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A Hypothesis for the Natural Time History of Breast Cancer

Biometry Branch, National Cancer Institute, NIH, USPHS, Bethesda, Maryland 20014

A new method of analysis is developed for inferring the natural history of a disease using only the information available on a patient at time of treatment. The technic is applied to the study of breast cancer and has resulted in a coherent theory of breast cancer which accounts for many biologic variables simultaneously. Among the findings are: (a) There are at least four distinct time histories. (b) The four histories divide into two pairs such that the onset of the disease in one pair precedes that of the other pair by eight years. This accounts for the break in age-incidence rate reported by other investigators. (c) Early diagnosis combined with radical mastectomy increases survival time for only one time history, whereas early diagnosis in the other time histories does not result in an appreciable increase in longevity. (d) Radical mastectomy does not appear to be effective in significantly prolonging survival for these latter time histories. (e) The first biological event in time which occurs in the four time histories is that the degree of sinus hyperplasia of the axillary lymph nodes changes from favorable to unfavorable status. (f) The nuclear grade of the primary tumor does not change with time.

¹ Present address: Department of Statistics, State University of New York at Buffalo, 4244 Ridge-Lea Road, Amherst, New York 14226.

Received 4/19/67. Accepted 10/ 3/67.

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