Abstract
The use of mammography in recent years has resulted in an increase in the detection of small breast cancers. The beneficial effects of early detection on breast cancer mortality seem to differ with age. To obtain more insight into this matter we studied the long-term prognosis of patients with early invasive breast cancers (T1) in three age groups: 144 patients of age 40-49, 402 patients of age 50-69 and 192 patients 70 years or older at diagnosis. In all age groups, patients with a tumour of 1 cm or less have a longer breast cancer specific survival than patients with a tumour larger than 2 cm. The survival advantage in the case of tumours of a size rounded to 1.5 cm compared with tumours larger than 2 cm in the under age 50 group was marginal (and not significant). However, older patients with tumours of this size do have a significantly improved survival. It is more difficult to improve survival in younger patients through early detection, partly because of an apparent early metastatic potential of their tumours. A reduction in breast cancer mortality might be expected in women younger than 50 years of age only if a substantial proportion of the invasive cancers are detected before their size exceeds 1 cm.
Highlights
Since 1975, data on all Nijmegen patients diagnosed as having breast cancer in either one of the two Nijmegen hospitals have been carefully recorded by the local cancer registry of the Departments of Diagnostic Radiology and Pathology of the Nijmegen University Hospital and of the Canisius Wilhelmina Hospital
Patients with lobular carcinomas in situ were not included because they are not treated as breast cancer patients
Few data are currently available on the prognosis of patients with small breast cancers, of those detected at screening
Summary
Since 1975, data on all Nijmegen patients diagnosed as having breast cancer in either one of the two Nijmegen hospitals have been carefully recorded by the local cancer registry of the Departments of Diagnostic Radiology and Pathology of the Nijmegen University Hospital and of the Canisius Wilhelmina Hospital. On record at the end of 1992 were 1333 patients, 40 years of age or older, diagnosed with primary breast cancer. Patients with lobular carcinomas in situ were not included because they are not treated as breast cancer patients. Tumour size of invasive lesions was determined mammographically. If the diameter could not be assessed mammographically, the histologically determined diameter was substituted (in 10% of the measurements). Tumour size was available in all but 19 of the invasive cases. We used the following categories of tumour size: 1 cm or less, 1.5 cm, 2cm, 2.5-4.5 cm, 5 cm or larger
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