Quality of life and life span are parameters which characterise a successful tumour diagnosis and therapy. We found out that the age-specific death rate and standardised death rate concerning gynaecological cancers and carcinoma of the breast in Bavaria increased and we compared different years. The standardized mortality ratio increased between 1977 and 1990 from 91 to about 108% Neither diagnostics using update equipment nor an individualised therapy improved the situation. The slightly increasing incidence rate does not explain the present rate of deaths in cancer. An important factor is the younger age and the endocrine situation of women at the time of the primary disease. 50% of our patients are less than 55 years old and pre- or perimenopausal. Estrogen-gestagen combinations used in contraceptives and hormone replacement therapy (HRS) seem to have a stimulating effect (Henderson). The significant decrease in cervical cancer is encouraging, but does not compensate the increase in breast cancer. No significant change is seen in ovarian cancer.

From 1976 to 1978 11, 197 women were examined clinically and mammographically. Biopsy material from 1,673 breasts were examined microscopically. In 536 cases, or almost every third case (32%), a carcinoma of the breast was detected. The cancer was bilateral in 19 cases and the total number of women was therefore 517. A clinically occult tumour was only found in 7.7% (40 of 517) of the cases. 5% of these patients were high risk patients and 2.7% preventive examinations. 5 women with occult carcinoma of the breast were under age 40 and 14 under age 50. Benign changes of the glandular tissue were found in 59.5% of the cases. Marked proliferative changes were found in 4.6% of the cases and carcinoma in situ was found in 3.8% of the patients. In the age group 45--54 benign and proliferative changes of the parenchyma occured almost twice as often as cancers. The ratio between benign and malignant findings was 1:1 in the age group 55--59 and was less than 1:2 in the age group over 70. A sophistication of the mammograhic technique must be obtained. A thorough microscopic examination of tissue from subcutaneous mastectomies and tissue obtained at the time of reduction mammoplasties showed occasionally unexpected malignant tissue in an unexpected location. Especially these cases are suitable for later comparison to the mammographies.

In 614 breasts tumours assumed to be harmless cysts on palpation were aspirated. In 430 cases aspiration was the definitive treatment. In the other 184 cases excision was necessary in order to obtain histology. 11 cysts were radiologically suspect after air filling. In one case excision demonstrated an undifferentiated milk duct carcinoma. 12 cysts had radiologically suspicious areas outside their margins. In 4 cases lobular carcinoma in situ was present. 161 excisions were necessary because no fluid was aspirated at puncture of the tumour. In 10 cases histology showed malignancy: half of these were metastases from a known primary tumour and half were primary breast carcinomas. Out of 17 precancerous states neoplasia could be demonstrated in two cases in addition to papillary and proliferative duct changes. We have classified this neoplasia as lobular carcinoma in situ.

67 breast cancers with a maximum diameter of up to 10 mm on the histological section were retrospectively analysed according to the primary situation for medical consultation and the way to cancer diagnosis. 46 women presented themselves with clinical signs. 19 women had an anamnestical risk, whereas only two women were without any risks or symptoms. 34 tumourspecific clinical signs are followed by 25 tumourspecific mammograms. Eight small invasive carcinomas were detected only under the microscope, two of them in mastectomy specimens. Even small cancers, therefore, are mostly diagnosed from the patients themselves. The contribution of mammography is tremendous. Intensified systematic histological examination of biopsies and mastectomy specimens is mandatory especially in high risk patients.

In the last 19 years 47,518 women had mammographies at the Department of Gynaecology of the University of Erlangen. 1653 patients had 2215 galactograms. Biopsies of the breast indicated by mammography were done in 1521 cases. 955 cases showed micro-calcifications in groups. 566 showed abnormal galactograms. The microscopic examination in the 955 cases with microcalcifications showed invasive carcinoma, carcinoma in situ or atypical epithelial proliferations in 1/3 of the cases In 10% of the cases small calcified fibroadenomata, papillomas or granulomas were found. In 60% of the biopsies mammary dysplasia partly with nonatypical epithelial proliferations were found. When the galactogram showed pathological contours the breast tissue was excised in a segment. In over 40% of 566 segmental excisions papillomata were the cause of pathological secretions from the breast. Ductal carcinomas, carcinoma in situ and extensive intraductal solid papillary or adenomatous epithelial proliferations were found in 27% of the cases. Approximately the same number of cases did not show atypical epithelial proliferations. Delay in the early diagnosis of changes which may be the first sign of malignant breast disease can be avoided by good cooperations between the physicians treating the cases.