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Correlations between obesity and prognosis of operated cancer of the breast have not been investigated until now. In 491 patients operated upon by radical mastectomy (1968 to 1972) it can be demonstrated that in patients in whom the weight of the resected breast is above 1100 g the survival rates are more unfavourable than in other cases. As to tumor size and invasion of lymphnodes the distribution in the group with "heavy breasts" is more unfavourable than in the other groups. The causes of the differences in survival may be attributed to worsened conditions for detection of cancer in cases with large breasts as well as to alterations of hormone production and metabolism in connection with nutritional factors.

This analysis of 1100 cases with cancer of the female breast treated by classical radical mastectomy demonstrates an improvement of the 5-year-survival-rate from 53,0% (1960-1964) to 61,2% (1968-1972). In this period we observed an increase of cases with cancernegative lymphnodes from 39,0% to 50,8%. This improvement is the result of earlier diagnosis because there has been no selection for surgical treatment during this period. Additional methods of treatment (irradiation, chemotherapy) are without convincing influence on survival rates. Therefore, earlier detection and radical surgical treatment will play the dominating role in the near future.

The value of radical mastectomy in treating cancer of the breast has been questioned by some authors. With regard to the results published and on the basis of our own experiences limited operations without or with additional radiotherapy cannot be considered to be reliable procedures at present: it is only possible to approximately equal results by a strict case selection. With special cases such as in-situ carcinoma or small well defined cancers with beginning infiltration being expected there is no real basis for the indication to limited surgery in a single case. With the increase of small prognostically favourable cancers and border-line cases due to improvement of early detection more attention should be devoted to the problem of treating breast cancer by limited operations.

A randomized clinical trial on adjuvant treatment of operable breast cancer in female aged between 35 and 70 years was performed from 1962 to 1972. Criteria for admission into the trial were: unequivocal clinical evidence of breast cancer stage T1-3 NC-3; no general or technical contraindications against standard radical mastectomy type Rotter-Halsted; no contraindications against radiation or cytostatic treatment: 435 patients entered the trial and 372 patients were evaluable. Of these 126 were treated by surgery, 126 by surgery followed by cyclophosphamide (100 mg/kg BW in daily intravenous doses of 200 mg), and 120 by preoperative radiation therapy (about 5500 rad tumour dose by telecobalt) and surgery. The crude 5-year survival rate was 58.7 percent, 57.1 percent, and 57.5 percent respectively. The number of local recurrences and local node metastases was 29.4% after surgery, 23.0% after surgery combined with chemotherapy, and 12,5% after surgery combined with preoperative radiation therapy. This significant reduction in locoregional recurrences was most impressive in the supraclavicular node region. In the irradiated group, the mean diameter of tumours in the surgical specimen was obviously smaller and in 11 cases the tumour in the breast was completely destroyed.