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Klinische Wochenschrift

, Volume 59, Issue 15, pp 819–829 | Cite as

Pathobiology of breast cancer: Hypothesis of biological predetermination and long-term survival

  • H. Vorherr
Übersichten

Summary

The pathobiology of breast cancer is complex: clinically “early” breast cancer may be tumorbiologically “late” progressing rapidly toward death. Accordingly, it has been suggested that two different breast cancer populations (slow tumor growth and long survival — fast tumor growth and short survival) exist, which cannot be identified by pathohistological criteria. However, these “populations” are most likely either patients with localized disease and occult metastases (long survival) or with diagnosable regional and occult or overt systemic spread (short survival). Since even small tumors (0.1 to 0.3 cm in diameter) can spread systemically, in most patients breast cancer upon clinical diagnosis may be considered an inevitably lethal disease. Present treatment modalities can only improve the quality of life and delay death, even though the overall long-term survival rates of breast cancer are better or at least equal to those of other cancers. However, with other cancers (Table 2) it is decided within the first 5 years which patients are cured because the survival rates for 5, 10, 15, and 20 years are similar. In contrast, survival rates of patients with breast cancer steadily decline and there is no point in time when patients can feel really safe; this is indicative of a peculiar tumor pathobiology of this disease, the nature of which remains to be investigated. Progress in the fight against breast cancer is only possible by application of sensitive physical, reliable immunological, and specific biochemical methods for early diagnosis and development of efficient therapeutic modalities for inhibition of growth or complete eradication of metastasized cancer cells.

Key words

Breast cancer Pathobiology Survival 

Pathobiologie des Mammakarzinoms: Hypothese der biologischen Prädetermination — Langzeit-Überleben

Zusammenfassung

Die Pathobiologie des Mammakarzinoms ist komplex. Brustkrebs diagnosed als klinisch im Frühstadium kann tumorbiologisch schon im Spätstadium sein und die Überlebenszeit ist kurz. Demzufolge wurde auf das Bestehen von zwei verschiedenen Brustkrebspopulationen hingewiesen: (1) langsames Tumorwachstum und lange Überlebenszeit, (2) rasches Tumorwachstum und kurze Überlebenszeit. Diese zwei Populationen sind nicht durch pathohistologische Kriterien identifizierbar. Sehr wahrscheinlich sind dies Patienten mit lokalisiertem Tumor und okulten Metastasen (lange Überlebenszeit) oder solche mit regionaler und systemisch okulter oder klinisch diagnostizierbarer Streuung (kurze Überlebenszeit). Da kleine Tumoren (0.1 bis 0.3 cm im Durchmesser) schon metastasieren können, so muß in den meisten Fällen Brustkrebs zur Zeit der klinischen Diagnose als unabwendbare tödliche Erkrankung angesehen werden. Da gegenwärtige Behandlungsmethoden nicht alle metastasierten Krebszellen vernichten können, so kann durch die Therapie nur die Qualität des Lebens verbessert und die Dauer verlängert werden. Trotzdem sind die Langzeit-Überlebensraten des Brustkrebses höher oder zumindest gleich denen anderer Karzinome. Allerdings ist bei anderen Malignomen (Tabelle 2) das Schicksal innerhalb von 5 Jahren entschieden und Patienten, die nach 5 Jahren noch leben, können als geheilt angesehen werden, da die Überlebensraten für 5, 10, 15 und 20 Jahre ähnlich sind. Im Gegensatz dazu nimmt die Überlebensrate für Brustkrebs ständig ab und zu keinem Zeitpunkt können sich die Patientinnen wirklich sicher fühlen; dies spricht für eine besondere Tumorpathobiologie dieser Erkrankung, deren Eigenheit noch zu erforschen ist. Fortschritt in der Bekämpfung des Brustkrebses ist nur möglich durch Anwendung von empfindlichen physikalischen, spezifischen biochemischen und verlässlichen immunologischen Methoden zur Diagnose sowie Entwicklung von therapeutischen Modalitäten zur Wachstumshemmung oder völliger Vernichtung metastasierter Karzinomzellen.

Schlüsselwörter

Brustkrebs Pathobiologie Überlebenszeit 

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Copyright information

© Springer-Verlag 1981

Authors and Affiliations

  • H. Vorherr
    • 1
  1. 1.Departments of Obstetrics-Gynecology and of PharmacologyThe University of New Mexico, School of MedicineAlbuquerque

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