Invasive Lobular vs. Ductal Breast Cancer: A Stage-Matched Comparison of Outcomes

Abstract

Background

Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC), more difficult to detect mammographically, and usually diagnosed at a later stage. Does delayed diagnosis of ILC affect survival? We used a national registry to compare outcomes of patients with stage-matched ILC and IDC.

Methods

Query of the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) tumor registry identified 263,408 women diagnosed with IDC or ILC between 1993 and 2003. Survival of patients matched by T and N stage was compared using Kaplan-Meier curves and log-rank analysis.

Results

When compared with IDC, ILC was more likely to be >2 cm (43.1 vs. 32.6%; P < 0.001), lymph node positive (36.8 vs. 34.4%; P < 0.001), and ER positive (93.1 vs. 75.6%; P < 0.001). The 5-year disease-specific survival (DSS) was significantly better for patients with ILC than for those with IDC, before (90 vs. 88%; P < 0.001) and after matching for stage T1N0 (98 vs. 96%; P < 0.001), T2N0 (94 vs. 88%; P < 0.001), and T3N0 (92 vs. 83%, P < 0.001). The 5-year DSS for patients with nodal metastasis of ILC vs. IDC was 89% vs. 88% (P = NS) for stage T1N1, 81 vs. 73% (P < 0.001) for T2N1, and 72 vs. 56% (P < 0.001) for T3N1. Multivariate analysis identified a 14% survival benefit for ILC (hazard ratio 0.86, 95% confidence interval 0.80–0.92).

Conclusions

Stage-matched prognosis is better for patients with ILC than for those with IDC. Our findings support a different biology for ILC and are important for counseling and risk stratification.

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Acknowledgment

Work was supported by grants from the Gonda (Goldschmied) Research Laboratories of the John Wayne Cancer Institute at Saint John’s Health Center. Also supported by funding from QVC and the Fashion Footwear Association of New York Charitable Foundation (New York, NY), the Margie and Robert E. Petersen Foundation (Los Angeles, CA), Mrs. Lois Rosen (Los Angeles, CA), the Associates for Breast and Prostate Cancer Studies (Santa Monica, CA), the Family of Robert Novick (Los Angeles, CA), Ruth and Martin H. Weil Fund (Los Angeles, CA), and the Wrather Family Foundation (Los Alamos, CA).

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Correspondence to Armando E. Giuliano MD.

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Wasif, N., Maggard, M.A., Ko, C.Y. et al. Invasive Lobular vs. Ductal Breast Cancer: A Stage-Matched Comparison of Outcomes. Ann Surg Oncol 17, 1862–1869 (2010). https://doi.org/10.1245/s10434-010-0953-z

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Keywords

  • Breast Conservation Surgery
  • Male Breast Cancer
  • Invasive Ductal Cancer
  • Invasive Ductal Cancer
  • Invasive Lobular Cancer