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Since there are no published data on breast cancer in British black women, we sought to determine whether, like African-American women, they present at a younger age with biologically distinct disease patterns. The method involved a retrospective review of breast cancer to compare age distributions and clinicopathological features between black women and white women in the UK, while controlling for socioeconomic status. All women presented with invasive breast cancer, between 1994 and 2005, to a single East London hospital. Black patients presented significantly younger (median age of 46 years), than white patients (median age of 67 years (P ¼ 0.001)). No significant differences between black and white population structures were identified. Black women had a higher frequency of grade 3 tumours, lymph node-positive disease, negative oestrogen receptor and progesterone receptor status and basal-like (triple negative status) tumours. There were no differences in stage at presentation; however, for tumours of p2 cm, black patients had poorer survival than white patients (HR ¼ 2.90, 95% CI 0.98 -8.60, P ¼ 0.05). Black women presented, on average, 21 years younger than white women. Tumours in younger women were considerably more aggressive in the black population, more likely to be basal-like, and among women with smaller tumours, black women were more than twice as likely to die of their disease. There were no disparities in socioeconomic status or treatment received. Our findings could have major implications for the biology of breast cancer and the detection and treatment of the disease in black women.

BACKGROUND: Several recent studies have shown that screen detection remains an independent prognostic factor after adjusting for disease stage at presentation. This study compares the molecular characteristics of screen-detected with symptomatic breast cancers to identify if differences in tumour biology may explain some of the survival benefit conferred by screen detection. METHODS: A total of 1379 women (aged 50 -70 years) with invasive breast cancer from a large population-based case -control study were included in the analysis. Individual patient data included tumour size, grade, lymph node status, adjuvant therapy, mammographic screening status and mortality. Immunohistochemistry was performed on tumour samples using 11 primary antibodies to define five molecular subtypes. The effect of screen detection compared with symptomatic diagnosis on survival was estimated after adjustment for grade, nodal status, Nottingham Prognostic Index (NPI) and the molecular markers. RESULTS: Fifty-six per cent of the survival benefit associated with screen-detected breast cancer was accounted for by a shift in the NPI, a further 3 -10% was explained by the biological variables and more than 30% of the effect remained unexplained. CONCLUSION: Currently known biomarkers remain limited in their ability to explain the heterogeneity of breast cancer fully. A more complete understanding of the biological profile of breast tumours will be necessary to assess the true impact of tumour biology on the improvement in survival seen with screen detection.

On review of the histology of 1050 primary breast carcinomas, 103 cases of infiltrating lobular carcinoma were identified and clinical and survival data collected in each case. The tumours were then separated into four groups on the basis of histological pattern and these groups shown to have significantly different survival times. Assessment of the presence of in situ carcinoma, elastosis and intracyto‐plasmic lumina was performed in each case and the effect of these features on survival investigated. In addition to stage of disease at presentation, the major significant factor in predicting survival of patients with this type of invasive carcinoma is histological type.

There is a small amount of overdiagnosis of ductal carcinoma in situ in mammography screening; however, this should not deter women from being screened. Training and practice in mammographic screening should emphasise detection of small, invasive lesions. Research into the natural history and treatment of the disease should aim at minimising overtreatment of those in situ lesions that are less likely to progress to invasive disease.

SummaryThe effect of reproductive factors on breast cancer risk was evaluated in a population-based casecontrol study, including 1,486 breast cancer cases diagnosed over a one-year period in Denmark. They were identified from the files of the nationwide trial of the Danish Breast Cancer Co-operative group and the Danish Cancer Registry. The control group was an age-stratified random sample of 1,336 women from the general population. Data on risk factors were collected by self-administered (mailed) questionnaires. Significantly increased relative risks (RR) were associated with never being pregnant (RR= 1.47), an early terminated first pregnancy (RR=1.43), and having a natural menopause after the age of 54 (RR= 1.67). Trends of decreasing risk were observed by increasing parity and age at menarche. These findings were independent of age at first full-term pregnancy which overall was not related to breast cancer risk, though a weak association appeared in women less than 50 years at diagnosis. The study confirmed that pregnancies must continue to term to offer protection against breast cancer.In 1970, MacMahon et al. showed in their International Collaborative Study that the protective effect of parity on breast cancer risk could be explained by maternal age at first full-term pregnancy from an association between high parity and early age at first birth. Several studies have confirmed this, but some found an additional protective effect of high parity (Soini, 1977;Tulinius et al., 1978;Paffenbarger et al., 1980;Brinton et al., 1983;Helmrich et al., 1983; Pathak et al., 1986). Others have failed to demonstrate an association between breast cancer risk and age at first birth (Choi et al., 1978; Thein-Hlaing & Thein-Maung-Myint, 1978;Adami et al., 1980;Pike et al., 1981;Harris et al., 1982;Kvale et al., 1987b).Conflicting evidence also exists in the literature regarding the role of early terminated pregnancies. Two reports (Pike et al., 1981;Hadjimichael et al., 1986) suggested that a first trimester abortion (induced or spontaneous) before the fullterm pregnancy might elevate the risk of breast cancer, while such an effect was not seen in two other studies (Vessey et al., 1982;Brinton et al., 1983).We were able to evaluate the effect of reproductive factors on breast cancer risk in a population-based case-control study including almost all incident cases over a one-year period in Denmark. Materials and methodsThe study was sampling frame exists in the national Central Population Registry, established in 1968, with the purpose of storing commonly used personal data for each inhabitant and acting as source material for the administrative system in Denmark. The key identifier is a unique 10-digit ID-number, the first 6 digits being the date of birth, which has been issued to all persons living in and entering the country (by birth or immigration) since 1968. The registry is computerised and updated on a regular basis. Through a linkage with the Danish Cancer Registry database, women with a breast cancer predating t...

Background:We analysed 10-year survival data in 19 411 women aged 50–64 years diagnosed with invasive breast cancer in the West Midlands region of the United Kingdom. The aim was to estimate the survival advantage seen in cases that were screen detected compared with those diagnosed symptomatically and attribute this to shifts in prognostic variables or survival differences specific to prognostic categories.Methods:We studied tumour size, histological grade and the Nottingham Prognostic Index in very narrow categories and investigated the distribution of these prognostic factors within screen-detected and symptomatic tumours. We also adjusted for lead time bias.Results:The unadjusted 10-year breast cancer survival in screen-detected cases was 85.5% and in symptomatic cases 62.8% after adjustment for lead time bias, survival in the screen-detected cases was 79.3%. Within narrow categories of prognostic variables, survival differences were small, indicating that the majority of the survival advantage of screen detection is due to differences in the distributions of size and node status.Conclusion:Our results suggested that a combination of lead time with size and node status in 10 categories explained almost all (97%) of the survival advantage. Only a small proportion remained to be explained by biological differences, manifested as length bias or overdiagnosis.

A histological review of 1003 invasive breast carcinomas identified 103 patients with infiltrating lobular carcinoma, for whom clinical and survival data were collected in each case. Six patients had bilateral carcinoma at diagnosis and 14 developed a contralateral carcinoma during the period of follow-up. The major factor predicting patients at risk of developing a contralateral carcinoma was histological type. Analysis of survival data on the patients with bilateral disease showed poor survival in the group with synchronous bilateral disease, but no difference in survival between patients with metachronous bilateral and unilateral disease. This suggests that the development of a metachronous contralateral carcinoma does not necessarily reduce the probability of survival of patients with infiltrating lobular carcinoma.