Summary Edinburgh was selected as one of the centres in the UK Seven-year Trial of Breast Screening of women aged 45-65 which began in 1979. Subsequently, our study was extended to a randomised trial with its own control population within the city. Half the practices were randomly allocated for screening, giving a cluster sampling of women. The total number in the trial is 65,000. Women with previously diagnosed breast cancer are excluded. Women allocated for screening are invited to the clinic and screened according to the procedures specified in the U.K. protocol, having clinical examination every year and mammography on alternate years. The two modalities of screening are assessed independently and the role of nurses is being evaluated. Breast cancer incidence is monitored by pathology register and the local cancer registry office and deaths from the General Register office. Long-term follow-up will be obtained through flagging at NHS Central Register. To determine the value of screening, standard statistical methods will be used to compare breast cancer mortality rates in the whole of the screening population with that of the controls. This trial has a power of 83% of detecting a reduction in mortality of 35% after 7 years of follow-up and a power of 95% of detecting a similar reduction at 10 years (oa=0.05, one-sided test).

The ability of pathology characteristics to predict outcome was tested with the 1029 cancers accumulated in the Edinburgh Randomized Trial of breast screening after 14 years follow-up. The majority (55.7%) were in the screening arm, which also had more operable cases (81.3% vs 62.2%); the reduction in the proportion of inoperable breast cancers in a UK female population invited to mammographic screening is a notable effect of the trial. In the 691 operable invasive cases the size, histological type, grade, node status and node number group individually showed highly significant (P< 0.001) association with survival. In multivariate analysis the Nottingham Prognostic Index (NPI) derived from these features showed highly significant association with survival (P< 0.001). However, when first adjusted for NPI, combined addition of pathological size in 6 categories and histological type as special or not had an independent association with survival that was statistically firmly based (P< 0.001). For operable breast cancer the gains are in smaller sizes, better histological features, and higher proportion node negative. The weighting factors applied to pathology indicators of survival in the NPI are not optimal for a population included in a trial of screening. In particular, a linear trend of the index with pathological size is not appropriate. Inclusion of histological type as special or not improves the index further. © 2000 Cancer Research Campaign

No abstract

Between 1980 and 1983, 689 women with primary breast cancer at the Royal Infirmary of Edinburgh and associated Hospitals had fine-needle aspiration biopsies prior to definitive surgery. Clinical factors relating to the success of these aspirations were evaluated. The most significant factor was which physician performed the aspiration. Size of the lesion was also an important variable; however, size difference could not account for the marked variation between different individuals performing the aspiration. There was no difference between node-positive and node-negative patients when matched by tumor size. A significantly lower rate of positive aspirations occurred in the 45 to 55 year age group which could not be accounted for by tumor size. Location of the mass was not significant, although there was a persistent lower rate of positive aspirates from the upper inner quadrants. Aspiration cytology was positive or suspicious in 65 percent of patients with primary breast cancer who had clinical diagnoses of benign breast lesions. It is concluded that the most significant variable in the accuracy of breast aspiration biopsy is the size of the lesion and the proficiency of the individual performing the procedure. With a skilled physician, positive aspiration results were obtained in over 80% of breast cancers.

SUMMARY Fine needle aspiration (FNA) cytology carried out on 1318 primary breast cancers from 1980 to 1986 inclusive showed that 198 were well recognised, histological special types. These included medullary, mucoid, tubular, cribriform and lobular invasive cancers, and non-invasive cancers. Excluding these special histological types, the overall number successfully identified (malignant plus suspicious) by fine needle aspiration was 940 (84%), although in only 820 (73%) was malignancy definitely diagnosed. The results for the special types were variable, the mucoid and medullary cancers being consistently identified while the other types were not. For tubular and cribriform, lobular and non-invasive ductal cancers a malignant diagnosis was made in 30% to 40% of cases, although inclusion of suspicious results gave identification figures of 60% to 70%.Particular cytological patterns are characteristic ofsome special histological cancer types but lesion cellularity, size, and physical definition are all intrinsic factors influencing success of FNA diagnosis. About 10% of all primary breast cancers seem to have certain histological properties which further reduce the success of fine needle aspiration.The main factors influencing the success ofFNA ofthe breast have already been reported."3 These include the aptitude of the aspirator, the experience of the cytopathologist, and the size and palpability of the lesion as the major variables. The tendency of cancers detected by screening to be well differentiated or of special histological type4 prompted an analysis of the effect of histological type on the results of fine needle aspiration. This seemed to be particularly relevant in view of the recommendation that fine needle aspiration cytology is incorporated in the assessment of abnormalities detected by screening.5 Material and methodsThe fine needle aspiration cytology specimens were received in the pathology department ofthe University of Edinburgh between 1980 and 1986 inclusive. They came from 1318 primary breast cancers, subsequently confirmed histologically. Most of these occurred in symptomatic patients but about 12% were referred from the Edinburgh Breast Screening Project.6 Pathology findings in the biopsy specimens were extracted from the pathology register maintained for Accepted for publication 2 February 1989 the Edinburgh Breast Screening Project6 which recorded all cancers detected by symptoms and at presentation by screening. The size of any invasive cancer was the maximum diameter of the lesion measured macroscopically in the biopsy specimen. Non-invasive cancers were not routinely measured but the extent was subsequently judged from the slides or specimen x-ray picture. The histological type ofeach cancer was recorded in the register and those of special histological type7 were reviewed.The aspirates were obtained processed and assessed as previously described. '8 In 1982'8 In , 1983'8 In , and 1985 an assigned aspirator performed most of the aspirates.2 With few exceptions the cytology was rep...