Seminars in Roentgenology VOL XXVIII, NO 3 JULY 1993

Letter From the Editor: Are We Really Doing Good?

T HIS ISSUE presents a number of aspects am sure that every reader of this journal knows on breast cancer, one of the most impor- someone well, perhaps a family member or a

tant and pervasive malignancies of our time. I very close friend, who has had breast cancer and

Fig 1. Age-adjusted cancer death rates for selected sites for women in the United States. (Re- printed with permission J)

Seminars in Roentgenology, Vol XXVlII, No 3 (July), 1993: pp 175-176 175

176 WALLACE T. MILLER

who either is a survivor of that experience or has succumbed to the ravages of that disease.

One of the very troubling aspects of this disease is that the mortality rate (Fig 1) has remained constant (or even increased slightly) since 1930. Other tumors such as colorectal carcinoma and uterine malignancy are decreas- ing, certainly partly because of medical interven- tions. Carcinoma of the stomach is also decreas- ing, but this probably reflects a true decrease in the incidence of the disease. Of course, the mortality rate from carcinoma of the lung is ascending rapidly in women as well as men.

Why has the mortality rate in carcinoma of the breast remained so stable? Every article in this issue points to improved survival from the techniques described by each of the authors. Certainly mammography has made a major contribution to early detection and long-term survival of breast carcinoma. So has chemother- apy. New surgical and radiation therapy tech- niques also show prolonged survival statistics. Why then no impact on the death rate? The answer must lie in the increasing incidence of breast carcinoma as described in the report by Kevin Fox. Somehow, the increased incidence just balances out the improved survival. Of course, we must always be concerned that the

increased incidence reflects detected low-grade tumors that were previously undetected and held little threat for the survival of the patient. This would suggest that all of our scientific and clinical efforts have had little impact on this very prevalent disease.

I hope that this is not so and do not believe that it is so. Various statistical studies have shown that it should not be so. Nonetheless, the nagging doubt persists: why hasn't that mortal- ity rate started downward, at least a little bit? It may be that it is too early to see the impact of many recent changes and that the decline will begin to occur in the next 10 or 15 years.

As physicians, we all like to think that we are "doing good" and making an impact on diseases such as cancer. But remember, many decades ago, some of our physician ancestors thought they were doing good by bleeding and purging the sick.

Wallace T. Miller, MD Editor

REFERENCES

1. Boring C, Squires TS, Tong T: Cancer Statistics 1993. CA Cancer J Clin 43:7-41, 1993