THE JOURNAL OF CANCER RESEARCH VOLUME XIV JUNE. 1930 NUMBER2 THE AGE AND SEX DISTRIBUTION AND INCIDENCE OF NEOPLASTIC DISEASES AT THE MEMORIAL HOSPITAL, NEW YORK CITY * GEORGE T . PACK AND ROBERT G . LEFEVRE TABLE OF CONTENTS I . Introduction ......................................... 169 I1. Statistical Data ...................................... 171 A . Tumors of the Skin ............................. 172 1. Epidermoid carcinoma ................... 172 2 . Basal-cell epithelioma ..................... 175 3 . Melanoma ............................... 176 4 . Sarcoma of skin .......................... 177 5 . Hemangioma ............................. 177 B. Tumors of the Nervous System .................. 177 1. Brain tumors ............................. 177 2 . Spinal cord tumors ........................ 177 3 . Neurofibroma ............................ 177 4 . Neurogenic sarcoma ....................... 179 C. Tumors of Bone and Cartilage ................... 179 1. Chondroma and Chondrosarcoma ........... 179 2 . Giant-cell tumor .......................... 181 3. Bone sarcoma ............................ 182 4 . Endothelial myeloma ...................... 183 5 . Multiple myeloma ........................ 184 D . Tumors of the Intra-oral Group ................. 185 1. Epidermoid carcinoma of lip ............... 185 2 . Epidermoid carcinoma of floor of mouth ..... 186 3 . Epidermoid carcinoma of tongue ............ 186 4 . Epidermoid carcinoma of buccal mucosa ..... 188 Aided by a grant from the Mrs . John L . Given Fund . 167 12 168 GEORGE T . PACK AND ROBERT a. LBFEVRE 5. Adenoid cystic epithelioma of mucous mem- branes ............................... 188 6 . Epidermoid carcinoma of antrum and superior maxilla .............................. 191 7 . Epidermoid carcinoma of inferior alveolus .... 191 8 . Epithelioma of faucial tonsil ............... 192 9 . Epidermoid carcinoma of larynx ............ 197 10. Carcinoma of nasal mucosa ................ 199 11. Tumora of parotid gland ................... 200 E . Tumors of Gastro-Intestinal Tract (exclusive of oral cavity) ..................................... 201 1. Carcinoma of esophagus ...................201 2 . Carcinoma of stomach .....................202 3 . Carcinoma of small intestine ............... 206 4 . Carcinoma of appendix ....................207 5. Carcinoma of colon ....................... 208 6. Carcinoma of rectum ......................208 7 . Carcinoma of anus ........................210 8 . Carcinoma of pancrem .................... 210 9 . Carcinoma of gall-bladder ................. 210 10. Primary carcinoma of liver ................. 211 F . Tumors of the Genito-Urinary System ............ 211 1. Carcinoma of urethra .....................211 2. Papilloma of urinary bladder ............... 215 3. Carcinoma of urinary bladder .............. 215 4 . Carcinoma of kidney ...................... 216 5. Adenomyosarcoma of kidney ............... 216 6. Hypernephroma .......................... 217 7. Epidermoid carcinoma of penis ............. 218 8 . Teratoma testis .......................... 219 9 . Sarcoma of testis .........................221 10. Carcinoma of prostate gland ............... 222 11. Sarcoma of prostate gland ................. 223 12. Epidermoid carcinoma of vulva ............. 224 13 . Epidermoid carcinoma of vagina ............ 224 14. Sarcoma of vagina ........................225 15. Carcinoma of cervix uteri .................. 226 16. Ca'rcinoma of body of uterus ............... 229 17. Leiomyofibroma of uterus .................. 230 18. Myosarcoma of uterus ..................... 231 AGE AND SEX DISTRIBUTION 169 19. Carcinoma of ovary ....................... 231 20 . Sarcoma of ovary .........................233 21. Benign ovarian cysts ...................... 234 G . Tumors of the Breast ...........................234 1. Fibro-adenoma ...........................234 2. Intra-cystic benign papilloma .............. 235 3 . Carcinoma of breast ...................... 235 4 . Sarcoma of breast ........................ 240 5 . PagetJa disease of nipple ................... 240 H . Tumors of the Soft Somatic Tissues .............. 241 1. Lipoma .................................241 2 . Liposarcoma .............................241 3 . Sarcoma of aoft parts ..................... 241 I. Tumors of Lymphoid Tisaue and Allied Diseases ... 245 1. Lymphosarcoma .......................... 245 2 . Sarcoma of spleen ........................ 245 3 . Thymic tumor ...........................246 4 . Endothelioma of lymph nodes ..............246 5. Hodgkin's diaesae ......................... 247 6. Lymphatic leukemia ......................247 7 . Spleno-myelogenous leukemia .............. 248 J . Miscellaneou Tumors .......................... 249 1. Ocular tumors ........................... 249 2 . Primary carcinoma of lungs ................ 249 3. Sarcoma of lung .......................... 252 4 . Sarcoma of thyroid ....................... 252 5. Thyroid adenoma ......................... 254 6. Thyroid carcinoma ....................... 254 I11 . Ascending Scale of Average Age Occurrence of Different Malignant Neoplasms ............................. 256 IV . Relation of Cancer to Old Age and Youth ............... 258 V. Influence of Sex on the Distribution of Neoplastic Diseases . 283 VI . Summary ...........................................286 VII . References ...........................................290 INTRODUCTION The purpose of this study is a consideration of the age and sex distribution and incidence of benign and malignant tumors at the Memorial Hospital of New York City. In the usual statistical study of tumors, there are several 170 GEORGE T. PACE AND ROBERT G. LEFEVRE palpaple sources of error. One such source is the variable latent period existing between the time the tumor begins and its dis- covery. This variability depends on many factors such as the type and nature of the particular tumor, the intelligence and personal concern of the patient and the diagnostic acumen of his physician. The difference in time is not so important as regards the age of patients with malignant tumors, because few cancers exist longer than one to two years without discovery by the patient. Proper consideration should be given to the length of time during which the tumor existed subsequent to its dis- covery and prior to the admission of the patient to the clinic. This period is considerable for such slow-growing tumors as basal-cell cancers, lipomas and neurofibromas. The patient's estimation of this time interval is frequently unreliable. An- other disturbing source of error is the obscurity of the primary location of certain carcinomas secondarily involving the liver or cervical lymph nodes. Some statistics covering cancer ages are based on mortality figures, which are naturally later than the ages of onset. The data of the Memorial Hospital are unique in several respects: The sole function of this hospital is the diagnosis and treatment of cancer and allied diseases; a central admitting office is maintained, wherein the primary and presumptive diag- noses are made, after which the patients are referred to suitable departments for confirmation of the diagnoses and appropriate treatment; the personnel of the different departments through long experience has become proficient in the clinical diagnosis of cancer; the pathology laboratory under the direct supervision of one pathologist for many years, has enjoyed an unusual opportunity in the histological diagnosis of neoplastic diseases; equal numbers of beds are available for men and women. Because of this abundance of material with unity of source, a considerable degree of reliability can be assumed for statistical data based on tumor diagnosis in this institution. Some of the facts to be determined in this study are: (1) the percentage of admissions to the hospital and clinics, comprised by each tumor group; (2) the age distribution of benign and AGE AND SEX DISTRIBUTION 171 malignant tumors; (3) the age incidence of the more malignant tumors; (4) the average age of the patient at the onset of each type of tumor; (5) the youngest and oldest age in each tumor group; (6) the quinquennial age-period of maximal liability; (7) the sex distribution in five year periods of all benign and malig- nant tumors; (8) the percentage occurrence of the benign and malignant tumors in each sex; (9) the percentage of the different histological tumor entities in each regional group, e. g., the breast, or the mouth; (10) the statistical determination of the tumors of youth and of old age. By age distribution, we refer to the particular number of cases found at each age period. By age incidence, we refer to the ratios found at any given age period, which are secured by a comparison of the percentage of carcinoma at that age period with the percentage of the general population at the same period. The average age at which any tumor occurs is usually less than the quinquennial age-period of maximal liability, due to the fact that a greater number of cases of this particular tumor occurs previous to this period than occurs subsequently. Finally, we shall insert certain brief case reports, for the pur- pose of illustration and to record certain tumor occurrences at unusual ages, particularly in the extremes of life. STATISTICAL DATA During the inclusive period, January 1, 1917 to January 1, 1929, nineteen thousand, one hundred and twenty-nine (19,129) patients with neoplastic diseases were accepted for diagnosis and treatment at the Memorial Hospital.