The pathology of invasive breast cancerA Syllabus Derived from Findings of the National Surgical Adjuvant Breast Project (Protocol No. 4)

Abstract

The inter-relationships of 32 pathologic and 7 clinical parameters encountered in the study of 1000 examples of invasive breast carcinoma have been presented. In some instances the biological significance of these associations is at present unclear. In others it is to be noted that there is no information provided as to the rank of their significance. Nevertheless, the associations that were encountered not only help further characterize the various forms of breast cancer but also provide information regarding the possible biological significance of some of their features. Although it is not our intention to minimize the possible significance of the inter-relationships of pathologic parameters, most emphasis in the summarizing statements which follow has been placed upon those correlations which may relate to prognosis. In this regard reference has been made to short-term treatment failure, vis a vis local recurrence and/or metastases, which may not necessarily accurately reflect patient survival, although generally such a relationship exists. Information in this regard as well as to the rank of the significance of these pathologic features shall be forthcoming when sufficient time has elapsed since the inception of this study to allow for such conclusions, i.e. survival or long-term treatment failure rates. Lastly, it becomes evident that the guidelines followed in the examination of these specimens appear to represent at least the minimum requirements necessary for a meaningful pathologic evaluation of breast carcinoma.

Invasive lobular carcinoma of the breast has better short- and long-term survival than invasive ductal carcinoma

“…carcinoma cells may cause thickening of the duct lining or grow in a pagetoid manner. Solid fillings of ducts may occur, and typical ILC may quite frequently exist in combination with other types of invasive carcinoma (Fisher et al, 1975). Moreover, several variants of ILC that differ from the classical form have been described: the solid or confluent variant (Fechner, 1975), the tubulolobular variant (Fisher et al, 1977) and trabecular and alveolar variants (Martinez and Azzopardi 1979).…”

Lymphocytes infiltrating human breast cancers lack K-cell activity and show low levels of NK-cell activity

“…The presence of a prominent lymphocytic infiltrate within mammary carcinomas has been found by many investigators to be a favourable prognostic sign (Moore & Foote, 1948;Berg, 1959;Anastassiades & Pryce, 1966;Hamlin, 1 968;Cutler et al, 1969;Di Paola et al, 1974;Fisher et al, 1975). The precise anti-tumour role of the tumour-infiltrating lymphocytes, however, is as yet improperly understood.…”

Enhanced risks of cancer from protracted exposures to X- or γ-rays: a radiobiological model of radiation-induced breast cancer

“…In contrast to the target cells in lung cancer, the lack of a reduction of the incidence of breast cancer with dose fractionation suggests that in this case the target cells were repair deficient. This inference is supported by a study in which the repair competencies of lymphocytes from AT heterozygotes and from sporadic breast cancer patients were compared with those from normal controls (Scott et al, 1994 (Fisher et al, 1975). Between puberty and menopause the cyclic oestrogen and progesterone secretions ensure that susceptible cells are stimulated to divide, albeit in a cyclic manner.…”