The Auxometric Dimension

A system of auxometric staging for the clinical growth rate of breast cancer can be created by considering the observed duration of the tumor and the concomitant occurrence of transition events. In an inception cohort of 219 women with histologically confirmed breast cancers that had first been treated at the Yale-New Haven Hospital during the interval 1962 to 1964, the overall five-year survival rate was 63%. Within categories of the three new auxometric stages, the five-year survival rates were as follows: slow, 37/45 (82%); intermediate, 85/133 (64%); and rapid, 15/41 (37%). These auxometric categories were combined with conventional TNM anatomic categories to form a composite anatomic-auxometric system of four stages, A through D. A particularly striking feature of the new composite system was the demarcation of 22 patients in stage A who had a 100% five-year survival rate, regardless of whether mastectomy was simple or radical. In stages B, C, and D, radical mastectomy appeared superior to simple mastectomy, but the results may have been affected by bias in selecting patients according to prognostic features that are not included in the composite new stages. The results are pertinent in therapeutic decisions for individual patients, in the design of large-scale therapeutic trials, and in biologic correlation of diverse laboratory research. Because a cancer has biologic function as well as anatomic structure, both the function and the structure require appropriate analytic attention. The exclusively anatomic categories that form the basis of conventional systems of staging for breast cancer can be complemented, augmented, and improved by suitable consideration of the clinical rate of growth. (JAMA228:180-185, 1974)