A comparison of axillary node status between cancers detected at the prevalence and first incidence breast screening rounds

Abstract

Summary Screen-detected breast cancers are smaller than those detected in symptomatic populations and, for any given size, they are associated with fewer lymph node metastases. The management of axillary lymph nodes in patients with screen-detected breast cancer (Crisp et al., 1993;Tabar et al., 1992). For any given size, screen-detected cancers are associated with fewer lymph node metastases than those detected in non-screened populations (Anderson et al., 1991). However, the Edinburgh Breast Screening Trial reported that these tumour variables differ between cancers detected at the prevalence (initial screen) and incidence (second or subsequent) screening rounds (Anderson et al., 1986(Anderson et al., , 1991. Although patient numbers in this study were relatively small, lymph node positivity was found to be 24.5% in the prevalence screen (PS) and 31.3% for incidence screen (IS)-detected cancers.The optimum surgical management of axillary lymph nodes in women with symptomatic or screen-detected breast cancer remains highly controversial. Some authors recommend axillary staging in all patients with operable invasive breast cancer to gain maximum prognostic information and to allow selection of patients for systemic adjuvant therapy (Fentiman, 1991). However, if we could identify those patients with breast cancer at low risk of nodal involvement, the number of patients needing axillary dissection would be reduced, resulting in a subsequent decrease in patient morbidity, operating time and cost. Several authors have suggested that axillary dissection can be abandoned for small (< 1 cm) symptomatic cancers, in view of the low rates of lymph node involvement. Instead patients could be selected for adjuvant therapy on the basis of primary tumour characteristics alone, with axillary dissection adding little if anything to the decision-making process (Silverstein et al., 1994;Chada et al., 1994;Cady, 1994

Impact of Axillary Dissection on Staging and Regional Control in Breast Tumors = 10 mm: The DBCG experience

“…Some groups prefer not to perform axillary surgery routinely in T1a +/−T1b tumors (10,11,(20)(21)(22). Others warn that axillary dissection should continue to be a standard approach, regardless of size (23,24). Our findings support the latter recommendation.…”

“…Again, it should be emphasized that the present material includes only a small proportion of screen-detected cancers with less frequent axillary metastases (5%) (11,26). But it should also be noted that the step from the prevalence to first incidence screening round was associated with an increase in axillary metastases from 5% to 14.3% (24). The DBCG results on the significance of local control are to some extent in contrast to the results from the NSABP B-04 trial (27).…”

Aberrant hypermethylation of ID4 gene promoter region increases risk of lymph node metastasis in T1 breast cancer

“…For patients with early breast cancers, the ability to predict nodal metastasis could alleviate the need for axillary staging. The rate of nodal metastasis in T1 (p2.0 cm) breast cancers is reportedly from 18 to 31% (Carter et al, 1989;Holland et al, 1996;Barth et al, 1997). There are several known risk factors of lymph node metastasis for invasive breast cancer to date.…”

Preoperative selection of symptomatic breast cancer patients appropriate for lymphatic mapping and sentinel node biopsy

“…Although, in general, palpable nodes are agreed to contraindicate attempts at SLNB, clinical examination lacks sufficient specificity and sensitivity to guide appropriate patient selection for this technique. While factors such as tumour palpability, size and grade along with lymphovascular invasion (LVI) are known independent predictors of axillary metastases by multivariate analysis there are limits as to how accurately they can be determined before definitive surgery [11,[17][18][19]. As palpability in itself cannot select symptomatic patients (due to the frequency with which it is found in this group) and as biopsy techniques are unreliable in their detection of LVI, only two of these parameters are readily assessable preoperatively and potential amenable for use in identifying patients suitable for SLNB prior to surgery-size (best assessed by means of ultrasound measurement) and grade (by core biopsy sampling)-however neither is 100% predictive of the results of the full pathological analysis [20,21].…”