Bilateral Invasive Breast Cancer Research Articles

Synchronous bilateral invasive breast cancer

Synchronous bilateral invasive breast cancer is a rare event. The etiology of bilateral breast cancer is uncertain, but most evidence supports independent tumors and not metastasis spread from one of the primary tumors. The prognosis of bilateral breast cancer was once thought to be poor, but recent data has suggested a similar survival for bilateral breast cancers as compared to unilateral disease.

Results of biopsies performed after breast conservation therapy for stage I-II breast cancer

843 Background: This study was performed to identify the factors predictive of positive biopsy after breast conservation therapy with definitive breast irradiation (RT) for early stage breast cancer. Methods: The records of patients treated for stage I-II unilateral or bilateral invasive breast cancer between 1977 and 1996 were reviewed to identify patients who had undergone post-treatment ipsilateral breast biopsies. Results: There were 195 biopsies performed in 193 treated breasts. The median time to biopsy was 49 months (mos) after irradiation. Among all biopsies, 59% were positive and 41% were negative. Subsequent biopsies were performed in 28 breasts, of which 27% were positive, thus 12% of women with a negative first biopsy later developed local recurrence. Biopsies were positive in 41% of patients with physical exam (PE) findings only, in 69% with mammographic findings only and in 80% with physical exam and mammographic abnormalities (p=0.001). When analyzed by type of biopsy, core biopsies were positive in 85% (6 of 7), excisional biopsies in 58%, and fine needle aspirations were positive in 28% (p=0.025). When analayzed by age at diagnosis, positive biopsies were obtained in 54% of patients age 51 or older, in 59% of patients age 36 to 50 and in 83% of patients 35 years or younger (p=0.05). Positive biopsy rate also increased with the interval from completion of radiation, as follows: ≤ 60 months = 50%; 61–120 months = 67%; 121–180 months = 80%; ≥ 181 months = 100% positive biopsies (p=0.01). Positive biopsy rate was not correlated with location of recurrence, pathologic T or N stage, ER/PR status or final pathologic margins of excision (all p ≥ 0.15). Conclusions: Biopsy remains the standard for diagnosis of local recurrence after breast conservation therapy. In this study, we identified groups at high risk for a positive biopsy. No significant financial relationships to disclose.

Results of biopsies performed after breast conservation therapy for stage I-II breast cancer

843 Background: This study was performed to identify the factors predictive of positive biopsy after breast conservation therapy with definitive breast irradiation (RT) for early stage breast cancer. Methods: The records of patients treated for stage I-II unilateral or bilateral invasive breast cancer between 1977 and 1996 were reviewed to identify patients who had undergone post-treatment ipsilateral breast biopsies. Results: There were 195 biopsies performed in 193 treated breasts. The median time to biopsy was 49 months (mos) after irradiation. Among all biopsies, 59% were positive and 41% were negative. Subsequent biopsies were performed in 28 breasts, of which 27% were positive, thus 12% of women with a negative first biopsy later developed local recurrence. Biopsies were positive in 41% of patients with physical exam (PE) findings only, in 69% with mammographic findings only and in 80% with physical exam and mammographic abnormalities (p=0.001). When analyzed by type of biopsy, core biopsies were positive in 85% (6 of 7), excisional biopsies in 58%, and fine needle aspirations were positive in 28% (p=0.025). When analayzed by age at diagnosis, positive biopsies were obtained in 54% of patients age 51 or older, in 59% of patients age 36 to 50 and in 83% of patients 35 years or younger (p=0.05). Positive biopsy rate also increased with the interval from completion of radiation, as follows: ≤ 60 months = 50%; 61–120 months = 67%; 121–180 months = 80%; ≥ 181 months = 100% positive biopsies (p=0.01). Positive biopsy rate was not correlated with location of recurrence, pathologic T or N stage, ER/PR status or final pathologic margins of excision (all p ≥ 0.15). Conclusions: Biopsy remains the standard for diagnosis of local recurrence after breast conservation therapy. In this study, we identified groups at high risk for a positive biopsy. No significant financial relationships to disclose.

Prognostic significance of the number of axillary lymph nodes removed in patients with node-negative breast cancer.

The objective of the study was to evaluate the association between the number of lymph nodes removed at axillary dissection and recurrence and survival for patients with node-negative invasive breast cancer. Subjects were 2,278 women with pathologically node-negative invasive breast cancer, diagnosed from 1989 to 1993 in British Columbia, Canada. Women aged > or = 90 years, with pure in-situ, bilateral invasive breast cancer or T4, N1, N2, or M1 stage, or who had axillary radiation were excluded. Two groups were defined for analysis: node-negative with no systemic therapy (n = 1,468) and node-negative with systemic therapy (n = 810). Median follow-up was 7.5 years. Prognostic variables assessed were age at diagnosis, tumor size, tumor grade, invasion of lymphatics, veins, or nerves, estrogen receptor status, and number of nodes removed. For patients not receiving systemic therapy, regional relapse was significantly increased with smaller numbers of nodes removed (P =.03). There was a trend toward shorter overall survival with fewer nodes removed (P =.06). Node-negative patients who received systemic therapy did not have a higher regional relapse rate or shorter overall survival when fewer nodes were recovered. Recovery of a small number of negative lymph nodes at axillary dissection likely understages patients and leads to undertreatment, resulting in an increased regional relapse rate and poorer survival. The use of systemic therapy may overcome this effect. The number of nodes removed, in conjunction with other prognostic factors, may be useful in selecting node-negative patients for systemic therapy.

Survival in bilateral breast cancer.

The presence of bilateral invasive breast cancer places the patient in a state of double jeopardy. At Memorial Sloan-Kettering Cancer Center, the overall 10-year recurrence rate for unilateral Stage I breast cancer was 16%, whereas the recurrence rate for simultaneous, bilateral Stage I breast carcinoma was 29%: almost twice as high. The average 10-year survival of all patients with negative axillary nodes was 57%. In this retrospective analysis of 403 patients with bilateral primary operable breast cancer treated at Memorial Sloan-Kettering Cancer Center, significant differences were noted in the disease-free survival between patients with bilateral noninvasive cancer, bilateral invasive cancer, and the combination of invasive and in situ cancers. Bilateral intraductal cancer and lobular carcinoma in situ offered an excellent prognosis. The combination of preinvasive cancer on one side and infiltrating carcinoma on the other had the next best survival. The in situ lesion, when treated by mastectomy, did not alter the patients' life expectancy from that of the general population with unilateral breast cancer, thus indicating that surgeons should strive to detect breast cancer in its preinvasive form. The 5- and 10-year relapse-free survival of patients with bilateral invasive disease, regardless of axillary nodal status and tumor size, was 60% and 51%, respectively, for patients with a bilateral presentation and 54% and 38%, respectively, for carcinomas presenting metachronously. More important in determining prognosis, however, was the number of axillary nodes involved and the level of involvement. Invasion of bilateral axillary nodes at all levels predicted a poor prognosis. Because of this shortened survival, systemic adjuvant therapy should be considered for patients with bilateral invasive disease. The most common preinvasive breast cancer was lobular carcinoma in situ and the most frequently invasive tumor was infiltrating duct cancer. Since a contralateral breast cancer at the time of definitive treatment of the first side does not always present as a mass or with positive mammography, a random biopsy of the second breast is recommended. This should be done in the upper, outer quadrant and should include the subareolar area. With prompt adequate treatment, it is expected that survival from bilateral breast cancer should improve.