A form of breast cancer characterized by rapid disease progression, inflammation, and edema is found in approximately 55% of the breast cancer patients presenting at the Institute Salah Azaiz, Tunis (Tunisia). In 581 patients seen between January 1, 1969, and December 31, 1974, we examined age, place of residence, reproductive history, delay in seeking treatment, and blood gropu as potential risk factors to determine the distinction between the rapidly progressing disease and the less aggressive form. Rural residence, blood type A, and recent pregnancy are risk factors among premenopausal women, but older age, rural residence, blood type A, late menarche, and delay in diagnosis are associated with postmenopausal rapidly progressing breast cancer. The most significant risk factors were rural residence and blood type A. Rapidly progressing breast cancer was diagnosed in two of every three breast cancer patients coming from a rural environment. Forty-three percent of 203 patients with rapid disease progression were blood type A, a significantly higher percentage than the 33% found in the general Tunisian population and the breast cancer patients without evidence of rapidly progressive disease. We observed that the risk factors for disease progression were quite different from those reported to influence the incidence of breast cancer.

Clinical and radiographic examination of 581 patients with histologically verified breast cancer has permitted us to define a subgroup having a significantly poorer prognosis than other patients. Their condition, called "poussée évolutive" (rapidly progressing), is characterized by rapid tumor growth and/or inflammation adjacent to the tumor. Statistical analysis of the survival of M0 patients (412 of the 581) shows that the diagnosis of "poussée évolutive" provides prognostic information beyond that given by T and N classifications and after delay between initial symptoms and diagnosis have been considered. Six years of clinical experience with this condition are discussed.

Biopsies obtained from 74 Tunisian women with breast cancer (33 cases), benign breast disease (17 cases), and cervical cancer (24 cases) were assayed for the presence of an antigen cross-reacting with gp52 of the mouse mammary tumor virus (MMTV) in order to determine the frequency and possible prognostic significance of this antigen in a form of rapidly progressing breast cancer designated poussée évolutive or PEV. Antigen was detected in 23/33 breast carcinomas (70%) but in none of the 41 control specimens. An evaluation of reactivity according to tumor aggressiveness and survival could be performed in retrospect on 29 of the breast cancer patients with a follow-up of up to 11 years. The frequency of gp52-related antigen was similar in the patients with the most aggressive form of PEV with inflammatory signs (8/12 or 67% positive) and those breast cancer patients without PEV (12/17 or 71% positive). Within each of the two groups, PEV+ and PEV 0, no correlation was observed between the presence or absence of antigen and the disease-free interval or survival. We conclude that the identification of gp52-related antigens in the breast cancer biopsies from North African women has implications different from those observed in other populations. While thus far not indicative of disease aggressiveness and prognosis, the higher frequency of detectable antigen in comparison to biopsies obtained from patients born in the United States and Europe may have relevance to the etiology and pathogenesis of the disease.

Based on two pretreatment evaluations, doubling time (DT) was calculated in 75 cases of invasive breast cancer (BC). The cases studied were more or less equally distributed between three DT groups: fast-growing tumors (DT < 90 days), intermediate cases (DT between 90 and 180 days), and slow-growing tumors (DT > 180 days). A correlation was found to exist between DT and patient age and, to an even greater extent, between DT and pathologic prognostic indicators such as histologic grading and nuclear grade. Inflammatory symptoms were not associated with DT, but were closely related to the size of the tumor and regional lymph node involvement. The date of detection of distant metastases depended heavily on the DT of the BC : BC with shorter DT = earlier metastatic spread. The presence of inflammatory signs was also decisive: within each DT category, inflammatory BC metastases were both more frequent and precocious. Cancer 642081-2089. 1989.