Casting-type calcifications on the mammogram suggest a higher probability of early relapse and death among high-risk breast cancer patients

Abstract

Introduction. A retrospective analysis of the relation between the presence of casting-type calcifications on the mammogram and the prognosis of breast cancer was performed. Materials and methods. The mammographic tumor features and other characteristics (invasive tumor size, histological tumor type, grade, nodal, hormone receptor and HER2 status, presence of lymphovascular invasion) of 55 high-risk breast cancers were studied. Results. After a median follow-up time of 29.1 months, the median relapse-free survival and overall survival times among breast cancer patients with tumors associated with casting calcifications were 26.6 and 29.6 months, respectively. The corresponding parameters among patients with tumors not accompanied by casting calcifications were 54.4 and 58.5 months, respectively. Significant associations were found between the presence of casting calcifications and the risks of relapse (HR03.048, 95% CI: 1.116Á8.323, p00.030) or death (HR03.504, 95% CI: 1.074Á11.427, p00.038). Positive associations were found between casting calcifications and ER/PR negativity (p00.015 and p 00.003, respectively) and HER2 overexpression (p00.019). Discussion. Our findings support the theory that breast tumors associated with casting-type calcifications at mammography comprise a disease entity which exhibits significantly more aggressive behavior and a poorer outcome than do cancers with other mammographic tumor features.

Invasive Lobular Carcinoma of the Breast: The Use of Radiological Appearance to Classify Tumor Subtypes for Better Prediction of Long-Term Outcome

“…A similar phenomenon was also noted in a recently published study demonstrating a 16-fold higher rate of local recurrence in breast cancer cases of ductal origin presenting with casting type calcifications on the mammogram [16]. In the new era of breast cancer control, breast cancers of ductal origin with or without associated castingtype calcifications on the mammogram and associated with 1-14 mm invasive acinar adenocarcinoma of the breast (AAB) account for the majority of breast cancer deaths, although they comprise a small minority of the breast cancer cases [6,15,17,18]. There is a clear need to further develop diagnostic and management strategies to decrease mortality from the breast cancers of ductal origin and the diffusely infiltrating special subtypes of ILC described above.…”

Individualized treatment of early breast cancer

“…found to be about threefold if the tumour was associated with casting calcifications on the mammogram [16]. In contrast, a highly favourable prognosis was experienced in small breast cancers appearing as stellate lesions on the mammogram [2,14].…”

“…The presence of casting-type calcifications has been demonstrated to be a prognostic factor which carries a significantly higher risk of death as compared with cancers not associated with this mammographic abnormality [2,[12][13][14][15][16]. In contrast, stellate lesions on the mammogram reflect a more favourable prognosis than any other mammographic appearances [2,[16][17].…”

“…The mammographic appearance of the cancer has recently been suggested as a prognostic factor [2,[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]54]. The risk of relapse or mortality in high-risk breast cancer patients was earlier…”

“…The presence of casting-type calcifications has been demonstrated to be a prognostic factor which carries a significantly higher risk of death as compared with cancers not associated with this mammographic abnormality [2,[12][13][14][15][16]. In contrast, stellate lesions on the mammogram reflect a more favourable prognosis than any other mammographic appearances [2,[16][17]. The prognostic significance of multifocality/multicentricity and the tumour burden have long been the subjects of investigation, but the results are inconclusive as the nomenclature and methods applied were not uniform [1,[18][19][20][21][22][23].…”