Summary Histological reports of 1869 consecutive women with invasive breast cancer have been reviewed to determine whether histological features of the tumours were related to the patients' age. The patients, treated between 1983 and 1992, were divided into four groups, based on age. There were 148 aged < 39 years, 355 aged [40][41][42][43][44][45][46][47][48][49] years, 984 aged 50-69 years and 382 aged 70 years or more. The most outstanding finding was the increase in incidence of grade IlIl infiltrating ductal carcinoma in those aged < 39 years (P< 0.0001). Certain tumour types, in particular lobular, were reported more frequently in the oldest age group. Additionally, there was a significant reduction of axillary lymph node metastases, vascular invasion and lymphoplasmacytic stromal reaction with increasing age, all of which were independent of tumour grade. These data suggest that there may be age-related changes in the histology of breast cancer and, in some cases, less aggressive features in the elderly. However, as the life expectancy of women over the age of 70 may be many years, treatment should be based on histological prognostic features of the primary tumour rather than age alone.Keywords: breast cancer; histology; age; tumour grade; axillary nodes There are reports indicating that breast cancer has a relatively unfavourable prognosis in young women (Jacquemier et al, 1985;Rosen et al, 1985;Rochefordiere et al, 1993), but is a disease of good prognosis among the elderly (Rosen et al, 1985). However, others have suggested that age does not influence the behaviour of the disease (Schaefer et al, 1984). Relatively few comparative studies of histological features of breast cancer in the young and old have been conducted. It has been reported that there is a significantly lower mean age for patients with medullary carcinoma, while lobular and mucoid carcinomas are relatively more frequent in the elderly (Rosen et al, 1985). Intracystic papillary carcinoma is also found more frequently in older women (Carter et al, 1983). In addition, it has been suggested that younger women have more aggressive high-grade tumours than the elderly (Jacquemier et al, 1985;Rosen et al, 1985).The aim of the present investigation was to review a large series of patients with invasive breast cancer and to analyse a variety of histopathological findings in relation to age, in order to determine whether there were any indications of less or more aggressive features in different age groups. PATIENTS AND METHODSThe study comprised 1869 women with invasive breast cancer who were treated consecutively at the Breast Unit, Guy's Hospital, in the 10-year period 1983-1992. The patients were divided into four age groups, < 39 years, 40-49 years, 50-69 years and > 70 years. These age groups were selected for the following reasons.The cut-off age for young women has ranged from 30-45 years in previous studies (Jacquemier et al, 1985;Rosen et al, 1985;Lee et al, 1992 Correspondence to: IS Fentiman reasonable size, which was compatible with ...
Aim-To investigate the relation between angiogenesis and inflammation in invasive carcinoma of the breast. Methods-Sections from 75 invasive carcinomas of the breast were stained using immunohistochemistry for von Willebrand factor, CD3, CD8, CD45RO, CD45RA, CD20, CD68, and c-erbB-2. Tumour vascularity was assessed by counting vessels in the three most vascular areas, and calculating the average (x400 magnification, field 0.168 mm2). Each pattern of inflammation was scored semiquantitatively.Results-The main pattern of inflammation was a diffuse infiltrate of macrophages, and to a lesser extent T cells. Perivascular and perilobular clusters of B and T cells were noted at the edge of the carcinomas, but were less prominent than the diffuse inflammation. Diffuse inflammation, particularly macrophages, was associated with high tumour grade, tumour necrosis, large tumour size, and c-erbB-2 expression. Perivascular and perilobular inflammation also increased with tumour grade. Tumour vascularity increased slightly with intensity of diffuse inflammation (Spearman's rank correlation coefficient r. = 0.17, p = 0.08), and was inversely related to perilobular inflammation (r, = -0.23, p = 0.03).Conclusions-The correlations between inflammation and vascularity were weak in this study (r2 about 0.04) and thus there was no evidence of an important relation. Discrepancies between this and other studies may be resolved by studying expression of angiogenic cytokines and proteolytic enzymes by tumour infiltrating inflammatory cells, and their relation to tumour vascularity. (J Clin Pathol 1997;50:669-673)
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