Skip to main content
SpringerLink
Log in

A New Approach to Early Breast Cancer

  • Chapter
  • First Online:
Breast Cancer, a Heterogeneous Disease Entity

Abstract

In the era of population-based organized mammographic screening, breast carcinoma is detected at an early stage of its natural history and corresponds to pure in situ carcinomas and/or invasive carcinomas < 15 mm in size in more than half of the cases. These tumours are characterized in general by less aggressive biological phenotypic parameters as compared with their more advanced counterparts, and they have an excellent long-term prognosis. Nevertheless, breast cancer in these early stages is already heterogeneous, and neither the first-generation prognostic factors (the tumour size, the extent of the in situ component, the lymph node status and the histology grade), nor the usual additional parameters (the receptor status and proliferation markers) are reliable enough to allow an estimate of the outcome. Newer approaches to a classification of early breast cancer include a consideration of the mammographic appearance, the extent of the disease instead of just the largest dimension of the main invasive focus, and the mode of detection or the use of molecular tests. Early breast cancers may occupy a relatively large area as they are multifocal and extensive in a considerable number of cases. Detailed preoperative characterization of the tumours with modern imaging methods and careful selection of the cases for individualized treatment ensure fewer complications and a long disease-free survival. Guidelines developed for the adjuvant therapy of operable breast cancers should not be implemented automatically for cancers in the very early stages. Most cancers in the very early stages do not need adjuvant systemic therapy; aggressive therapy should be reserved for high-risk cases. A further reduction of therapy-related risks may be achieved by the implementation of individualized radiotherapy or its avoidance in selected cases.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 219.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  • AJCC Cancer Staging Handbook (2009) TNM classification of malignant tumors, 6th edn. Springer, New York, pp 255–281

    Google Scholar 

  • Alexander MC, Yankaskas BC, Biesemier KW (2006) Association of stellate mammographic pattern with survival in small invasive breast tumors. Am J Roentgenol 187:92–37

    Google Scholar 

  • Andea AA, Bouwman D, Wallis T et al (2004) Correlation of tumor volume and surface area with lymph node status in patients with multifocal/multicentric breast carcinoma. Cancer 100:20–27

    PubMed  Google Scholar 

  • Anttinen J, Kautiainen H, Kuopio T (2006) Role of mamography screening as a predictor of survival in postmenopausal breast cancer patients. Br J Cancer 94:147–151

    PubMed  CAS  Google Scholar 

  • Badra FA, Karamouzis MV, Ravazoula P et al (2006) Non-palpable breast carcinomas: correlation of mammographically detected malignant-appearing microalcifications and epidermal growth factor receptor (EGFR) family expression. Cancer Lett 244:34–41

    PubMed  CAS  Google Scholar 

  • Bergh J, Holmquist M (2001) Who should not receive adjuvant chemotherapy? J Natl Cancer Inst Monogr 30:103–108

    PubMed  Google Scholar 

  • Berry DA (2008) The screening mammography paradox: better when found, perhaps better not to find. Br J Cancer 98:1729–1730

    PubMed  CAS  Google Scholar 

  • Boyages J, Jayasinghe UW, Coombs N (2010) Multifocal breast cancer and survival: each focus does matter particularly for larger tumors. Eur J Cancer 46:1990–1996

    PubMed  Google Scholar 

  • Bucchi L, Barchielli A, Ravaioli A et al (2005) Screen-detected vs cilinical breast cancer: the advantage in the relative risk of lymph node metastases decreases with increasing tumour size. Br J Cancer 92:156–161

    PubMed  CAS  Google Scholar 

  • Bucchi L, Foca F, Ravaioli A et al (2009) Receipt of adjuvant systemic therapy among patients with high-risk breast cancer detected by mammography screening. Breast Cancer Res Treat 113:559–566

    PubMed  CAS  Google Scholar 

  • Campbell I, Royle G, Coddington R et al (1993) Management of screen-detected breast cancer. audit of the first 100 cases int he Southampton and Salisbury breast screening programme. Ann R C Surg Engl 73:13–17

    Google Scholar 

  • Carlson RW, Allred DC, Anderson BO et al (2009) Breast cancer. Clinical practice guidelines in oncology. J Natl Compr Canc Netw 7:122–192

    PubMed  CAS  Google Scholar 

  • Carter CL, Allen C, Henson DE (1989) Relation of tumor size, lymph node status, and survival in 24,740 breast cancer cases. Cancer 63:181–187

    PubMed  CAS  Google Scholar 

  • Colleoni M, Rotmensz N, Peruzzotti G et al (2004) Minimal and small size invasive breast cancer with no axillary lymph node involvemen: the need for tailored adjuvant therapies. Ann Oncol 15:1633–1639

    PubMed  CAS  Google Scholar 

  • Coombs NJ, Boyages J (2005) Multifocal and multicentric breast cancer: does each focus matter? J Clin Oncol 23:7497–7502

    PubMed  Google Scholar 

  • Cortesi L, Chiuri VE, Ruscelli S et al (2006) Prognosis of screen-detected breast cancers: results of a population based study. BMC Cancer 6:17

    PubMed  Google Scholar 

  • Cserni G, Bianchi S, Vezzosi V et al (2007) Sentinel lymph node biopsy in staging small (up to 15 mm) breast carcinomas. Results from a European multiinsitutional study. Pathol Oncol Res 13:5–14

    PubMed  Google Scholar 

  • Curigliano G, Viale G, Bagnardi V et al (2009) Clinical relevance of HER2 overexpression/amplification in patients with small tumor size and node-negative breast cancer. J Clin Oncol 34:5693–5699

    Google Scholar 

  • Darby S, McGale P, Taylor CW, Peto R (2005) Long-term mortality from heart disease and lung cancer after radiotherapy for early breast cancer: prospective cohort study of about 300 000 women in US SEER cancer registries. Lancet Oncol 6:557–565

    PubMed  Google Scholar 

  • Delaney G, Shafiq J, Chappell G et al (2008) Establishing treatment benchmarks for mammography–screened breast cancer population based on a review of evidence-based clinical guidelines. Cancer 112:1912–1922

    PubMed  Google Scholar 

  • Dong W, Berry DA, Bevers TB et al (2008) Prognostic role of detection method and its relationship with tumor biomarkers in breast cancer: the university of Texas M.D. Anderson Cancer Center experience. Cancer Epidemiol Biomarkers Prev 17:1096–1103

    CAS  Google Scholar 

  • Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of radiotherapy and of differences in the extent of surgery for early breast cancer on local recurrence and 15-year survival: an overview of the randomised trials. Lancet 366:2087–2106

    Google Scholar 

  • Egan RL (1982) Multicentric breast carcinomas: clinical–radiographic pathologic whole organ studies and 10-year survival. Cancer 49:1123–1130

    PubMed  CAS  Google Scholar 

  • Emami B et al (1999) Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 21:109–117

    Google Scholar 

  • Ernst MF, Voogd AC, Coebergh JW et al (2004) Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mamographic screening. Cancer 100:1337–1344

    PubMed  Google Scholar 

  • Ernster VL, Barclay J, Kerlikowske K et al (2000) Mortality among women with ductal carcinoma in situ of the breast in the population-based Surveillance, Epidemiology and Results Program. Arch Intern Med 160:953–958

    PubMed  CAS  Google Scholar 

  • Evans AJ, Rakha EA, Pinder SE et al (2007) Basal phenotype: a powerful prognostic factor in small screen-detected invasive breast cancer with long-term follow-up. J Med Screen 14:210–214

    PubMed  CAS  Google Scholar 

  • Fisher B, Dignam J, Tan-Chiu E et al (2001) Prognosis and treatment of patients with breast tumors of one centimeter or less and negative axillary lymph nodes. J Natl Cancer Inst 93:112–120

    PubMed  CAS  Google Scholar 

  • Fisher B, Anderson S, Bryant J et al (2002) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 347:1233–1241

    PubMed  Google Scholar 

  • Forrest AP, Stewart HJ, Everington D (1996) Randomised controlled trial of conservation therapy for breast cancer: 6-year analysis of the Scottish trial. Scottish Cancer Trials Breast Group. Lancet 348:708–713

    PubMed  CAS  Google Scholar 

  • Fyles AW, McCready DR, Manchul LA et al (2004) Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 351:963–970

    PubMed  CAS  Google Scholar 

  • Gallagher HS (1976) Treatment selection in primary breast cancer. Pathologic considerations. Am J Roentgenol 126:135–138

    Google Scholar 

  • Gill PG, Farshid G, Luke CG et al (2004) Detection by screening mammography is a powerful independent predictor of survival in women diagnosed with breast cancer. Breast 13:15–22

    PubMed  CAS  Google Scholar 

  • Gill PG, Luke CG, Roder DM (2006) Clinical and pathological factors predictive of lymph node status in women with screen-detected breast cancer. Breast 15:640–648

    PubMed  CAS  Google Scholar 

  • Glas AM, Floore A, Delahaye LJ, et al (2006) Converting a breast cancer microarray signature into a high-throughput diagnostic test. BMC Genomics. 7:278

    PubMed  Google Scholar 

  • Gluz O, Liedtke C, Gottschalk N et al (2009) Triple-negative breast cancer-current status and future directions. Ann Oncol 20:1913–1927

    PubMed  CAS  Google Scholar 

  • Goldhirsch A, Ingle JN, Gelber RD et al (2009) Thresholds for therapies: highlights of the St Gallen International Expert Consensus on the Primary therapy of Early Breast Cancer 2009. Ann Oncol 20:1319–1329

    PubMed  CAS  Google Scholar 

  • Gonzales-Angulo AM, Litton JK, Broglio KR et al (2009) High risk of recurrence for patients with breast cancer who have human epidermal growth factor receptor 2-positive, node-negative tumors 1 cm or smaller. J Clin Oncol 27:5700–5706

    Google Scholar 

  • Groenendijk RPR, Horst H, John GMT et al (2002) Critical analysis of the treatment of non-palpable breast cancer: toward a less invasive future? World J Surg 26:285–289

    PubMed  Google Scholar 

  • Hanrahan EO, Valero V, Gonzalez-Angulo AM et al (2006) Prognosis and management of patients with node-negative invasive breast carcinoma that is 1 cm or smaller in size (stage 1, T1a,bN0M0): a review of the literature. J Clin Oncol 24:2113–2122

    PubMed  Google Scholar 

  • Hartmann WH (1984) Minimal breast cancer. An update. Cancer 53(3 Suppl):681–684

    PubMed  CAS  Google Scholar 

  • Henson DE, Chu KC, Levine PH (2003) Histologic grade, stage, and survival in breast carcinoma. Comparison of African American and Caucasian woman. Cancer 98:908–917

    PubMed  Google Scholar 

  • Hughes KS, Schnaper LA, Berry D et al (2004) Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 351:971–977

    PubMed  CAS  Google Scholar 

  • Immonen-Raiha P, Kauhava L, Parvinen I et al (2005) Mammographic screening reduces risk of breast carcinoma recurrence. Cancer 103:474–482

    PubMed  Google Scholar 

  • James JJ, Evans AJ, Pinder SE et al (2003) Is the presence of mammographic comedo calcification really a prognostic factor for small screen-detected invasive breast cancers? Clin Radiol 58:54–62

    PubMed  CAS  Google Scholar 

  • Joensuu H, Pylkkanen L, Toikkanen S et al (1999) Late mortality from pT1N0M0 breast carcinoma. Cancer 85:2183–2189

    PubMed  CAS  Google Scholar 

  • Joensuu H, Isola J, Lundin M et al (2003) Amplification of erbB2 and erbB2 expression are superior to estrogen receptor status as risk factors for distant recurrence in pT1N0M0 breast cancer: a nationwide population-based study. Clin Cancer Res 9:923–930

    PubMed  CAS  Google Scholar 

  • Joensuu H, Lehtimaki T, Holli K et al (2004) Risk for distant recurrence of breast cancer detected by mammography screening or other methods. JAMA 292:1064–1073

    PubMed  CAS  Google Scholar 

  • Joergensen LE, Gunnarsdottir KA, Lanng C et al (2008) Multifocality as a prognostic factor in breast cancer patients registered in Danish Breast Cancer Cooperative Group (DBCG) 1996–2001. Breast 17:587–591

    PubMed  CAS  Google Scholar 

  • Kahán Z, Csenki M, Varga Z et al (2007) The risk of early and late lung sequelae after conformal radiotherapy in breast cancer patients. Int J Radiat Oncol Biol Phys 68:673–681

    PubMed  Google Scholar 

  • Klemi PJ, Joensuu H, Toikkanen S et al (1992) Aggressiveness of breast cancers found with and without screening. BMJ 304:467–469

    PubMed  CAS  Google Scholar 

  • Klemi PJ, Parvinen I, Pylkkanen L et al (2003) Significant improvement in breast cancer survival through population-based mammography screening. Breast 12:308–313

    PubMed  Google Scholar 

  • Köster F, Engel JB, Schally AV (2009) Triple-negative breast cancers express receptors for growth hormone-releasing hormone (GHRH) and respond to GHRH antagonists with growth inhibition. Breast Cancer Res Treat 116:273–279

    PubMed  Google Scholar 

  • Krzyzanowska MK, Tannock IF (2005) Should screen-detected breast cancers be managed differently? J Natl Cancer Inst 97:1170–1171

    PubMed  Google Scholar 

  • Kyndi M, Overgaard M, Nielsen HM et al (2009) High local recurrence risk is not associated with large survival reduction after postmastectomy radiotherapy in high-risk breast cancer: a subgroup analysis of DBCG 82 b&c. Radiother Oncol 90:74–79

    PubMed  Google Scholar 

  • Lawrence G, Wallis M, Allgood P et al (2009) Population estimates of survival in women with screen-detected and symptomatic breast cancer taking account of lead time and length bias. Breast Cancer Res Treat 116:179–185

    PubMed  Google Scholar 

  • Leitner SP, Swern AS, Weinberger D et al (1995) Predictors of recurrence for patients with small (one centimeter or less) localized breast cancer (T1a,b N0 M0). Cancer 76:2266–2274

    PubMed  CAS  Google Scholar 

  • Liljegren G, Lindgren A, Bergh J et al (1997) Risk factors for local recurrence after conservative treatment in stage I breast cancer. Definition of a subgroup not requiring radiotherapy. Ann Oncol 8:235–241

    Google Scholar 

  • Liljegren G, Holmberg L, Bergh J et al (1999) 10-Year results after sector resection with or without postoperative radiotherapy for stage I breast cancer: a randomized trial. J Clin Oncol 17:2326–2333

    PubMed  CAS  Google Scholar 

  • Liu GF, Yang Q, Haffty BG, Moran MS (2009) Clinical—pathological features and long-term outcomes of tubular carcinoma of the breast compared with invasive ductal carcinoma treated with breast conservation therapy. Int J Radiat Oncol Biol Phys 75:1304–1308

    PubMed  Google Scholar 

  • Luck AA, Evans AJ, James JJ et al (2008) Breast carcinoma with basal phenotype: mammographic findings. Am J Roentgenol 191: 346–351

    Google Scholar 

  • MacMillan RD, Purushotham AD, Cordiner C et al (1995) Predicting local recurrence by correlating pre-operative mamographic findings with pathological risk factors in patients with breast cancer. Br J Radiol 68:445–449

    PubMed  CAS  Google Scholar 

  • Malik HZ, Wilkinson L, George WD, Purushotham AD (2000) Preoperative mammographic features predict clinicopathological risk factors for the development of local recurrence in breast cancer. Breast 9:329–333

    PubMed  CAS  Google Scholar 

  • Mannino M, Yarnold JR (2009) Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld? Radiother Oncol 90:14–22

    PubMed  Google Scholar 

  • Masood S (1995) Prediction of recurrence for advanced breast cancer. Traditional and contemporary pathologic and molecular markers. Surg Oncol Clin N Am 4:601–632

    PubMed  CAS  Google Scholar 

  • Molino A, Pavarana M, Micciolo R et al (2000) Comparative study of clinical, pathological and biological characteristics of symptomatic versus asymptomatic breast cancers. Ann Oncol 11:581–586

    PubMed  CAS  Google Scholar 

  • Moody-Ayers SY, Wells CK, Feinstein AR (2000) “Benign” tumors and “early detection” in mamography-screened patients of a natural cohort with breast cancer. Arch Intern Med 160:1109–1115

    PubMed  CAS  Google Scholar 

  • Nealon TF, Nkongho A, Grossi CE et al (1981) Treatment of early cancer of the breast (T1N0M0 and T2N0M0) on the basis of histologic characteristics. Surgery 89:279–289

    PubMed  Google Scholar 

  • Nguyen PL, Taghian AG, Katz MS et al (2008) Breast cancer subtype approximated by estrogen receptor, progesterone receptor, and HER-2 is associated with local and distant recurrence after breast-conserving therapy. J Clin Oncol 26:2373–2378

    PubMed  Google Scholar 

  • Offersen BV, Overgaard M, Kroman N, Overgaard J (2009) Accelerated partial breast irradiation as a part of breast conserving therapy of early breast cancer: a systematic review. Radiother Oncol 90:1–13

    PubMed  Google Scholar 

  • Padmore RF, Fowble B, Hoffman J et al (2000) Microinvasaive breast carcinoma: clinicopathologic analysis of a single institution experience. Cancer 88:1403–1409

    PubMed  CAS  Google Scholar 

  • Pálka I, Ormándi K, Gaál S et al (2007) Casting-type calcifications on the mammogram suggest a higher probability of early relapse and death among high-risk breast cancer patients. Acta Oncol 46:1178–1183

    PubMed  Google Scholar 

  • Pálka I, Kelemen G, Ormándi K et al (2008) Tumor characteristics in screen-detected and symptomatic breast cancers. Pathol Oncol Res 14:161–167

    PubMed  Google Scholar 

  • Park YH, Kim ST, Cho EZ et al (2010) A risk stratification by hormonal receptors (ER, PgR) and HER-2 status in small ( £ 1 cm) invasive breast cancers: who might be possible candidates for adjuvant treatment? Breast Cancer Res Treat 119:653–661

    PubMed  Google Scholar 

  • Peacock C, Given-Wilson RM, Duffy SW (2004) Mammographic casting-type calcification associated with small screen-detected invasive breast cancers: is this a reliable prognostic indicator? Clin Radiol 59:165–170

    PubMed  CAS  Google Scholar 

  • Pedersen L, Gunnarsdottir KA, Rassmussen BB et al (2004) The prognostic influence of multifocality in breast cancer patients. Breast 13:188–193

    PubMed  CAS  Google Scholar 

  • Polgár C, Limbergen EV, Pötter R et al (2010) Patient selection for accelerated partial-breast irradiation (APBI) after breast-conserving surgery: recommendations of the Groupe Européen de Curiethérapie-European Society for Therapeutic Radiology and Oncology (GEC-ESTRO) breast cancer working group based on clinical evidence (2009). Radiother Oncol 94:264–273

    PubMed  Google Scholar 

  • Pötter R, Gnant M, Kwasny W et al (2007) Lumpectomy plus tamoxifen or anastrozole with or without whole breast irradiation in women with favorable early breast cancer. Int J Radiat Oncol Biol Phys 68: 334–340

    PubMed  Google Scholar 

  • Rakha EA, Ellis IO, Reis-Filho JS (2008a) Immunohistochemical heterogeneity of breast carcinomas negative for estrogen receptors, progesterone receptors and Her2/neu (basal-like breast carcinomas). Mod Pathol 21:1060–1061

    Google Scholar 

  • Rakha EA, Reis-Filho JS, Ellis IO (2008b) Impact of basal-like breast carcinoma determination for a more specific therapy. Pathobiol 75:95–103

    Google Scholar 

  • Rosen PP, Groshen S (1990) Factors influencing survival and prognosis in early breast carcinoma (T1N0M0-T1N1M0). Assessment of 644 patients with median follow up of 18 years. Surg Clin North Am 70:937–962

    PubMed  CAS  Google Scholar 

  • Rouzier R, Perou CM, Symmans WF et al (2005) Breast cancer molecular subtypes respond differently to preoperative chemotherapy. Clin Cancer Res 11:5678–5685

    PubMed  CAS  Google Scholar 

  • Shen Y, Yang Y, Lurdes, Inoue LY et al (2005) Detection method in predicting breast cancer survival: analysis of randomized screening trials. J Natl Cancer Inst 97:1195–1203

    PubMed  Google Scholar 

  • Sihto H, Lundin J, Lehtimaki T et al (2008) Molecular subtypes of breast cancers detected in mammography screening and outside of screening. Clin Cancer Res 14:4103–4110

    PubMed  CAS  Google Scholar 

  • Smart CR, Byrne C, Smith RA et al (1997) Twenty-year follow-up of the breast cancers diagnosed during the Breast Cancer Detection Demonstration Project. CA Cancer J Clin 47:134–149

    PubMed  CAS  Google Scholar 

  • Smith BD, Arthur DW, Buchholz TA et al (2009) Accelerated partial breast irradiation consensus statement from the American Society for Radiation Oncology (ASTRO). Int J Radiat Oncol Biol Phys 74:987–1001

    PubMed  Google Scholar 

  • Sousa JA, Diener–West M, Gusev Y et al (1998) Association between extent of axillary lymph node dissection and survival in patients with stage I breast cancer. Ann Surg Oncol 5:140–149

    Google Scholar 

  • Sparano JA, Hortobágyi GN, Gralow JR et al (2009) Recommendations for research priorities in breast cancer by the Coalition of Cancer Cooperative Groups Scientific Leadership Council: systemic therapy and therapeutic individualization. Breast Cancer Res Treat 120(2):273–284

    PubMed  Google Scholar 

  • START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EG et al (2008a) The UK Standardisation of Breast Radiotherapy (START) Trial A of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet Oncol 9:331–341

    CAS  Google Scholar 

  • START Trialists’ Group, Bentzen SM, Agrawal RK, Aird EG et al (2008b) The UK Standardisation of Breast Radiotherapy (START) Trial B of radiotherapy hypofractionation for treatment of early breast cancer: a randomised trial. Lancet 371(9618):1098–1107

    CAS  Google Scholar 

  • Straver ME, Glas AM, Hannemann J, et al (2010) The 70-gene signature as a response predictor for neoadjuvant chemotherapy in breast cancer. Breast Cancer Res Treat 119:551–558

    PubMed  Google Scholar 

  • Tabár L, Chen HH, Duffy SW et al (2000) A novel method for perdiction of long-term outcome of women with T1a, T1b, and 10–14 mm invasive breast cancers: a prospective study. Lancet 355:429–433

    PubMed  Google Scholar 

  • Tabár L, Chen HHT, Yen MFA et al (2004) Mammographic tumor features can predict long-term outcomes reliably in women with 1–14 mm invasive breast carcinoma. Suggestions for the reconsideration of current therapeutic practice and the TNM classification system. Cancer 101:1745–1759

    PubMed  Google Scholar 

  • Tabár L, Tot T, Dean PB (2007) Breast cancer. Early detection with mammography. Casting type calcifications: sign of a subtype with deceptive features. Thieme, Stuttgart

    Google Scholar 

  • Tabár L, Dean PB, Chen HHT et al (2010) Early detection of breast cancer challenges current standards of care. In: Silberman H, Silberman AW (eds) Principles and practice of surgical oncology: a multidisciplinary approach to difficult problems. Lippincott Williams and Wilkins, Philadelphia, pp 276–291

    Google Scholar 

  • Tabár L, Dean PB, Tot T et al (2011) The implications of the imaging manifestation of multifocal and diffuse breast cancers. In: Tot T (ed) Breast cancer, a lobar disease. Springer, London, pp 87–152

    Google Scholar 

  • Tavassoli FA (1995) Pathology of advanced primary breast carcinoma. Surg Oncol Clin N Am 4:591–600

    PubMed  CAS  Google Scholar 

  • The Swedish Organized Service Screening Evaluation Group (2006) Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with expanded data. Cancer Epidemiol Biomarkers Prev 15:45–51

    Google Scholar 

  • Thurfjell E, Thurfjell MG, Lindgren A (2001) Mammographic finding as predictor of survival in 1–9 mm invasive breast cancers. Worse prognosis for cases presenting as calcifications alone. Breast Cancer Res Treat 67:177–180

    PubMed  CAS  Google Scholar 

  • Tinterri C, Gatzemeier W, Zanini V et al (2009) Conservative surgery with and without radiotherapy in elderly patients with early-stage breast cancer: a prospective randomised multicentre trial. Breast 18:373–377

    PubMed  CAS  Google Scholar 

  • Tot T (2006) The limited prognostic value of measuring and grading small breast carcinomas: the whole sick lobe versus the details within it. Med Sci Monit 12RA:170–175

    Google Scholar 

  • Tot T (2007) The clinical relevance of the distribution of the lesions in 500 consecutive breast cancer cases documented in large-format histological sections. Cancer 110:2551–2560

    PubMed  Google Scholar 

  • Tot T (2009) The metastastic capacity of multifocal breast carcinomas: extensive tumors versus tumors of limited extent. Hum Pathol 40:199–205

    PubMed  Google Scholar 

  • Tot T (2010) Towards a renaissance of subgross breast morphology. Eur J Cancer 46:1946–1948

    PubMed  Google Scholar 

  • Tot T (2006) Radiologic-pathologic correlation of ductal carcinoma in situ of the breast using two- and three-dimensional large histologic sections. Semin Breast Dis 8:144–151

    Google Scholar 

  • Tot T, Pekár Gy, Hofmeyer S et al (2009) The distribution of the lesions in 1–14 mm invasive breast carcinomas and its relation to metastatic potential. Virchows Arch 455:109–115

    PubMed  CAS  Google Scholar 

  • Untch M, Gelber RD, Jackisch C et al (2008) Estimating the magnitude of trastuzumab effects within patient subgroups in the HERA trial. Ann Oncol 19:1090–1096

    PubMed  CAS  Google Scholar 

  • Veronesi U, Cascinelli N, Mariani L et al (2002) Twenty-year follow-up of a randomized study comparing breast-conserving surgery with radical mastectomy for early breast cancer. N Engl J Med 347:1227–1232

    PubMed  Google Scholar 

  • Weissenbacher TM, Zschage M, Janni W et al (2010) Multifocal and multicentric versus unifocal breast cancer: Is the tumor-node-metastasis classification justified? Breast Cancer Res Treat 122:27–43

    PubMed  CAS  Google Scholar 

  • Whelan TJ, Julian J, Wright J, et al (2000) Does locoregional radiation therapy improve survival? A meta-analysis. J Clin Oncol 18:1220–1229

    PubMed  CAS  Google Scholar 

  • Whelan TJ, Kim DH, Sussman J (2008) Clinical experience using hypofractionated radiation schedules in breast cancer. Semin Radiat Oncol 18:257–264

    PubMed  Google Scholar 

  • Wishart GC, Greenberg DC, Britton PD et al (2008) Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone? Br J Cancer 98:1741–1744

    PubMed  CAS  Google Scholar 

  • Wishart GC, Azzato EM, Greenberg DC et al (2010) PREDICT: a new UK prognostic model that predicts survival following surgery for invasive breast cancer. Breast Cancer Res 12:R1

    Google Scholar 

  • Yarnold J (2009) Early and locally advanced breast cancer: diagnosis and treatment. National Institute for Health and Clinical Excellence guideline 2009. Clin Oncol (R Coll Radiol) 21:159–160

    CAS  Google Scholar 

  • Zafrani B, Vielh P, Fourquet A et al (1989) Conservative treatment of early breast cancer: prognostic value of the ductal in situ component and other pathological variables on local control and survival. Long-term results. Eur J Cancer Clin Oncol 25:1645–1650

    PubMed  CAS  Google Scholar 

  • Zunzunegui RG, Chung MA, Oruwari J et al (2003) Casting-type calcifications with invasion and high-grade ductal carcinoma in situ. Arch Surg 138:537–540

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Pathology, Central Hospital Falun, Uppsala University, 79182, Falun, Sweden

    Tibor Tot

  2. Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary

    Zsuzsanna Kahán

Authors
  1. Tibor Tot
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zsuzsanna Kahán
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tibor Tot .

Editor information

Editors and Affiliations

  1. , University of Szeged, Department of Oncotherapy, Korányi fasor 12, Szeged, 6720, Hungary

    Zsuzsanna Kahán

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer Science+Business Media B.V.

About this chapter

Cite this chapter

Tot, T., Kahán, Z. (2011). A New Approach to Early Breast Cancer. In: Kahán, Z. (eds) Breast Cancer, a Heterogeneous Disease Entity. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-0489-3_1

Download citation

Publish with us

Policies and ethics

Search

Navigation