Early breast cancer: evaluation of the prognostic role of the site of the primary tumor.

Abstract

Early breast cancers situated in central/ internal quadrants have a worse prognosis compared with those in lateral quadrants, in terms of distant metastases and survival. Irradiation of the internal mammary chain for internal/medial tumors could be suggested, but, to date, the therapeutic strategy is still controversial.

Tumor Location of the Lower-Inner Quadrant Is Associated with an Impaired Survival for Women With Early-Stage Breast Cancer

“…Some studies showed higher risks of death from breast cancer in patients with tumors of the inner quadrants, 9,10,12 or inner quadrants plus central portion of the breast, 11 or lower quadrants, 24 or all quadrants except the upperouter quadrant, 25 whereas other studies showed no association whatsoever between tumor location and breast cancer prognosis. [13][14][15]26 These inconsistencies could be explained by the fact that some studies that reported no association date from an era when women did not receive ), period of diagnosis, method of discovery, grade, tumor size, surgery, radiotherapy, tumor location, histologic type, and hormone therapy; * P < 0.05, ** P < 0.01, *** P < 0.001. adjuvant chemotherapy in case of axillary or IMC lymph node metastases.…”

“…[9][10][11][12]24,25,27,28 As these patients were already candidates for adjuvant therapy, the potential impact of undetected IMC metastases on survival was low. Among the few studies providing powerful subgroup analyses for lymph node negative patients, 9,12,25,29 the majority reported a stronger effect of tumor location on breast cancer mortality among lymph node negative patients.…”

“…There is growing evidence that tumors occurring in the inner quadrants have a higher breast cancer mortality. [9][10][11][12] However, the real impact of tumor location on the risk of IMC node metastases and on prognosis is still controversial, mainly because of the inconclusive findings in older studies. 4,[13][14][15] We used data from the Geneva Cancer Registry to evaluate the impact of tumor location on breast cancer mortality among women with stage I disease.…”

Why do we need irradiation of internal mammary lymph nodes in patients with breast cancer: Analysis of lymph flow and radiotherapy studies

“…In order to calculate the probability of lymph flow from primary lesions, localized [3][4][5][6][7][8] As in descriptions of some studies we did not find figures that characterized patient distribution according to localization of primary lesion in the breast, we used average rate extracted from two large population based trials. 8,14 In accordance with these studies, we assumed that, on average, 32% of women with BC had internal/central and remaining 68% -external localization of primary tumour.…”

Comment by G.G. Grabenbauer on V. Vinh-Hung et al. The Effect of Adjuvant Radiotherapy on Mortality Differs According to Primary Tumor Location in Women with Node-Positive Breast Cancer

“…This topic seems very interesting and should motivate radiation oncologists … It has been well known for decades that medial and central location of breast cancer is associated with a less favorable prognosis as compared to tumors arising in the lateral quadrants [1]. This increase in mortality risk due to medial tumor location was reported as being in the order of 15-20% [5], in patients with node-positive tumors even as high as 50% [2]. The herein reported SEER analysis by Vincent Vinh-Hung confirms this data: in women with medial tumor location following mastectomy (and one to three metastatic axillary nodes), the mortality risk increased from 1.09 (1.03-1.16) to 1.26 (1.16-1.37) compared to women with lateral tumors (9,000 vs. 1,000 patients).…”