Growth rate of 147 mammary carcinomas

Abstract

In 147 cases of mammary carcinoma, 388 serial mammographies were performed before final treatment. The average retrospective observation time was 27 months with a range of two months to 11 years. The number of serial mammographies per case ranged between two and 11. The tumor volume doubling times (TV); obtained by measuring the growth of the tumor nucleus shadow in the mammographies, ranged from 44 to 1869 days with an average of 212 days. No correlation between volume doubling time and histologic differentiation could be found. One hundred of these cancer patients were found in a screening population of 22,000 women receiving serial mammographies in a time period ranging from two to 16 years. An additional 40 cancer patients surfaced in this group without roentgenologic but with foregoing clinical or thermographic abnormalities before final diagnosis. An additional 21 cancer patients surfaced without any foregoing abnormalities. The follow-up tumor ranged between three months and two years with a mean time of one year and nine months. Not considering tumor size, pathologic-thermographic signs appeared with greater frequency the faster the tumor grew. Theoretically, an average of more than 16 years should elapse before an initial tumor cell develops into a 10-mm primary mammary carcinoma (30 doubling times). Therefore the length of time necessary for a 2-mm tumor to grow to a size of 10-mm is, on the average, four years.

Estimates of Breast Cancer Growth Rate From Mammograms and Its Relation to Tumour Characteristics

“…The estimated average tD of 282 days in this study was in the range of other reported studies (105-327 days) (1)(2)(3)(6)(7)(8)(9)(10)(11)(12) . Previous reporting of tumour growth and histopathological findings are inconsistent and some of these studies use outdated histopathological measures making a direct comparison difficult.…”

“…Previous reporting of tumour growth and histopathological findings are inconsistent and some of these studies use outdated histopathological measures making a direct comparison difficult. Nevertheless, patient age (8,9,11) , axillary lymph node involvement (2,7) and advanced TNM stage (11,12) have been shown to correlate with tD. Kusama et al and Kuroshi et al both found that tumour volume doubling time correlated with survival (9,11) .…”

“…Regarding those cases when the tumour cannot be precisely defined, i.e. when a discrepancy between mammographic and pathologic size occur; it is not necessary to obtain a correct mammographic size, it is sufficient that the deviations from correct measurement are reproducible and consistent with each mammogram when calculating the tumour growth rate based on exponential growth (2) . Also, the measured diameter was used to estimate tD based on a spherical tumour shape, but a better approximation might have been to assume an ellipsoid shape, however, the average difference between calculated growth rates of the two shape assumptions is small and varies only by a couple of days (7) .…”

“…One way to estimate the tD is to measure the tumour diameter at diagnosis and on the preceding mammogram assuming that the volume-doubling time is constant and the tumour approximately spherical in shape (1) . Some tumours can retrospectively be tracked on numerous serial mammograms, generating growth curves, which can be described by either exponential, logistic or Gompertz functions (2)(3)(4) .…”

“…Several studies have estimated the volume doubling time of breast cancers based on mammograms (1,2,(5)(6)(7)(8)(9)(10)(11) , however, few have correlated tD with histopathological characteristics (2,7,(9)(10)(11) . To the best of the authors' knowledge, only one study based on ultrasound has correlated tD with tumour characteristics such as the oestrogen receptor (ER), the progesterone receptor (PR), the human epidermal growth factor receptor 2 (HER2) and Ki-67 expression (12) .…”