Heimann and Hellman (1) reported the survival of 2136 breast patients with local or regional cancer. The figure below is reproduced from their Fig. 1. It depicts the survival of patients with a tumor greater than 2 cm, divided into three groups according to their lymph node status. Respectively 0, 1-3, or more than three positive lymph nodes. Survival is depicted on a logarithmic scale. The line depicts the slope following diagnosis.

Following diagnosis survival declines rapidly and gradually levels off. This pattern is an epidemiological hallmark of cancer. It can be summarized by the following statement” The longer you live the better your chances to survive” and is explained elsewhere.

The slope of the line is it’s survival derivative, which is closely related to the hazard rate. It indicates that about three years following treatment the hazard is relatively high and declines afterwards, like in this figure.

The rising hazard following treatment indicates that the patient depends somehow on her tumor . The survival slope is shaped by  two factors: 1. Disease progression and 2. Treatment.  As cancer progresses the patient depends more and more on her tumor, the survival  slope becomes  steeper and the hazard rises.

The therapeutic implication is straight forward: As long as tumor does not impinge upon a vital function and does not cause pain or suffering it ought to be left intact. Treatment ought to preserve the tumor and alleviate its secondary manifestations.

Additional reading:
Pernicious cachexia
Metastasis following treatment
Bi-modal hazard rate
WOB controls cancer


1 Ruth Heimann, Samuel Hellman
Clinical Progression of Breast Cancer Malignant Behavior: What to Expect and When to Expect it.
Journal of Clinical Oncology, Vol 18, Issue 3 (February), 2000: 591

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