Skip to main content

Advertisement

SpringerLink
Log in

Tumour characteristics among women with very low-risk breast cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

It has been proposed that a proportion of non-palpable breast cancers that are diagnosed through mammography represents a very low-risk subgroup of cancers that may not affect survival (overdiagnosis). The salient pathologic features of cancers in this theoretical subgroup are not known, and therefore, it is not possible to predict which patients have a cancer of this type. We reviewed the clinical characteristics and survival experiences of 715 patients with an invasive breast cancer of 5.0 cm or less. The tumour from each patient was represented in triplicate on a tissue microarray. Cases were divided into low-risk and moderate-/high-risk categories based on lymph node status and palpability. Low-risk cancers were those that were non-palpable, node-negative and were only detected by mammographic screening. All other cancers were high/moderate risk. The two groups of cancer patients were compared for a number of tumour characteristics, based on immunohistochemistry. There were 79 low-risk cancers and 636 moderate-/high-risk cancers. The low-risk cancers were characterized by ER-positivity, PR-positivity, HER2-negativity, ck5/6-negativity, EGFR-negativity and p53-negativity. About 54 of the 79 low-risk cancers (68 %) were of the luminal A subtype versus 335 of 636 moderate-/high-risk cancers (53 %; p = 0.008). Among 42 women with a non-palpable, mammogram-detected PR+ HER2– cancer of 5.0 cm or less, the 15-year distant recurrence-free survival rate was 100 %. Small breast cancers that are PR+ and HER2– and that are detectable by mammogram alone have a very low risk of recurrence. A proportion of these may represent examples of overdiagnosis.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Zahl PH, Gøtzsche PC, Mæhlen J (2011) Natural history of breast cancers detected in the Swedish mammography screening programme: a cohort study. Lancet Oncol 12:1118–1124

    Article  PubMed  Google Scholar 

  2. Welch HG, Black WC (2010) Over-diagnosis in cancer. J Natl Cancer Inst 102:605–613

    Article  PubMed  Google Scholar 

  3. Narod S (2012) Disappearing breast cancers. Curr Oncol 19:59–60

    Google Scholar 

  4. Nofech-Mozes S, Trudeau M, Kahn HK, Dent R, Rawlinson E, Sun P, Narod SA, Hanna WM (2009) Patterns of recurrence in the basal and non-basal subtypes of triple-negative breast cancers. Breast Cancer Res Treat 118:131–137

    Article  PubMed  Google Scholar 

  5. Dent R, Trudeau M, Pritchard KI, Hanna WM, Kahn HK, Sawka CA, Lickley LA, Rawlinson E, Sun P, Narod SA (2007) Triple-negative breast cancer: clinical features and patterns of recurrence. Clin Cancer Res 13:4429–4434

    Article  PubMed  Google Scholar 

  6. Dent R, Hanna WM, Trudeau M, Rawlinson E, Sun P, Narod SA (2009) Time to disease recurrence in basal-type breast cancers: effects of tumor size and lymph node status. Cancer 115:4917–4923

    Article  PubMed  Google Scholar 

  7. Sørlie T, Perou CM, Tibshirani R, Aas T, Geisler S, Johnsen H, Hastie T, Eisen MB, van de Rijn M, Jeffrey SS, Thorsen T, Quist H, Matese JC, Brown PO, Botstein D, Eystein Lønning P, Børresen-Dale AL (2001) Gene expression patterns of breast carcinomas distinguish tumor subclasses with clinical implications. Proc Natl Acad Sci USA 98:10869–10874

    Article  PubMed  Google Scholar 

  8. Narod SA (2011) Age of diagnosis, tumor size, and survival after breast cancer: implications for mammographic screening. Breast Cancer Res Treat 128:259–266

    Article  PubMed  Google Scholar 

  9. Tovey SM, Brown S, Doughty JC, Mallon EA, Cooke TG, Edwards J (2009) Poor survival outcomes in HER2–positive breast cancer patients with low-grade, node-negative tumours. Br J Cancer 100:680–683

    Article  PubMed  CAS  Google Scholar 

  10. Blows FM, Driver KE, Schmidt MK, Broeks A, van Leeuwen FE, Wesseling J, Cheang MC, Gelmon K et al (2010) Subtyping of breast cancer by immunohistochemistry to investigate a relationship between subtype and short and long term survival: a collaborative analysis of data for 10,159 cases from 12 studies. PLoS Med 7(5):e1000279

    Article  PubMed  Google Scholar 

  11. Foulkes WD, Stefansson IM, Chappuis PO, Bégin LR, Goffin JR, Wong N, Trudel M, Akslen LA (2003) Germline BRCA1 mutations and a basal epithelial phenotype in breast cancer. J Natl Cancer Inst 95:1482–1485

    Article  PubMed  CAS  Google Scholar 

  12. Crook T, Crossland S, Crompton MR, Osin P, Gusterson BA (1997) p53 mutations in BRCA1-associated familial breast cancer. Lancet 350:638–639

    Article  PubMed  CAS  Google Scholar 

  13. Warner E, Hill K, Causer P, Plewes D, Jong R, Yaffe M, Foulkes WD, Ghadirian P, Lynch H, Couch F, Wong J, Wright F, Sun P, Narod SA (2011) Prospective study of breast cancer incidence in women with a BRCA1 or BRCA2 mutation under surveillance with and without magnetic resonance imaging. J Clin Oncol 29(13):1664–1669

    Google Scholar 

Download references

Acknowledgments

We thank the Canadian Breast Cancer Foundation (Ontario Chapter) for support of the Henrietta Banting database. We thank Ellen Rawlinson for maintaining the Banting database.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Women’s College Research Institute, University of Toronto, 790 Bay Street, 7th Floor, Toronto, ON, M5G 1N8, Canada

    S. A. Narod, A. Valentini & P. Sun

  2. Department of Pathology, Sunnybrook Health Sciences Center, Toronto, ON, M4N 3M5, Canada

    S. Nofech-Mozes & W. Hanna

Authors
  1. S. A. Narod
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Valentini
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Nofech-Mozes
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P. Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. W. Hanna
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to S. A. Narod.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Narod, S.A., Valentini, A., Nofech-Mozes, S. et al. Tumour characteristics among women with very low-risk breast cancer. Breast Cancer Res Treat 134, 1241–1246 (2012). https://doi.org/10.1007/s10549-012-2065-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-012-2065-x

Keywords

Search

Navigation