Summary
BACKGROUND: The efficacy and reproducibility of mammographic tumour feature use for predicting patient outcome were tested in consecutive in situ and 1–14 mm invasive breast cancer cases from two breast centres in two different health care systems. METHODS: All in situ and 1–14 mm invasive cancers detected in Falun from 1996–2006 (n = 971), in Roanoke from 2002–2007 (n = 555), and in women aged 40–69 (age limits for invitation to screening) in Falun from 1977–1995 (n = 844) were included; of these the mammograms, pathology slides and follow-up information were available in 95%, 97% and 91% of the cases, respectively. The cancers were classified according to their mammographic appearance: stellate or circular without associated calcifications, or malignant type calcifications with or without an associated tumour mass. The mammographic tumour features and the disease specific survival were correlated. Terminal digit preference of tumour size measurements was examined. RESULTS: Mammographic tumour features were similarly represented in both centres. A significant preference was observed for tumour size measurements divisible by 5 mm. Outcome was significantly poorer for cases having casting type calcifications on the mammogram and excellent for the remaining cases. CONCLUSIONS: Outcome prediction of patients with 1–14 mm invasive breast cancer is significantly improved by the addition of mammographic tumour features to the currently used prognostic factors. The integration of imaging morphology into the TNM classification of invasive breast cancers smaller than 15 mm facilitates specifically targeted therapy and may curtail overtreatment. The significant digit preference found in this study may justify using the terminal digits of "4" and/or "9" as upper size limits for tumour size categories.
Similar content being viewed by others
References
Tabar L, Fagerberg CJ, Gad A, et al. Reduction in mortality from breast cancer after mass screening with mammography: a randomised trial from the Breast Cancer Screening Working Group of the Swedish National Board of Health and Welfare. Lancet, 1: 829–832, 1985
Day NE, Williams DR, Khaw KT. Breast cancer screening programmes: the development of a monitoring and evaluation system. Br J Cancer, 59(6): 954–958, 1989
Nyström L, Rutqvist LE, Wall S, Lindgren A, Lindqvist M, Rydén S, Andersson I, Bjurstam N, Fagerberg G, Frisell J, et al. Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet, 341(8851): 973–978, 1993
Vainio H, Bianchini F. IARC handbooks of cancer prevention. Vol. 7: Breast cancer screening. Lyon (France): WHO/IARC Press; 2002
Tabar L, Yen MF, Vitak B, Chen HH, Smith RA, Duffy SW. Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet, 361(9367): 1405–1410, 2003
Smith RA, Duffy SW, Gabe R, Tabar L, Yen AM, Chen TH. The randomized trials of breast cancer screening: what have we learned? Radiol Clin North Am, 42(5): 793–806, 2004
Swedish Organised Service Screening Evaluation Group. Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev, 15(1): 45–51, 2006
Swedish Organised Service Screening Evaluation Group. Effect of mammographic service screening on stage at presentation of breast cancers in Sweden. Cancer, 109(11): 2205–2212, 2007
Duffy SW, Tabar L, Fagerberg G, Gad A, Gröntoft O, South MC, Day NE. Breast screening, prognostic factors and survival–results from the Swedish two county study. Br J Cancer, 64(6): 1133–1138, 1991
Tot T. The limited prognostic value of measuring and grading small invasive breast carcinomas: the whole sick lobe versus the details within it. Med Sci Monit, 12(8): RA170–175, 2006
Tabár L, Chen THH, Yen AMF, Dean PB. Detection, Diagnosis, and Treatment of Early Breast Cancer Requires Creative Interdisciplinary Teamwork. Semin Breast Dis. 8: 4–9, 2007
Tabár L, Tot T, Dean PB. Breast Cancer: Early Detection with Mammography. Casting Type Calcifications: Sign of a Subtype with Deceptive Features. Stuttgart, Thieme, 2007
Tabar L, Dean PB, Chen H-HT, Duffy SW, Yen AM-F, Chiu SY-H. Early detection of breast cancer challenges current standards of care. In: Silberman H, Silberman A. Principles and Practice of Surgical Oncology: Multidisciplinary Approach to Difficult Problems. London: Hodder Arnold (in press.) 276–291, 2009
Tabar L, Chen HH, Duffy SW, Yen MF, Chiang CF, Dean PB, Smith RA. A novel method for prediction of long-term outcome of women with T1a, T1b, and 10–14 mm invasive breast cancers: a prospective study. Lancet, 355: 429–433, 2000
Thurfjell E, Thurfjell MG, Lindgren A. 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(2): 177–180, 2001
Zunzunegui RG, Chung MA, Oruwari J, Golding D, Marchant DJ, Cady B. Casting-type calcifications with invasion and high-grade ductal carcinoma in situ: a more aggressive disease? Arch Surg, 138(5): 537–540, 2003
Tabar L, Tony Chen HH, Amy Yen MF, Tot T, Tung TH, Chen LS, Chiu YH, Duffy SW, Smith RA. Mammographic tumor features can predict long-term outcomes reliably in women with 1–14 mm invasive breast carcinoma. Cancer, 101(8): 1745–1759, 2004
Peacock C, Given-Wilson RM, Duffy SW. Mammographic casting-type calcification associated with small screen-detected invasive breast cancers: is this a reliable prognostic indicator? Clin Radiol, 59(2): 165–170, 2004
Tabar L, Tot T, Dean PB: Breast Cancer: Breast Cancer: The Art and Science of Early Detection with Mammography. Stuttgart, Germany: Georg Thieme Verlag; 2005
Alexander MC, Yankaskas BC, Biesemier KW. Association of stellate mammographic pattern with survival in small invasive breast tumors. AJR Am J Roentgenol, 187(1): 29–37, 2006
López-Encuentra A, Duque-Medina JL, Rami-Porta R, de la Cámara AG, Ferrando P; Bronchogenic Carcinoma Co-operative Group of the Spanish Society of Pneumology and Thoracic Surgery. Staging in lung cancer: is 3 cm a prognostic threshold in pathologic stage I non-small cell lung cancer? A multicenter study of 1,020 patients. Chest, 121(5): 1515–1520, 2002
Hayes SJ. Does terminal digit preference occur in pathology? J Clin Pathol, 61(8): 975–976, 2008
Hayes SJ. Terminal digit preference occurs in pathology reporting irrespective of patient management implication. J Clin Pathol, 61(9): 1071–1072, 2008
Bopp M, Faeh D. End-digits preference for self-reported height depends on language. BMC Public Health, 30(8): 342, 2008
Jackson PA, Merchant W, McCormick CJ, Cook MG. A comparison of large block macrosectioning and conventional techniques in breast pathology. Virchows Arch, 425(3): 243–248, 1994
Tot T, Tabár L, Dean PB. The pressing need for better histologic-mammographic correlation of the many variations in normal breast anatomy. Virchows Arch, 437(4): 338–344
Wingfield D, Cooke J, Thijs L, Staessen JA, Fletcher AE, Fagard R, Bulpitt CJ; Syst-Eur Investigators. Terminal digit preference and single-number preference in the Syst-Eur trial: influence of quality control. Blood Press Monit, 7(3): 169–177, 2002
Tabár L, Tot T, Dean PB. Early Detection of Breast Cancer: Large-section and Subgross Thick-section Histologic Correlation with Mammographic Appearances Radiographics, 27: S5–S35, 2007
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Tabár, L., Tucker, L., Davenport, R. et al. The use of mammographic tumour feature significantly improves outcome prediction of breast cancers smaller than 15 mm: a reproducibility study from two comprehensive breast centres. memo 4, 149–157 (2011). https://doi.org/10.1007/s12254-011-0287-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12254-011-0287-y