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The increase of high general operative risks in women presenting for gynaecological operations suggested the investigation of the influence of these risks on the choice of treatment of gynaecologic cancers appropriate for the stage. The primary treatment of 426 gynaecologic and breast cancers of the year 1977 is reviewed. There were 53 endometrial carcinomas, 29 ovarian carcinomas, 185 breast cancers, 142 carcinomas of the cervix and pre-invasive carcinoma of the cervix. There were 17 other carcinomas. 354 patients were selected for operative treatment. 72 patients were selected for primary radiotherapy. A considerable number of patients (40-60%) were selected for treatment appropriate for the stage of the cancer by a system of diagnosis of risks, classifications of risks, evaluation of risks and pre-operative treatment of operative risks. The choice of the cancer treatment appropriate to the stage is not influenced by single risks but by the sum of the general operative risks. Typical mistakes in evaluation of operative risks versus indications for the operations are described in case reports. The reports include avoidable and unavoided risks.

A review is presented on 520 patients who had biopsies of the breast which did not show cancer between 1972-1974. These patients are compared to 304 patients whose biopsies definitely showed cancer of the breast and 520 patients who came to the hospital because of well defined gynaecological disease such as uterine fibroids or uterine prolapse. Comparison of these groups regarding age, past history, indications for the biopsy showed that patients with a biopsy without proof of cancer are difficult to follow for diagnosis. Follow-up on these patients is difficult, however, it is important since up to 4% of these patients with previous negative biopsies later have cancer of the breast. A decrease of biopsies in favor of non-surgical diagnosis of breast lesions can only be recommended under optimal conditions. Under other circumstances the risk of cancer of the breast is high enough to justify a liberal indication for breast biopsies.