Summary
The pathobiology of breast cancer is complex: clinically “early” breast cancer may be tumorbiologically “late” progressing rapidly toward death. Accordingly, it has been suggested that two different breast cancer populations (slow tumor growth and long survival — fast tumor growth and short survival) exist, which cannot be identified by pathohistological criteria. However, these “populations” are most likely either patients with localized disease and occult metastases (long survival) or with diagnosable regional and occult or overt systemic spread (short survival). Since even small tumors (0.1 to 0.3 cm in diameter) can spread systemically, in most patients breast cancer upon clinical diagnosis may be considered an inevitably lethal disease. Present treatment modalities can only improve the quality of life and delay death, even though the overall long-term survival rates of breast cancer are better or at least equal to those of other cancers. However, with other cancers (Table 2) it is decided within the first 5 years which patients are cured because the survival rates for 5, 10, 15, and 20 years are similar. In contrast, survival rates of patients with breast cancer steadily decline and there is no point in time when patients can feel really safe; this is indicative of a peculiar tumor pathobiology of this disease, the nature of which remains to be investigated. Progress in the fight against breast cancer is only possible by application of sensitive physical, reliable immunological, and specific biochemical methods for early diagnosis and development of efficient therapeutic modalities for inhibition of growth or complete eradication of metastasized cancer cells.
Zusammenfassung
Die Pathobiologie des Mammakarzinoms ist komplex. Brustkrebs diagnosed als klinisch im Frühstadium kann tumorbiologisch schon im Spätstadium sein und die Überlebenszeit ist kurz. Demzufolge wurde auf das Bestehen von zwei verschiedenen Brustkrebspopulationen hingewiesen: (1) langsames Tumorwachstum und lange Überlebenszeit, (2) rasches Tumorwachstum und kurze Überlebenszeit. Diese zwei Populationen sind nicht durch pathohistologische Kriterien identifizierbar. Sehr wahrscheinlich sind dies Patienten mit lokalisiertem Tumor und okulten Metastasen (lange Überlebenszeit) oder solche mit regionaler und systemisch okulter oder klinisch diagnostizierbarer Streuung (kurze Überlebenszeit). Da kleine Tumoren (0.1 bis 0.3 cm im Durchmesser) schon metastasieren können, so muß in den meisten Fällen Brustkrebs zur Zeit der klinischen Diagnose als unabwendbare tödliche Erkrankung angesehen werden. Da gegenwärtige Behandlungsmethoden nicht alle metastasierten Krebszellen vernichten können, so kann durch die Therapie nur die Qualität des Lebens verbessert und die Dauer verlängert werden. Trotzdem sind die Langzeit-Überlebensraten des Brustkrebses höher oder zumindest gleich denen anderer Karzinome. Allerdings ist bei anderen Malignomen (Tabelle 2) das Schicksal innerhalb von 5 Jahren entschieden und Patienten, die nach 5 Jahren noch leben, können als geheilt angesehen werden, da die Überlebensraten für 5, 10, 15 und 20 Jahre ähnlich sind. Im Gegensatz dazu nimmt die Überlebensrate für Brustkrebs ständig ab und zu keinem Zeitpunkt können sich die Patientinnen wirklich sicher fühlen; dies spricht für eine besondere Tumorpathobiologie dieser Erkrankung, deren Eigenheit noch zu erforschen ist. Fortschritt in der Bekämpfung des Brustkrebses ist nur möglich durch Anwendung von empfindlichen physikalischen, spezifischen biochemischen und verlässlichen immunologischen Methoden zur Diagnose sowie Entwicklung von therapeutischen Modalitäten zur Wachstumshemmung oder völliger Vernichtung metastasierter Karzinomzellen.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
Adair F, Berg J, Joubert L, Robbins GF (1974) Long-term follow-up of breast cancer patients: The 30-year report. Cancer 33:1145–1150
Ahmann DL, Scanlon PW, Bisel HF, Edmonson JH, Frytak S, Payae WS, O'Fallon JR, Hahn RG, Ingle JN, O'Connell MJ, Rubin J (1978) Repeated adjuvant chemotherapy with phenylalanine mustard or 5-fluorouracil, cyclophosphamide, and prednisone with or without radiation, after mastectomy for breast cancer. Lancet 1:893–896
Aisner J (1978) Specialty rounds. Management of disseminated carcinoma of the breast. Am J Med Sci 275:4–16
Allan E (1978) Breast cancer: The error of the exponential. Eur J Cancer 14:1389–1393
Ashikari R, Hajdu SI, Robbins GF (1971) Intraductal carcinoma of the breast (1960–1969). Cancer 28:1182–1187
Asire AJ, Shambaugh EM (1976) Cancer of the breast. In: Axtell LM, Asire AJ, Myers MH (eds) Cancer patient survival report. Number 5. DHEW Publication No. (NIH) 77–992. US Dept. of Health, Education, and Welfare, National Cancer Institute, Bethesda, Maryland, p 157
Bässler R (1978) Pathologie der Brustdrüse. Springer, Berlin Heidelberg New York
Baum M (1976) The curability of breast cancer. Br Med J 1:439–442
Black MM (1970) Human breast carcinoma. Part I. Clinical considerations. NY State J Med 70:863–868
Blamey RW (1979) Adjuvant chemotherapy for breast cancer. Lancet 2:305
Bonadonna G (1978) Bonadonna's results at four years. Still big improvement for CMF group. Cancer Lett 4 (No. 47):4
Bonadonna G, Brusamolino E, Valagussa P, Rossi A, Brugnatelli L, Brambilla C, De Lena M, Tancini G, Bajetta E, Musumeci R, Veronesi U (1976) Combination chemotherapy as an adjuvant treatment in operable breast cancer. N Engl J Med 294:405–410
Bonadonna G, Rossi A, Valagussa P, Banfi A, Veronesi U (1977) The CMF program for operable breast cancer with positive axillary nodes. Cancer 39:2904–2915
Bond WH (1968) The influence of various treatments on survival rates in cancer of the breast. In: Jarrett AS (ed) The treatment of carcinoma of the breast. Syntex Pharmaceuticals Ltd., Maidenhead. p 24
Brennan MJ, McMahan CA (1976) Analysis of recent breast cancer treatment studies. In: Homburger F (ed) The physiophology of cancer, Vol 2, 3rd edn. Karger, Basel München Paris London New York Sydney, p 182
Brinkley D, Haybittle JL (1968) A 15-year follow-up study of patients treated for carcinoma of the breast. Br J Radiol 41:215–221
Brinkley D, Haybittle JL (1975) The curability of breast cancer. Lancet 2:95–97
Burnet FM (1977) Morphogenesis and cancer. Med J Aust 1:5–9
Buzdar AU, Blumenschein GR, Gutterman JU, Tashima CK, Hortobagyi GN, Smith TL, Campos LT, Wheeler WL, Hersh EM, Freireich EJ, Gehan EA (1979) Postoperative adjuvant chemotherapy with fluorouracil, doxorubicin, cyclophosphamide, and BCG vaccine. A follow-up report. JAMA 242:1509–1513
Campos JL (1972) Observations on the mortality from carcinoma of the breast. Br J Radiol 45:31–38
Cancer Patient Survival Report (1976) Number 5. DHEW Publication No. (NIH) 77-992 Axtell LM, Asire AJ, Myers MH (eds). U.S. Dept. of Health, Education, and Welfare, National Cancer Institute, Bethesda, Maryland
Caprini JA, Oviedo MA, Cunningham MP, Cohen E, Trueheart RS, Khandekar JD, Scanlon EF (1980) Adjuvant chemotherapy for stage II and III breast carcinoma. JAMA 244:243–246
Carbone PP (1977) The estrogen receptor test as aid to breast cancer treatment. JAMA 237:157
Carey RW, Sohier WD, Kaufman S, Weitzman SA, Kelley RM, Lew RA, Halpern E (1979) 5-drug adjuvant chemotherapy for breast cancer. Cancer 44:35–41
Carter SK (1978) Adjuvant chemotherapy in breast cancer: Critique and perspectives. Cancer Chemother Pharmacol 1:187–195
Chabner BA (1977) Second neoplasm — A complication of cancer chemotherapy. N Engl J Med 297:213–214
Cooper RG, Holland JF, Glidewell O (1979) Adjuvant chemotherapy of breast cancer. Cancer 44:793–798
Crowther D (1979) Controlled adjuvant chemotherapy trials for breast cancer in the United Kingdom. In: Jones SE, Salmon SE (eds) Adjuvant therapy of cancer II. Grune & Stratton, New York, p 237
del Regato, JA (1977) Cancer of the breast. JAMA 238:2407–2410
Dent DM (1977) Adjuvant chemotherapy for breast cancer. S Afr Med J 52:714–716
Devitt JE (1965) The significance of regional lymph node metastases in breast carcinoma. Can Med Assoc J 93:289–293
Edelstyn GA (1979) Personal communication
Edelstyn GA, MacRae KD (1979) Trials of adjuvant chemotherapy in breast cancer. Lancet 1:324
Feinleib M, Garrison RJ (1969) Interpretation of the vital statistics of breast cancer. Cancer 24:1109–1116
Fidler IJ, Kripke ML (1980) Tumor cell antigenicity, host immunity, and cancer metastasis. Cancer Immunol Immunother 7:201–205
Fisher B, Carbone P, Economou SG, Frelick R, Glass A, Lerner H, Redmond C, Zelen M, Band P, Katrych DL, Wolmark N, Fisher ER (1975) 1-Phenylalanine mustard (L-Pam) in the management of primary breast cancer. N Engl J Med 292:117–122
Fox MS (1979) On the diagnosis and treatment of breast cancer. JAMA 241:489–494
Friedell GH (Primary Therapy of Breast Cancer Study Group) (1978) Identification of breast cancer patients with high risk of early recurrence after radical mastectomy. Cancer 42:2809–2826
Haskell CM (1977) Management of metastatic breast cancer. Med Clin North Am 61:967–978
Helman P (1977) Whither breast cancer? Report on the inaugural meeting of the national breast cancer group. S Afr Med J 52:711–713
Jungi WF, Senn HJ (1978) Prognoseverbesserung durch adjuvante postoperative Chemotherapie des operierten Mammakarzinoms. In: Schmähl D (ed) Behandlung und Nachbehandlung des Mammakarzinoms, Vol 2. Thieme, Stuttgart, p 155
Key C (1979) Data New Mexico Tumor Registry. Personal communication
Leis HP Jr (1977) The diagnosis of breast cancer. CA-Ca J Clin 27:(No 4), 209–232
Letton AH, Wilson JP, Mason EM (1977) The value of breast screening in women less than fifty years of age. Cancer 40:1–3
Lynch HT, Guirgis H, Brodkey F, Maloney K, Lynch PM, Rankin L, Lynch J (1976) Early age of onset in familial breast cancer. Genetic and cancer control implications. Arch Surg 111:126–131
MacDonald I (1951) Biological predeterminism in human cancer. Surg Gynecol Obstet 92:443–452
McKinnon NE (1954) Control of cancer mortality, Lancet 1:251–254
Miller DG (1976) The early diagnosis of cancer. In: Homburger F (ed) The physiopathology of cancer, Vol 2, 3rd edn. Karger, Basel München Paris London New York Sydney, p 5
Millis RR, Thynne GSJ (1975) In situ intraduct carcinoma of the breast: A long term follow-up study. Br J Surg 62:957–962
Moskowitz M (1977) Screening for breast cancer. JAMA 238:213
Moskowitz M (1979) Personal communication
Mueller CB, Ames F (1978) Bilateral carcinoma of the breast: Frequency and mortality. Can J Surg 21:459–465
Mueller CB, Ames F, Anderson GD (1978) Breast cancer in 3,558 women: Age as a significant determinant in the rate of dying and causes of death. Surgery 83:123–132
Myers MH (1973) Breast cancer survival over three decades. Recent Res Cancer Res 42:87–91
Nissen-Meyer R (1979) One short chemotherapy course in primary breast cancer: 12-year follow-up in series 1 of the Scandinavian adjuvant chemotherapy study group. In: Jones SE, Salmon SE (eds) Adjuvant therapy of cancer II. Grune & Stratton, New York, p 207
Ozzello L, Sanpitak P (1970) Epithelial-stromal junction of intraductal carcinoma of the breast. Cancer 26:1186–1198
Powles TJ, Smith IE, Ford HT, Coombes RC, Jones JM, Gazet J-C (1980) Failure of chemotherapy to prolong survival in a group of patients with metastatic breast cancer. Lancet 1:580–582
Rainey JM, Jones SE, Salmon SE (1979) Combination chemotherapy for advanced breast cancer utilizing vincristine, adriamycin, and cyclophosphamide (VAC). Cancer 43:66–71
Rivkin S, Glucksberg H, Rasmussen S (1979) Adjuvant chemotherapy in stage II breast cancer. Proc Am Assoc Cancer Res 20:353
Sauer H, Jehn U, Wilmanns W (1979) Zum gegenwärtigen Stand der Internistischen Therapie des Mammacarcinoms. II. Adjuvante Chemotherapie, palliative Polychemotherapie, Chemoimmuntherapie — Stellenwert und Ergebnisse. Klin Wochenschr 57:921–926
Seidman H, Silverberg E, Holleb AI (1976) Cancer statistics, 1976. A comparison of white and black populations. CA-Ca J Clin 26:(No 1) 2–29
Shapiro S, Strax P, Venet L, Fink R (1968) The search for risk factors in breast cancer. Am J Public Health 58:820–835
Silverberg E (1977) Cancer statistics, 1977. CA-Ca J Clin 27:(No 1) 26–41
Silverberg E (1979) Cancer statistics, 1979. CA-Ca J Clin 29:(No 1) 6–21
Slack NH, Blumenson LE, Bross IDJ (1969) Therapeutic implications from a mathematical model characterizing the course of breast cancer. Cancer 24:960–971
Stark AM (1976) Critical appraisal of new early detection techniques. In: Heuson JC, Mattheiem WH, Rozencweig M (eds) Breast cancer: Trends in research and treatment. Raven Press, New York, p 279
Stoll BA (1978) Ovarian function and adjuvant chemotherapy for breast cancer. Lancet 1:1159
Surgical Rounds (1978) Cancer survival among women. Surgical Rounds 1:(No 3) 70–72
Taylor SGIV (1978) The systemic therapy of breast cancer. Ration Drug Ther 12:1–7
Valenta J, Levy J (1977) Combination of regional chemotherapy and mastectomy in the treatment of carcinoma of the breast. Five-year results. Neoplasma 24:415–420
Vorherr H (1980) Breast Cancer. Epidemiology, endocrinology, biochemistry and pathobiology. Urban & Schwarzenberg, Baltimore, Maryland
Wendt AG, Mill RC, Heusinkveld RS, Giordano GF, Jackson RA, Salmon SE, Jones SE (1979) Adjuvant treatment of breast cancer with adriamycin-cyclophosphamide +/- radiotherapy. Program and abstracts of the 2nd International Conference on the Adjuvant Therapy of Cancer, March 28–31, 1979. Tucson AZ University of Arizona Cancer Center (Tucson AZ), p 56
Westbrook KC, Gallager HS (1975) Intraductal carcinoma of the breast. A comparative study. Am J Surg 130:667–670
Young RC (1977) Perspectives in the treatment of breast cancer: 1976. Ann Intern Med 86:784–798
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Vorherr, H. Pathobiology of breast cancer: Hypothesis of biological predetermination and long-term survival. Klin Wochenschr 59, 819–829 (1981). https://doi.org/10.1007/BF01721051
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01721051