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In 1,000 specimens of mastectomy with microscopically proven carcinoma of the breast, cancer was found in the nipple in approximately every fifth case. Extension of the carcinoma into the nipple is more frequent in the higher age group of women. Extension into the nipple is more common with larger tumor size. The microscopic growth pattern of the carcinoma has an influence on the presence of tumor in the nipple whereas the microscopic grading for malignancy according to WHO has no clear cut correlation to tumor in the nipple. The frequency of extension of carcinoma of the breast in the nipple in our series and in most series in the literature is in our opinion a contra-indication to conservative types of operation.

On the basis of experience with more than 5000 patients, a new classification of potentially precancerous alterations of the breast tissue was undertaken on the basis of more than 200 000 sections. This new classification distinguishes a mastodysplasia minima, a mastodysplasia media and mastodysplasia persevera (lobular and ductular structure). The borderline cases of mastodysplasia media require especially intensive discussion. The histological description is made to serve patient-orientated medicine. On the basis of this classification, potential prestages of breast cancer can be healed when the appropriate inference is made from the exact diagnosis. With advances in technique of breast surgery, subcutaneous mastectomy is to be considered as a possible method of choice. In particular, this also applies as prophylactic therapy in unclear borderline cases, above all in mastodysplasia persevera, and in occasional cases also in mastodysplasia media. The classification of the different degrees of severity of mastodysplasia (as a potential precancerous condition of the breast) has been used successfully for more than six years in a large number of patients.

In a random sample of 1,000 mastectomies from microscopically proven cancer of the breast the concomitant evidence of cancer in the nipple and the axillary lymph nodes were studied. Cases with evidence of cancer in the nipple showed axillary metastases twice as often as cases without evidence of cancer in the nipple. In cases with diffuse or lymphangetic evidence of cancer in the nipple the incidence of metastases in the axillary lymph nodes was twice as high in cases with intra-ductal or paget type evidence of carcinoma in the nipple. In cases with evidence of cancer in the nipple, the incidence of metastases in the axillary lymph nodes decreases more with age than in cases without evidence of breast cancer in the nipple. With increasing tumour size the evidence of breast cancer in the axillary lymph nodes was higher in cases without evidence of cancer in the nipple than in cases with evidence of cancer in the nipple. The microscopic differentiation and the grade of malignancy also had an influence on the incidence of axillary metastases in correlation to evidence of cancer in the nipple.