We have reviewed our experience with 50 patients with malignant effusion secondary to breast cancer. Prior to any therapy for this problem the malignant cause of the effusion must be firmly established. Permanent cell block with cytologic examination of such cells proved exceedingly accurate in our hands. Once the diagnosis is known secondary to malignancy the type of effusion must be investigated since those in which there are a large number of free cells or diffuse serosal studding respond best to intracavitary therapy. Those in which the effusion is due to lymphatic or venous blockage secondary to a single large tumor mass do not respond well to intracavitary therapy. Forty‐nine of our patients had pleural effusion and were treated either by aspiration of fluid alone, aspiration of fluid combined with systemic treatment, or aspiration of fluid combined with intracavitary administration of radioactive gold, or nitrogen mustard. In the course of their therapy each patient averaged 6 thoracenteses prior to symptomatic relief, and usually remained symptom free after a course of treatment. An interval of 19 months from the time of the appearance of the effusion until death was found in the 38 patients who have succumbed to their disease ‐in the 12 who are still living 54 months have passed since initial appearance of their effusion to the present time. We believe that effusion is not a signal of the last stage of this disease and should be aggressively treated.

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