Metastasis to the Bones from Carcinoma of the Breast: A Roentgenologic Study

METASTASIS to the bones from carcinoma of the breast is of great practical interest because of its frequency. The roentgenologic examination is of paramount importance in detecting the condition. Careful interpretation of the roentgenograms often determines operability of carcinoma of the breast, averts fruitless surgery, and enhances the accuracy of prognosis. In view of these considerations, we have reviewed the records of 1,985 cases of carcinoma of the breast examined at the Mayo Clinic during the last six years. In sixty-seven (3.48 per cent) metastasis to the bones had occurred. Necropsy records, which obviously cannot be compared with statistics of the living, have shown percentages as high as 26.5 (4). In 329 necropsies at Middlesex Hospital, metastasis from carcinoma of the breast was found in seventy-three cases (22 per cent) (3). Matthews quotes Leutzinger's statistics showing that there is metastasis to the bone in 14 per cent of cases of carcinoma of the breast. Muller, in 858 necropsies, found metastasis to the bone in 144 cases (16.5 per cent). Since the bones are rarely all examined at necropsy, the maximal estimate of 26.5 per cent at the time of death is doubtless still too low. As Pfahler suggests, complete examination of the bones with the roentgen ray would probably be more reliable. It is fairly certain, however, that with carcinoma of the breast there is a higher incidence of metastasis to the bones than with carcinoma in any other organ. Sixty-four of the patients were females and three were males. The average age was forty-eight and seven-tenths years; the youngest patient was twenty-nine and the oldest sixty-seven. The average number of pregnancies was 2.4. The right breast was the primary seat of growth in thirty-five cases, and the left in thirty-one; in one case both breasts were affected. Examination of the urine was negative. The Wassermann test was negative in the sixty-one cases in which it was performed. Symptoms which led to roentgenologic examination were variable pains, referred to the back, hips, legs, and so forth, in sixty-one cases. The pain was usually neuritic, occurred below the site of the affected part, and varied from mild “rheumatic” or “sciatic” to severe and continuous, requiring opiates. Many of the patients did not appear very ill nor had they lost weight markedly. In three cases of the series, fracture from trauma insufficient to produce fracture of a normal bone was the first sign. In two cases there was no reason to suspect metastasis, and it was discovered by the routine roentgenologic examination. A palpable tumor at the site of metastasis was noted in only one case. The axillary glands were found to be affected in forty cases, the supraclavicular glands in three, both supraclavicular and axillary glands in six, and the chest wall in two, making a total of fifty-three cases (79 per cent) in which there was glandular involvement.