Clinical characteristics of different histologic types of breast cancer

Abstract

Breast cancer is a heterogeneous disease, though little is known about some of its rarer forms, including certain histologic types. Using Surveillance, Epidemiology, and End Results Program data on 135 157 invasive breast cancer cases diagnosed from 1992 to 2001, relationships between nine histologic types of breast cancer and various tumour characteristics were assessed. Among women aged 50 -89 years at diagnosis, lobular and ductal/lobular carcinoma cases were more likely to be diagnosed with stage III/IV, X5.0 cm, and node-positive tumours compared to ductal carcinoma cases. Mucinous, comedo, tubular, and medullary carcinomas were less likely to present at an advanced stage. Lobular, ductal/lobular, mucinous, tubular, and papillary carcinomas were less likely, and comedo, medullary, and inflammatory carcinomas were more likely to be oestrogen receptor (ER) negative/progesterone receptor (PR) negative and high grade (notably, 68.2% of medullary carcinomas were ERÀ/PRÀ vs 19.3% of ductal carcinomas). In general, similar differences were observed among women diagnosed at age 30 -49 years. Inflammatory carcinomas are associated with more aggressive tumour phenotypes, and mucinous, tubular, and papillary tumours are associated with less aggressive phenotypes. The histologic types of breast cancer studied here differ greatly in their clinical presentations, and the differences in their hormone receptor profiles and grades point to their likely different aetiologies. British Journal of Cancer (2005) Although breast cancer remains the most commonly diagnosed cancer among women in the United States (US) and worldwide, it is a heterogeneous disease. Breast cancer can be categorized in several ways, including based on its clinical features, its expression of tumour markers, and its histologic type. The two most common histologic types of invasive breast cancer are ductal and lobular carcinomas, accounting for approximately 75 and 15% of all cases in the US, respectively (Li et al, 2003a). Interest in lobular carcinoma in particular has recently been piqued by data indicating that incidence rates of lobular carcinoma are increasing more rapidly than are rates of ductal carcinoma in the US. Specifically, lobular rates have increased by 65% from 1987 to 1999, while rates of ductal carcinoma have increased only by 3% (Li et al, 2003a). Studies also suggest that lobular carcinomas are more likely than ductal carcinomas to be hormone receptor positive (Arpino et al, 2004;Korhonen et al, 2004). This difference may partly explain why seven studies have consistently observed that combined oestrogen and progestin postmenopausal hormone use is more strongly related to lobular carcinoma risk than to ductal carcinoma risk (Li et al, 2000(Li et al, , 2003bChen et al, 2002;Newcomb et al, 2002;Daling et al, 2003;Newcomer et al, 2003).While several studies have now examined the clinical, pathologic, and epidemiologic differences between ductal and lobular carcinomas, much less is known about the rarer histologic types of breast cancer,...

Established breast cancer risk factors by clinically important tumour characteristics

“…high grade, large size, node positive, ER negative) differ aetiologically (Mueller, 1988;Anderson et al, 2004b;Li et al, 2005). Our data support this notion, challenging the view that tumour aggressiveness results entirely from stochastic molecular events that occur over time (Hellman and Harris, 2000).…”

Reproductive factors and specific histological types of breast cancer: prospective study and meta-analysis

“…HRT results in a greater increase in the incidence of lobular and tubular than of ductal cancers (Reeves et al, 2006), and lobular breast tissue may be more responsive than ductal to hormones involved in reproduction (Stalsberg et al, 1989). Alternatively, as lobular cancers are more likely than other subtypes to be hormone sensitive (Li et al, 2005) the findings may reflect a greater effect of certain reproductive factors on hormonesensitive breast cancers (Althuis et al, 2004). Although our findings show clearly that age at first birth has a stronger effect on lobular than ductal cancer, they do not suggest a corresponding difference in the effect of parity on these two subtypes.…”

Response and prognosis after neoadjuvant chemotherapy in 1,051 patients with infiltrating lobular breast carcinoma

“…In comparison with non-ILC, ILC is significantly more likely to occur in older patients, to be of larger size, hormone-receptor positive, of intermediate grade and without vascular invasion [3,4]. Pleomorphic lobular carcinomas of the breast display histological features associated with ILC, yet they also exhibit more nuclear atypia and pleomorphism, and an aggressive clinical behaviour [5][6][7].…”