Chapter I. Biology and natural history of breast cancer

Pontén, Jan; Holmberg, Lars; Trichopoulos, Dimitrios; Kallioniemi, Olli-Pekka; Kvåle, Gunnar; Wallgren, Ame; Taylor‐Papadimitriou, Joyce

doi:10.1002/ijc.2910460703

Cited by 34 publications

(18 citation statements)

References 67 publications

(44 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The poor grade of interval cancers occurs mainly in cancers less than 2 cm in diameter, Significance of difference between observed and expected, P = 0.7. (Ponten et al, 1990). They conclude that the evidence is against it occurring, citing results that DNA ploidy is similar in (incidence) screen detected as in clinically detected cancers, even though the former are diagnosed on average some 3 years earlier.…”

Section: Resultsmentioning

confidence: 99%

Breast screening, prognostic factors and survival – results from the Swedish two county study

Duffy

Tabár²,

Fagerberg³

et al. 1991

Br J Cancer

157

View full text Add to dashboard Cite

SummaryThe results of the Swedish two-county study are analysed with respect to tumour size, nodal status and malignancy grade, and the relationship of these prognostic factors to screening and to survival. It is shown that these factors can account for much of the differences in survival between incidence screen detected, interval and control group cancers but to a lesser extent for cancers detected at the prevalence screen where length bias is greatest. Furthermore, examination of the relationships among the prognostic factors and mode of detection indicates that malignancy grade, as a measure of inherent malignant capacity, evolves as a tumour grows. The proportion of cancers with poor malignancy grade is several fold lower for cancers of diameter less than 15 cm than for cancers greater than 30 cm, independent of the length bias of screening. The implications of these findings for screening frequency are briefly discussed.It has been shown that mortality from breast cancer can be reduced by mass screening using mammography (Shapiro et al., 1982;Tabar et al., 1985), a reduction resulting from earlier diagnosis. The natural history of breast cancer, however, is clearly heterogeneous, with substantial variation among tumours in their malignant potential, rate of growth and prognosis. Further, little is known of the rate at which prognosis deteriorates as a tumour develops or conversely how prognosis improves as the time of diagnosis is advanced.It is known that screening does reduce rates of larger tumours and of metastases Tabar et al., 1987). Moreover, these factors affect survival, as does malignancy grades. However, these relationships have not been fully quantified in a screening context, so the mechanism whereby screening can reduce mortality is not fully understood. The purpose of the present paper is to examine, using the results of the Swedish two-county study:(1) the relationships among the prognostic factors: tumour size, nodal involvement and malignancy grade; (2) the change in these factors brought about by screening; (3) the extent to which the change in the distributions of prognostic factors achieved by screening can account for the mortality reduction; (4) (Bloom & Richardson, 1957;Scarff & Torloni, 1968) was determined by one pathologist in each county, but as results demonstrate, there were differences between the two counties in proportions of grades 1, 2 and 3, probably reflecting subjectivity in classification of tumour grade rather than a difference in the two tumour populations. No such differences were observed between counties for tumour size or node status.Statistical analysis of associations among tumour characteristics was performed using log-linear modelling and logistic regression (Aitkin et al., 1989). These methods yield likelihood ratio (deviance) chi-squared tests for significance of associations and odds ratio estimates of relative risks (for example of being nodes positive for given grade relative to grade 1). Survival analysis was performed using proportional hazards regres...

show abstract

Section: Resultsmentioning

confidence: 99%

Breast screening, prognostic factors and survival – results from the Swedish two county study

Duffy

Tabár²,

Fagerberg³

et al. 1991

Br J Cancer

157

View full text Add to dashboard Cite

show abstract

“…According to the proposed multi-step process of carcinogenesis (Ponten et al, 1990), i.e. initiation, promotion, tumour and progression, undifferentiated cells, which have not undergone the maturation process, may be initiated by carcinogens and after promotion give rise to a breast tumour several years later.…”

Section: Epidemiologymentioning

confidence: 99%

Differential effects of reproductive factors on the risk of pre- and postmenopausal breast cancer. Results from a large cohort of French women

2002

View full text Add to dashboard Cite

The aim of this study was to obtain a better understanding of the role of hormonal factors in breast cancer risk and to determine whether the effect of reproductive events differs according to age at diagnosis. It analysed the effect of age at menarche, age at first full-term pregnancy, number of full-term pregnancies and number of spontaneous abortions both on the overall risk of breast cancer and on its pre-or postmenopausal onset, using the data on 1718 breast cancer cases, obtained from a large sample of around 100 000 French women participating in the E3N cohort study. The results provide further evidence that the overall risk of breast cancer increases with decreasing age at menarche, increasing age at first pregnancy and low parity. No overall effect of spontaneous abortions was observed. The effect of these reproductive factors differed according to menopausal status. Age at menarche had an effect on premenopausal breast cancer risk, with a decrease in risk with increasing age of 7% per year (P50.05). Compared to those who had their first menstrual periods at 11 or before, women experiencing menarche at 15 or after had an RR of 0.66 (95% CI 0.45 -0.97) in the premenopausal group. Age at first full-term pregnancy had an effect on both pre-and postmenopausal breast cancer risk, with significant tests showing increasing risk per year of increasing age (P=0.001 and P50.05 respectively). A first full-term pregnancy above age 30 conveyed a risk of 1.63 (95% CI 1.12 -2.38) and 1.35 (95% CI 1.02 -1.78) in the pre-and postmenopausal groups respectively. A protective effect of high parity was observed only for postmenopausal breast cancer risk (P for trend test =0.001), with point estimates of 0.79 (95% CI 0.60 -1.04), 0.69 (95% CI 0.54 -0.88), 0.66 (95% CI 0.51 -0.85) and 0.64 (95% CI 0.48 -0.86) associated to a one, two, three and four or more full-term pregnancies. A history of spontaneous abortion had no significant effect on the risk of breast cancer diagnosed before or after menopause. Our results suggest that reproductive events have complex effects on the risk of breast cancer. There is a considerable body of evidence that reproductive factors play a role in the aetiology of breast cancer risk (Kelsey et al, 1993). However, the biological mechanism is not yet clearly understood.Results showing the effect of these factors by age or menopausal status at the time of diagnosis may help to give a better understanding of their role.A pooled analysis of the literature showed that early age at menarche and late age at first full-term pregnancy (FFTP) had a greater effect on the risk of breast cancers diagnosed early (i.e. at an early age or before menopause) than on the risk of those diagnosed late (i.e. after 55 or after menopause). In contrast, it has been shown that the protective effect of multiparity is greater on late breast cancers (Clavel-Chapelon and Gerber, 2001). Epidemiological studies reporting on the relationship between breast cancer risk and spontaneous or induced abortions by age have produced con...

show abstract

“…A morphologic continuum exists from proliferative breast disease to carcinoma in situ and eventually to invasive tumors with a potential to metastasize, but the evidence that the common breast cancers actually proceed through all these stages is mostly circumstantial (Ponté n et al, 1990;Lennington et al, 1994;Page et al, 1995). Some of the primary cytogenetic changes characteristic of breast carcinomas have also occasionally been detected in the epithelial component of benign breast proliferations and in mammary tissue predisposed to carcinogenesis Dietrich et al, 1995;Teixeira et al, 1996a).…”

Section: Karyotypic Model Of Breast Carcinogenesismentioning

confidence: 99%

Cytogenetic clues to breast carcinogenesis

Teixeira

Pandis

Heim

2001

Genes Chromosomes & Cancer

View full text Add to dashboard Cite

The somatic mutation theory of cancer maintains that tumorigenesis is driven by genetic alterations, many of which are visible cytogenetically. We have examined breast cancer by chromosome banding analysis after short-term culturing of tumor cells and here review our findings in 322 karyotypically abnormal samples obtained since 1992 from 256 patients. The screening capabilities of this technique enabled us to identify several cytogenetic subgroups of breast cancer, to study the intratumor heterogeneity of breast carcinomas, and to compare primary tumors with their metastases. Using chromosome abnormalities as clonality markers, we could determine on an individual basis when multiple, ipsilateral or bilateral breast, tumors were independent de novo carcinomas and when they resulted from the spreading of a single malignant clone within one breast or from one breast to the other. The distribution of chromosomal breakpoints and genomic gains and losses is clearly nonrandom in breast cancer, something that can guide further investigations using molecular methods. Based on the total dataset, we propose a multipathway model of mammary carcinogenesis that takes into consideration the genetic heterogeneity revealed by the karyotypic findings and review the karyotypic-pathologic correlations and the possible clinical applications of the cytogenetic knowledge.

show abstract

Chapter I. Biology and natural history of breast cancer

Cited by 34 publications

References 67 publications

Breast screening, prognostic factors and survival – results from the Swedish two county study

Breast screening, prognostic factors and survival – results from the Swedish two county study

Differential effects of reproductive factors on the risk of pre- and postmenopausal breast cancer. Results from a large cohort of French women

Cytogenetic clues to breast carcinogenesis

Contact Info

Product

Resources

About