The pattern of spread and survival in 596 cases of breast cancer related to clinical staging and histological grade

Carcinoma of the breast in 596 patients diagnosed between 1949 and 1966 at the Reading group of hospitals has been evaluated. All operable cases were treated by simple mastectomy and post-operative radiotherapy to the chest wall and regional nodes. Tumours were graded for malignancy either routinely or retrospectively on all patients with carcinoma simplex or scirrhous carcinoma, and the relation of grading to the subsequent development and distribution of metastases studied. Recurrence developed in 348 patients, 184 of whom suffered local recurrence. Eighty-three per cent of locally recurrent cases developed generalised metastases. The incidence of pulmonary and liver metastases was significantly increased in Grade II and III tumours compared with Grade I. Very significant differences in the survival rates between grades were noted, unfavourable to the higher grade tumours; and the influence of grading on prognosis is discussed.