Staging and treatment of clinically occult breast cancer

Five hundred fifty-seven biopsies were performed for clinically occult mammary lesions, detected by mammography as clustered calcifications or nonpalpable masses within the breast. One hundred seventy-five cancers were demonstrated within this group, including 106 invasive carcinomas, 10 microinvasive carcinomas, 45 in situ ductal carcinomas, and 14 lobular carcinomas in situ (lobular neoplasia). No patient with in situ or microinvasive carcinoma had evidence of axillary node metastases in 33 specimens studied. However, a disturbingly high proportion of those patients with invasive carcinomas, approximately 35%, had histologically confirmed axillary node metastases, despite the small size of the primary tumors. These observations suggest that the use of the term "minimal" cancer is misleading when applied to invasive carcinoma. Staging systems for breast cancer have been imprecise when referring to nonpalpable lesions. Cancers detected as clustered calcifications only or as areas of parenchymal distortion without an accompanying mass are properly considered as T-0 cancers, with a suggested T-0(m) to indicate that the lesion was detected by mammography. However, when the mammogram indicates the presence of a mass that proves to be malignant, although the clinical examination may have been negative, the cancer should be staged according to the size of the mass on the mammogram, with the notation that it was detected by mammography, e.g., T-1(m), T-2(m), etc. The incidence of axillary node metastases even in these so-called occult cancers is significant, so that recommendations for treatment for any invasive cancer, regardless of its size, must take these observations into account. Similarly, the incidence of multifocal sites of cancer within the breast, even in the noninvasive cancers encountered, must be remembered when treatment is suggested.     

Ultrasound-guided lumpectomy of nonpalpable breast cancers: A feasibility study looking at the accuracy of obtained margins.

BACKGROUND AND OBJECTIVES: Complete excision of a nonpalpable breast cancer after wire localization is a difficult procedure. Often, adequate margins are not obtained, and a second procedure is then required. Prospectively, we studied the feasibility of ultrasound-guided excisions of nonpalpable breast cancers, with particular attention to the accuracy of the procedure in obtaining adequate margins. METHODS: Prospectively, 19 patients with 20 mammographically detected nonpalpable, highly suspect, breast tumors were entered in this feasibility study. In 15 of these, the diagnosis of invasive malignancy was established preoperatively. All patients underwent ultrasound-guided excision with the intent to obtain adequate margins. We also reviewed our own experience with the excision of nonpalpable breast cancers after wire localization. RESULTS: Of the 20 excisions with ultrasound guidance, there were 19 carcinomas and 1 ductal carcinoma in situ. Of the 19 carcinomas, 17 (89%) were excised with adequate margins. Of the 43 carcinomas that were excised after wire localization, only 17 (40%) had been resected with adequate margins. CONCLUSIONS: Ultrasound-guided excision appears to be a reliable procedure for obtaining adequate margins in the resection of nonpalpable breast cancers. Other advantages of this procedure are increased patient comfort and decrease in operating room time.     

基质金属蛋白酶8在乳腺癌中的表达及其临床意义

目的 分析基质金属蛋白酶8（MMP-8）在乳腺癌中的表达及其与各临床病理参数间的关系,评估MMP-8的表达与乳腺癌转移的相关性.方法 收集具有完整临床资料的乳腺浸润性导管癌标本50例及癌旁正常乳腺组织标本20例,采用免疫组织化学染色SP法检测原发灶中MMP-8表达情况.结果 50例乳腺癌组织中MMP-8阳性表达率高于正常乳腺组织标本[68％（34/50）比15％（3/20）,P＜ 0.05].Ⅰ期乳腺癌MMP-8阳性表达率高于Ⅱ、Ⅲ＋Ⅳ期[94％（15/16）、57 ％（13/23）、55％（6/11）,P＜0.05],无淋巴结转移乳腺癌患者MMP-8阳性表达率高于有淋巴结转移者[84％（21/25）比50％（13/25）,P＜0.05].结论 MMP-8的表达与乳腺癌的转移相关,MMP-8可能参与抑制乳腺癌的转移.     

Clinically Positive Axillary Lymphadenopathy May Lead to False Diagnosis of Overstaged Breast Cancer in Patients with Sjögren's Syndrome: A Case Report

Sj?gren's syndrome (SS) is an autoimmune disease that chronic inflammation and lymph node proliferation. Patients with SS carry a greater risk of developing lymphoproliferative malignancy. In addition to other organ cancers, breast cancer may also occur in these patients. Considering these, breast cancer in patients with SS can be misdiagnosed as being in an advanced stage particularly in the presence of axillary lymphadenopathy. Here, we report a rare case of a 45-year-old woman with SS who presented with a breast mass. Radiology showed a 4 cm solid lesion and conglomerates of axillary lymphadonepathy. A breast biopsy revealed ductal carcinoma in situ. A modified radical mastectomy was performed; however, no axillary metastases were detected. Clinicians should remain vigilant to the possibility that a false clinical impression of axillary metastasis may occur in such patients with breast cancer. Therefore, axillary node status should be verified first.     

Clinically Positive Axillary Lymphadenopathy May Lead to False Diagnosis of Overstaged Breast Cancer in Patients with Sj?gren's Syndrome: A Case Report

Sjögren''s syndrome (SS) is an autoimmune disease that chronic inflammation and lymph node proliferation. Patients with SS carry a greater risk of developing lymphoproliferative malignancy. In addition to other organ cancers, breast cancer may also occur in these patients. Considering these, breast cancer in patients with SS can be misdiagnosed as being in an advanced stage particularly in the presence of axillary lymphadenopathy. Here, we report a rare case of a 45-year-old woman with SS who presented with a breast mass. Radiology showed a 4 cm solid lesion and conglomerates of axillary lymphadonepathy. A breast biopsy revealed ductal carcinoma in situ. A modified radical mastectomy was performed; however, no axillary metastases were detected. Clinicians should remain vigilant to the possibility that a false clinical impression of axillary metastasis may occur in such patients with breast cancer. Therefore, axillary node status should be verified first.     

乳腺癌前哨淋巴结微转移的非前哨淋巴结转移率探讨

目的:探讨乳腺导管内癌(DCIS)和浸润性导管癌前哨淋巴结(SN)微转移对非SN转移率的影响。方法:采用常规HE染色和CK19免疫组化法回顾性研究24例DCIS和41例浸润性导管癌患者的SN微转移和非SN转移情况。结果:对65例早期乳腺癌患者的103枚SN进行了研究。24例DCIS患者中,1例SN转移其非SN也有转移(4·2%),23例SN阴性的DCIS中未发现SN微转移;41例浸润性导管癌患者中,10例SN转移中6例有非SN转移;其余31例SN阴性患者中,CK19免疫组化法染色发现SN微转移4例(12·9%),其中1例患者有非SN转移;SN微转移患者中非SN转移率25·0%(1/4),SN转移患者中非SN转移率63·6%(7/11),多枚SN仅1枚微转移患者中的非SN转移率50·0%(1/2)。结论:初步研究提示,CK19免疫组化法检测SN微转移有助提高SN转移的发现,SN微转移患者若放弃腋淋巴结清除可能造成转移灶的残留。SN微转移的研究可作为腋淋巴结清除或放疗的一个参考指标。     

To乳腺癌的X线诊断

目的：总结Ｔｏ乳腺癌Ｘ线特征及与病理的关系。方法;对１２０例次乳腺Ｔｏ癌患者中,有乳腺Ｘ线检查的９７例次病例进行了回顾性分析。结果：Ｔｏ乳腺癌的Ｘ线检查阳性率为３２．９９％,可疑率２１．６５％,合计５４．６４％。Ｔｏ乳腺癌Ｘ线表现以局限致浸润及钙化为主,占Ｘ线阳性表现病例中６６％,以肿块为表现者罕见,仅３例。     

Lymph node metastases versus DNA ploidy as prognostic factors for invasive ductal carcinoma of the breast

We evaluated the relationship between the DNA ploidy status and other variable prognostic factors, especially regional lymph node metastases, in 121 patients with invasive ductal carcinoma of breast, together with the value of these factors in estimating the prognostic of breast cancer. The ploidy status was diploid in 40% of the patients, and aneuploid in 60%. A significantly higher incidence of aneuploidy was found in patients with more than 4 positive axillary lymph nodes, positive internal mammary lymph nodes, or clinical stage 3 of malignancy. In a univariate study, overall survival and disease-free survival were significantly correlated with axillary and internal mammary lymph node metastases, tumor size, and clinical stage of malignancy. The disease-free survival rates for the diploid group tended to be somewhat higher than those for the aneuploid group of patients without axillary lymph node metastases. In the multivariate analysis, however, only axillary lymph node metastasis was significantly correlated with overall survival and disease-free survival. There was also a trend for the internal mammary lymph node metastases to be correlated with survival. As the DNA ploidy status was closely correlated with the axillary and internal mammary lymph node metastases, it did not appear to be an independent prognostic factor in this small series.     

The effect of chemotherapy on status of estrogen receptors in primary tumors and lymph node metastases of human ductal breast cancer

The aim of the study was the evaluation of ERalpha and ERbeta expression in primary tumors and lymph node metastases of breast cancer as well as the assessment of the influence of preoperative chemotherapy on these receptors with regard to changes in morphological appearance of primary tumors and their metastases. Immunohistochemical examinations were conducted on surgically removed ductal invasive breast cancers and their lymph node metastases of 135 patients. Seventy-one patients were spared preoperative chemotherapy which was administered to other 64 patients. Primary breast cancers with preoperative chemotherapy showed lower mean percentage of cells with a positive reaction to ERalpha and ERbeta as compared to primary tumors without preoperative chemotherapy. There were positive correlations among primary tumors and lymph node metastases regardless of preoperative chemotherapy applied. On the other hand, ERalpha and ERbeta expressions were negatively correlated in primary tumors without chemotherapy in contrast to primary tumors after chemotherapy. Furthermore, it was observed that preoperative chemotherapy was responsible for significantly less damage to lymph node metastases of breast cancer in comparison to primary tumors. In cases of such advanced damage of primary tumors that made determination of estrogen receptor expression impossible, their evaluation was performed on metastases to regional lymph nodes. Although preoperative chemotherapy did not severely impair estrogen receptor expression, presented changes of their distribution are a sufficient reason for simultaneous labeling of estrogen receptors in both primary tumors and metastases due to various sensitivity to chemotherapy of primary cancers in comparison with involved lymph nodes.     

Reduced expression of PTEN protein and its prognostic implications in invasive ductal carcinoma of the breast

OBJECTIVE: The PTEN tumor suppressor gene has been demonstrated to be inactivated in a variety of human tumors. In breast cancer, the PTEN gene mutation is not commonly found whereas loss of heterozygosity affecting the PTEN locus is frequently found. The aim of this study was to analyze PTEN protein expression in breast cancer and to evaluate the prognostic significance of PTEN protein expression. METHODS: Paraffin-embedded sections ofinvasive ductal carcinoma of the breast were immunohistochemically stained for PTEN protein expression in 236 breast cancers. The immunohistochemical expression of breast cancer cells was judged to be either normal or reduced compared with the PTEN protein expression of the normal mammary gland. Results: The expression of PTEN protein was found to have decreased in 67 (28%) of 236 breast cancers. The reduced expression correlated with lymph node metastasis (p = 0.0371), but not with tumor size, nuclear grade, MIB-1 counts or p53 protein expression. Univariate analysis indicated that patients with a reduced PTEN expression had a shorter disease-free survival (DFS) than those with a normal PTEN expression (p = 0.0174). Univariate analyses also determined tumor size, lymph node metastases, nuclear grade, MIB-1 counts, p53 protein as well as PTEN protein expression to be significant factors for DFS, while multivariate analysis determined lymph node metastases and the MIB-1 counts to be independent significant factors for DFS. CONCLUSIONS: The inactivation of PTEN, demonstrated by a reduced expression of PTEN protein by immunohistochemistry, was found in about one third of all breast cancers. The reduced expression of PTEN protein correlated with lymph node metastases and a worse prognosis in the patients with breast cancer.     

Is the BI-RADS Categorization Valuable for Nonpalpable Breast Lesions in Chinese Women？

OBJECTIVE To evaluate the feasibility of the Breast Imaging Reporting and Data System （BI-RADS） in the categorization of nonpalpable breast lesions （NPBLs） and to determine its value in aiding decision-making for biopsy in a Chinese population. METHODS One hundred and seventy-four nonpalpable breast lesions in 155 female patients examined by mammography were retrospectively categorized according to the BI-RAD System, 4th edition, which was established by the American College of Radiology （ACR）. All the lesions were diagnosed by a histopathological analysis after mammographically guided wire-localization biopsy. RESULTS The 174 Iocalizations yielded 125 （71.8%） benign lesions and 49 （28.2%） cancers, including 14 （28.6%） ductal carcinomas in situ and 35 （71.4%） invasive cancers. The overall positive predictive value （PPV） for cancer was 28.2% （49/174）. After categorization according to the BI- RAD System, there were 12 category 2, 59 category 3, 83 category 4 and 20 category 5 lesions. The PPV for cancer for each category were 0% （0 of 12 lesions） in category 2, 3.4% （2 of 59 lesions） in category 3, 37.3% （31 of 83 lesions） in category 4 and 80.0% （16 of 20 lesions） in category 5. t is concluded that BI-RADS is valuable for the catego- rization of nonpalpable breast lesions in our Chinese population. This system greatly improved the diagnostic specificity of nonpalpable breast lesions and was feasible in aiding decision-making for biopsy. It is suggested that nonpalpable breast lesions in categories BI-RADS 4 and 5 should receive a biopsy because these lesions have a moderate and high positive predictive value for cancer.     

Small cell carcinoma of the breast

Small cell carcinoma of the breast (SCCB) is an uncommon neoplasm that accounts for less than 1% of primary breast cancers. Histologically, these tumors have striking similarities to small call carcinoma of the lung, usually with evidence of associated ductal carcinoma-in-situ (DCIS) with areas of ductal, lobular, or papillary differentiation. Immunoreactivity for neuroendocrine markers is documented in two thirds of cases, while 33% to 50% are positive for estrogen receptor (ER) or progesterone receptor (PR). Her2/neu expression has not been reported in SCCB. Treatment, which may include surgery, radiotherapy, and combination chemotherapy, is based on clinical stage and the presence of metastases. Prognosis is variable and is dependent on the initial stage of disease.     

Expression of estrogen,progesterone and epidermal growth factor receptors in primary and metastatic breast cancer

The prognostic value of epidermal growth factor receptor (EGFR) expression and its biological role in estrogen receptor-positive (ER⁺) and ER-negative (ER^?) primary breast cancer is controversial. In this study, distributions of ER, progesterone receptor and EGFR have been established using immunohisto-chemistry in both primary breast tumors and their matched axillary lymph node metastases of 26 patients or their matched distant metastases of 2 patients. In addition, 5 patients with bilateral breast cancer were studied. ER⁺ tumor cells were detected in 22 (69%) and EGFR⁺ tumor cells were detected in 11 (34%) primary breast carcinomas. Expression of ER and EGFR was inverse regarding the individual tumor cells in both primary tumors and metastases. Relationship of EGFR expression with poorly differentiated and large breast tumors was observed. Furthermore, primary tumors with a predominant lobular component were ER⁺ and, with one exception, EGFR^?. Invasive ductal carcinomas were more frequently EGFR⁺. No apparent differences in receptor expression were observed between primary tumors and lymph node metastases or chro-nously or metachronously occurring bilateral breast cancers. Only one ER⁺ primary tumor showed a switch to EGFR expression in the involved lymph node. Our study shows that a shift in receptor phenotype between primary tumors and lymph node metastases is a rare event and, thus, additional analyses of involved lymph nodes will not likely serve as a better predictor for response to anti-estrogen therapy. We conclude that expression of EGFR is not a prerequisite for development of metastases. © 1995 Wiley-Liss, Inc.     

Paget disease of the breast: analysis of 41 patients

The treatment for the patients with Paget disease of the breast is controversial. This review of its natural history, treatment approach, and clinical outcome will help to formulate treatment. Forty-one patients with a diagnosis of Paget disease of the breast were retrospectively reviewed at Providence Hospital & Medical Centers from 1980 to 1999. Ninety-eight percent of patients had underlying carcinoma (ductal carcinoma in situ and/or invasive ductal cancer). Patients with a palpable mass have a much higher incidence of invasive ductal cancer, positive lymph node, and a worse survival rate. The median length of follow-up was 42 months (range: 6--200 months). Twenty-seven percent of patients (11/41) had conservative operations, including 1 patient with a palpable mass; 10 patients with no palpable mass; and 3 patients with recurrence after conservative operation. Thirty-seven percent of patients received adjuvant therapy. Paget disease of the breast has very high incidence of underlying carcinoma (100% in a palpable mass, 96% in nonpalpable mass). Patients with a palpable mass have a worse survival than do patients with nonpalpable mass. Conservative operation should cautiously be selected even for patients with no palpable mass because of a higher recurrence rate.     

Clinicopathological Characteristics of Primary Breast Cancer in Older Geriatric Women: A Study of 39 Japanese Patients over 80 Years Old

The number of primary breast cancers occurring in elderly women is increasing in Japan. Optimization of treatment regimens in this age group requires precise evaluation of the biological aggressiveness of these tumors as well as the performance status and extent of tumor spread. In 39 breast cancer patients who were at least 80 years old, we examined several parameters; the form of surgical therapy, the lymph node status, presence or absence of distant metastases, the histological type and grade of atypia, and overexpression of the c-erbB-2 oncoprotein in the cancer cells. They were correlated with the clinical outcome of the patient. Of the 33 patients who underwent a mastectomy and axillary lymph node dissection, five died from cancer recurrence. Only one out of 22 patients without lymph node metastases died from cancer, while four out of the eight patients with metastases to three or more lymph nodes died from cancer recurrence within 2.7 years of surgery. The overall survival curves also differed between patients with low-risk histological tumors or grade 1 or 2 invasive ductal carcinoma and those with grade 3 invasive dnctal/lobular carcinoma. Overexpression of c-erbB-2 also affected survival. Regional recurrence occurred in three out of the six patients for whom only lumpectomy or simple mastectomy was performed. These results indicate that, although primary breast cancer occurring in patients over 80 years old was largely of low-grade malignancy, patients with three or more lymph node metastases, invasive ductal/lobular carcinomas of grade 3, or c-erbB-2 overexpression frequently exhibited an aggressive clinical course.     

Role of salvage chemotherapy with topotecan and cisplatin in patients with paclitaxel- and platinum-resistant recurrent ovarian or primary peritoneal cancer: a phase II pilot study

BACKGROUND AND OBJECTIVES: The introduction of multimodal therapy has improved the prognosis in stage III breast cancer. A knowledge of the likely axillary lymph node status at presentation is important, both to plan surgical therapy to the axilla and to establish the effect of induction therapy on the axillary nodes. METHODS: The study involved a chart review of 114 patients with stage III breast cancer who were treated by modified radical mastectomy without prior systemic therapy. A standard method was used for axillary dissection and numbers and levels of pathologically involved lymph nodes were recorded. The incidence of lymph node metastases was correlated with tumour size, grade, and clinical T stage. The accuracy of clinical axillary staging and the relationship between level III invasion and the number of level I and II nodes invaded was also assessed. RESULTS: Overall, 96 of 114 (84%) patients had axillary nodal metastases, and 37 of 114 (32%) patients had level III metastases. Eighteen of 43 tumours (42%) 30 mm or less had level III metastases and 27% of larger tumours had level III metastases (6/25 31-49-mm tumours, and 12/42 50+-mm tumours). Of 98 gradable cancers, only 1 out of 10 well-differentiated tumours had level III metastases, but the rate in moderately and poorly differentiated tumours was 36% (19/53) and 37% (13/35), respectively. Clinical node staging was unreliable. A group of patients with a low likelihood of level III metastases who might benefit from an axillary procedure less than level III dissection could not be identified preoperatively. CONCLUSIONS: Patients with stage III breast cancer have a high incidence of level III axillary lymph node metastases. A subgroup with a low incidence of level III metastases could not be identified in this study. Until axillary downstaging has been convincingly demonstrated with induction therapy, a less than complete axillary procedure may leave the patient at high risk of axillary relapse.     

Prospective evaluation of radiologically directed fine-needle aspiration biopsy of nonpalpable breast lesions

The application of fine-needle aspiration biopsy (FNAB) to the diagnosis of nonpalpable breast lesions was evaluated with a new method which uses standard needle localization under mammographic guidance to assure accurate sampling by FNAB. This method was prospectively applied to 100 mammographically detected breast lesions in 100 women (mean age, 53 years). All 100 patients underwent surgical excision of these nonpalpable lesions after cytologic aspiration. Sufficient aspirated material was obtained for cytologic diagnosis from 91 patients (91%). The histologic and cytologic interpretations were then compared. Twenty malignancies were ultimately diagnosed by histology (12 invasive ductal carcinoma, six ductal carcinoma in situ, and two lobular carcinoma in situ), of which 17 had been cytologically diagnosed. There were no false-positive diagnoses of malignancy by FNAB. False-negative readings (3.3%) included two cases of lobular carcinoma in situ and one case of ductal carcinoma in situ. This technique thus demonstrated a sensitivity of 85%, specificity of 100%, and overall diagnostic accuracy of 96.7% for the nonsurgical detection of malignancy in nonpalpable breast lesions. These results suggest that the established safety, reliability, and cost-effectiveness of FNAB can be maintained in this clinical setting. This procedure may obviate the need for open surgical biopsy in those patients with an unequivocal diagnosis of malignancy. It can also be done using standard techniques and equipment available in many community hospitals.     

Post screen-detected breast cancer within the Screening Mammography Program of British Columbia

The histological characteristics and extent of mammographic density were compared between 170 post screen-detected (PSD) breast cancers and 466 screen-detected (SD) breast cancers in women attending the Screening Mammography Program of British Columbia. In addition, methods of detection and clinical presentation for the PSD cancers were examined. Invasive ductal, comedo, and medullary carcinoma were significantly more common in PSD cancer in women under age 50 years, and invasive ductal carcinoma in women over age 50 years. Mammographic density was more common in PSD cancers for all age groups under 70 years. The majority of PSD cancers were node negative with no evidence of metastases; however, they tended to be of more advanced stage than SD cancer. Most PSD cancers regardless of age were initially found by the woman herself, presenting as a palpable mass, and the likelihood of being detected within 12 months of the last screening mammogram was higher at younger ages.     

Microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation.

An analysis was performed of 39 consecutive women with microinvasive ductal carcinoma of the breast treated with breast-conserving surgery and definitive irradiation during the period 1977 to 1988. Microinvasive ductal carcinoma was defined as predominantly intraductal carcinoma with microscopic or early invasion. Surgical treatment of the primary tumor included excisional biopsy or wide resection. Axillary lymph node staging showed that 37 patients were pathologically node negative and two patients were pathologically node positive, each with only one positive lymph node. The median follow-up was 55 months (mean = 65 months; range = 25-135 months). The 5-year actuarial rate of overall and cause-specific survival were both 97%. The 5-year actuarial rate of freedom from distant metastases was 93%. Nine patients developed a recurrence in the breast; eight of the nine patients had isolated local only first failures, and one of the nine patients had a local recurrence simultaneously with distant metastases. The median time to local failure was 42 months (mean = 53 months; range = 20-116 months). Of the eight patients with local only first failure, seven patients have been salvaged with further treatment and remain free of disease at the time of last follow-up, and one patient has died of subsequent distant metastatic disease. Median follow-up after salvage treatment was 29 months (mean = 27 months; range = 0-54 months). Comparison of the patients with microinvasive ductal carcinoma with two control groups of intraductal carcinoma and invasive ductal carcinoma was performed. Although the rate of local failure was significantly higher for patients with microinvasive ductal carcinoma as compared to the two control groups, the rates of survival and freedom from distant metastases for patients with microinvasive ductal carcinoma were intermediate to the two control groups. Because of the high rates of survival and freedom from distant metastases and because of the ability to salvage patients with local recurrence, breast-conserving surgery and definitive irradiation should continue to be considered as an alternative to mastectomy for appropriately selected and staged patients with microinvasive ductal carcinoma of the breast.     

A comparison of the risks of in-breast recurrence after a diagnosis of dcis or early invasive breast cancer

Background

It is controversial whether ductal carcinoma in situ (dcis) is a preinvasive marker of breast cancer or if it is part of a spectrum of small cancers with malignant potential. Comparing clinical outcomes in women with invasive and noninvasive breast lesions might help to resolve the issue.

Methods

From a database of 2641 patients with breast cancer, we selected women who had been treated with breast-conserving surgery for a cancer that was 2.0 cm or less in size, node-negative, and nonpalpable. No subject received chemotherapy. Cancers were categorized as noninvasive (stage 0, n = 172) or invasive (stage 1, n = 401) based on a review of the pathology records. We compared the actuarial risks of in-breast recurrence after invasive and noninvasive breast lesions before and after adjusting for tamoxifen and radiotherapy.

Results

The 18-year cumulative risk of in-breast recurrence was 35.2% for patients with dcis and 12.8% for patients with small invasive cancers (hazard ratio: 2.4; 95% confidence interval: 1.5 to 3.8; p < 0.0003). After adjustment for radiotherapy and tamoxifen treatment, the difference was small and nonsignificant (hazard ratio: 1.4; 95% confidence interval: 0.9 to 2.4; p = 0.22).

Conclusions

For women with small, nonpalpable, node-negative breast cancers, the likelihood of experiencing an in-breast recurrence was associated with radiotherapy and with tamoxifen, but not with the presence of cancer cells invading beyond the basement membrane.