Multiple Primary Cancers

Introduction Because multiple primary cancers have been found to occur oftener than expected among necropsy cases at the State of Wisconsin General Hospital, a tabulation of such cases has been made and their incidence computed. Comparison with previous reports has been facilitated by the work of Warren and Gates (1), who published in 1932 the results of a comprehensive survey of all cases reported up to that date, beginning with the initial case described by Billroth (2) in 1869. From all sources (they cite 430 authors in their exhaustive bibliography), they were able to collect 1219 apparently authentic cases, to which they added their own series of 40, making a total of 1259. They computed the incidence of multiple malignancy among all malignancies at 1.84 per cent on the basis of the collected statistics, at 3.9 per cent on the basis of American statistics alone, and at 3.7 per cent on their own series. Of reports published prior to 1932, one from the American literature should receive brief recognition, that of Major (3) of the University of Kansas, appearing in 1918. With one interesting surgical case of his own as an inspiration, he collected 220 additional cases, mainly from foreign sources, of which approximately 180 to 190 would qualify as true multiple primary cancers today. His bibliography lists 196 authors, mostly German. Of reports published subsequent to 1932, the more important contributions, in which whole series rather than individual cases are described, are those of Hurt and Broders (4) of the Mayo Clinic, Schreiner and Wehr (5) from the State Institute for the Study of Malignant Diseases at Buffalo, N. Y., and Bugher (6) of the University of Michigan.