Breast cancer--biology and malpractice.

Cure of breast cancer, strictly defined, is the elimination of hazard for death due to breast cancer. Five-year survival is often incorrectly equated with cure. A review of the literature reveals (a) the relative survival for breast cancer maintains a negative slope for up to 30+ years, a sign of incurability; (b) no more than 20% of women diagnosed with breast cancer survive their disease and die of other causes (personal cures). The incidence of breast cancer has been rising for over 50 years; a rise in breast cancer mortality is possibly beginning. Modest evidence for cure of breast cancer is largely based on the results of the Health Insurance Plan study. Important methodologic problems of the study warrant cautions interpretation. When treatment expectations are maintained at a high level and there is no improvement and perhaps a worsening of mortality, the stage is set for a distressingly large volume of medical malpractice actions.