Some of the difficulties encountered in the diagnosis and treatment of breast tumors are well illustrated in the record of a patient recently seen. A woman, aged sixty-three, consulted me because of several “lumps” in the right pectoral region along the lower border of the pectoralis major, near the anterior fold of the right axilla. These “lumps” were small, and neither tender nor painful, so that the patient paid little attention to them after she first noticed them early in February, 1930, until in October, 1930, when she found that they had increased considerably in size. Even then, though nine months had elapsed since they were first noticed, she explained that she would not have come for examination had not an intimate friend been operated upon recently for a tumor of the breast which proved to be cancer.
Physical examination revealed a string of lymph nodes extending into the axilla, the largest of which was several centimeters in diameter. They lay along the lower border of the pectoralis major muscle and axilla for a distance of about 10 cm. The overlying skin was freely movable. There was no dimpling. The right breast was large, regular in outline, and most careful palpation by several other clinicians and myself failed to arouse the slightest suspicion of a tumor. The left breast was also normal. The patient was in good general health with no abnormalities which could be discovered except two small soft subcutaneous tumors on the right forearm, which were considered to be lipomas and unrelated to the growth in the axilla.