recurrences after operation, in the neighboring skin or elsewhere, demonstrates the fact that surgery is but an attempt to rectify past errors, which might or might not have been prevented by careful medical foresight and action; we must, however, be thankful for the measure of success which has followed the noble efforts of our distinguished surgeons, only it is to be hoped that hereafter other measures will also be more commonly adopted, looking towards a prevention of the recurrence of carcinoma after operation.
Not to detain you too long with these clinical considerations, I would like to give the details of a few of the cases which have been most striking.
Mrs. B. E. C., aged 44, was first seen on account of trouble in the right breast, on September 19, 1892. She then had a flat tumor in the outer lower segment, an inch and a half in diameter, rather sharply defined, and tender on pressure at the sides, which she had noticed about two months. Not satisfied with the diagnosis of cancer, and hesitating at the thought of medical treatment, she consulted a well known, prominent surgeon, who pronounced the tumor as undoubtedly cancer, and urged its instant removal; this I did not know until she informed me of it some time later, after the tumor had entirely disappeared under treatment. I saw her at frequent intervals for six months, and the breast became entirely normal. Four years later she was again seen in regard to the menopause, which she was undergoing, and the breast was found still to be normal: she was maintaining her diet. Nearly three years later I learned from her husband that she was in perfect health, with absolutely no breast trouble, and for eight years later, while he himself was under occasional treatment, I learned repeatedly that she remained still perfectly well, over sixteen years after beginning treatment, with no recurrence of the breast tumor.
Miss B. M. L., aged 45, was first seen on January 4, 1894, with a tumor in the left breast, which had been diagnosed as cancer by three medical men, and one of them, a surgeon of prominence, had arranged for immediate surgical removal the next day. The mass was situated in the upper and outer quadrant, well defined, not painful on moderate handling, but subsequently she experienced pain in it. Two months later the lump was recorded as less distinct and flatter, and within eleven months it had entirely disappeared. A month or two later she had some pain in the breast, in connection with the menstrual disturbance accompanying the menopause, but no trace of the tumor. On Nov. 8th, 1905, she called, bringing a relative for treatment, and the breast was found perfectly normal, and again five years later she called, with another trouble, the breast still remaining perfectly well, also sixteen years after first coming under treatment.
Miss J. M. A., aged 45, was first seen October 12th, 1905, with a tumor of the left breast, above, toward the median line, near the nipple, not painful on handling, though there was some pain afterwards, and it had been awaking her with pain at night for some months, with also a numb, shooting pain in the daytime. She had seen a number of medical men always with the diagnosis of cancer, but she had declined operation. Two months later, Dec. 15th, 1905, it was recorded that there was very little to be felt in the breast, and there was no pain at any time, and on January 5th, 1906, both breasts were the same on palpation, with no sign of the former tumor. For one reason or another she has been seen from time to time, almost up to the present date, and remains perfectly free from her former trouble, a period of over nine years. She has been a most faithful patient, adhering strictly to diet and more or less medication, except when on certain occasions I have let up on the same; and all the time from the first she has been under great strain of work, mental and physical, as a city missionary.
Another very similar case was in the person of Miss G. M., aged 44, who has been under constant observation and treatment off and on for various troubles from November 13, 1905, until yesterday. Fifteen years previous to her first visit she had fallen and struck the left breast which was bruised, but the effects wore off in some months, and there was no sensation in the breast for some years. Then 7 or 8 years later she began to have pain in the breast, aggravated before and during menstruation, which had continued until her visit, and for the last months she had been kept from her work in school, the pain being severe in the breast, and more recently in the axilla: in July there had been bleeding from the nipple. She had seen a number of medical men, with the diagnosis of cancer, and one surgeon of prominence in one of the large hospitals had strongly pressed for an immediate operation.