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American Journal of Roentgenology, Vol 99, 965-972, Copyright © 1967 by American Roentgen Ray Society

THE PARADOX OF BREAST CANCER

VINCENT P. COLLINS M.D.1 and ROBERT M. ADAMS B.S.1

1 From the Department of Radiology, Baylor University College of Medicine, Houston, Texas

An explanation is proposed for certain paradoxical observations on the course of treated breast cancer whereby, in the face of unchanging mortality rates, it appears that treatment is continually improving, yet all treatment methods have identical effect, or none at all.

This paper does not propose that treatment of breast cancer is ineffective.

This paper does propose that the effect of treatment cannot be determined by survival rate.

The paradox results from reliance on survival rates.

The first effect of earlier diagnosis and treatment is to lengthen the survival period by beginning it earlier; survival rate improvement is then credited to whatever treatment is offered. Occult metastases, rate of growth, errors in diagnosis, and treatment of uncured cancer all exert an influence on survival which masks the effect of treatment.

When treatment methods in asynchronous or successive periods are compared, the most recent series will always show a better survival rate as long as education and cancer detection continue to produce ever-earlier diagnosis.

When treatment methods in synchronous or simultaneous periods are compared, the masking factors obscure the actual effect ofall treatment equally.


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Copyright © 1967 by the American Roentgen Ray Society.