No abstract

Radiographic, gross, and histopathologic studies on 158 whole breasts with primary operable carcinoma revealed intramammary lymph nodes in 28%, and of these breasts, 10% contained a metastatic deposit of carcinoma. Cancerous and noncancerous nodes were found in all quadrants of the breast with the positive ones being in the same quadrant as the carcinoma only 50% of the time. There was no demonstrable connection with the usual lymphatic drainage of the breast. With Stage II carcinoma, positive intramammary lymph nodes had no direct effect on prognosis, merely representing advanced disease and indicating a greater likelihood of axillary metastatic disease. There was a trend toward poorer prognosis in Stage I lesions with positive intramammary lymph nodes. This may indicate the Stage I carcinomas that have a similar prognosis as Stage II tumors. Conceivably, a Stage Ia, positive intramammary lymph node(s) but normal axillary lymph nodes, could be defined and used.

No abstract

Mammography studies, from 1963 through 1972, on 5,918 women over age 30 years with 327 breast cancer on initial studies, were prospectively categorized on a scale of 1 to 4 of increasing amounts of fibroglandular tissue. Approximately 60% of the cancers occurred in classes 1 and 2 breasts, about one-third of the patients, while 40% of the cancer were in the remaining two-thirds, comprising classes 3 and 4. There were 54 cancers that developed in breast that previously were free of symptoms, clinical signs, and x-ray abnormality. Up to 36 months one cancer was found in class 1, while 26 cancers were detected in class 4 breasts; two cancers developed in class 2 and seven in class 3. Cancers developing 38 to 88 months after normal examination had an incidence of 0.23% in combined classes 1 and 2 and an incidence of 0.21% in classes 3 and 4. Dense fibroglandular tissue delays detection of breast cancer by mammography. Apparent increase in cancer risk in such breasts is due to this delay. More than a 3-year follow-up is required to assess the life history of breast cancer by mammography.

Selection of breast cancer patients with microscopically limited disease but with excess mortality or women with regional disease and lessened mortality has remained an unsolved and critical challenge. The many usual histologic features such as tumor size, stage of disease or tumor differentiations were found reduced to lessened significant prognostic factors by the presence of multicentricity of tumors and multiplicity of histologic types of carcinoma. This observation was noted upon review of 161 clinical, radiographic and histopathologic whole breast studies on 156 patients with follow-up from 11-15 years. Epidemiologic, clinical, and radiographic data had been compiled prospectively prior to diagnosis. Women with single site and single type of carcinoma had a better prognosis (2.5% mortality per year) than those with multiple sites and multipe types (15% mortality per year) even though the stage of the disease may be similar. When the latter groups contained a scirrhous type duct carcinoma, the annual mortality rate approached 25%.