Abstract
We studied the 24-year survival of 714 women with 1–14 mm invasive breast cancer according to mammographic features, including appearance of calcifications and masses. The most common mammographic feature was a stellate lesion with no associated calcifications (420 cases, 59%). Patients with stellate lesions had excellent long-term survival (95%). Casting-type calcifications were observed in 52 (7%) cases and were significantly associated with a positive lymph node status, poorer histological grade, and increased risk of breast cancer death (hazard ratio = 9.19, 95% confidence interval = 4.18–20.17). Except for tumours with casting type calcifications, all tumours less than 10 mm had excellent survival, regardless of node status, histological grade or treatment. For those with casting-type calcifications, survival was poorer even with 1–9 mm tumours (72% at 20 years). For 10–14 mm tumours, 20-year survival was 52% for those with casting calcifications, and 86–100% otherwise. Small invasive cancers accompanied by casting-type calcifications have unexpectedly poor prognosis for their size. Neoductgenesis offers a possible explanation for the unexpectedly poor outcome. There is a need to develop treatment protocols for this group. After exclusion of tumours with casting-type calcifications, the remainder have extremely good prognosis when treated with surgery and no adjuvant therapy.
Highlights
Neoplastic tissue contains elevated levels of choline-containing metabolites [1,2]
We examined the extent to which the lower mammographic sensitivity found in hormone replacement therapy (HRT) users could be explained by any association of HRT use with higher density and more difficult to detect cancers
The results suggest that applying compression does not ensure breast thickness reduction and observing physical changes does not guarantee that breast thickness has been minimised
Summary
Neoplastic tissue contains elevated levels of choline-containing metabolites (tCho) [1,2]. The presence of spiculation arising from a mass detected at mammography makes malignancy a probable diagnosis This is confirmed by this review of the first 8 years of screening in East Sussex where only 3.6% of masses with spiculation were benign at excision (24 out of 668), compared with 33.3% of masses without spiculation (102 out of 306). When breast core biopsy reveals lobular neoplasia (lobular carcinoma in situ [LCIS] or atypical lobular hyperplasia [ALH]) a management dilemma follows, as uncertainty regarding the significance of LCIS/ALH exists. Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Should surgical excision be undertaken in these cases?
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