Medullary cancer of the breast revisited

Fisher, Edwin R.; Kenny, Julia P.; Sass, Richard; Dimitrov, Nikolay V.; Siderits, Richard; Fisher, Bernard

doi:10.1007/bf01806330

Cited by 51 publications

(27 citation statements)

References 20 publications

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“…Ten-year survival rates for those without LNM were 68.7–80.2%. Patients with LNM not receiving chemotherapy had 10-year survival rates of 44.4–50.0% [9]. Our OS was similar, with 10-year survival rates of 67.5 and 81.9% in those with and without LNM, respectively.…”

Section: Discussionmentioning

confidence: 53%

Medullary carcinoma of the breast: a population-based perspective

et al. 2010

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Prognostic factors specific to medullary carcinoma of the breast (MCB) are unknown. Our objective was to identify patient and tumor factors predictive of overall survival (OS) in a large cohort of MCB patients. The Surveillance, Epidemiology, and End Results database was used to identify patients with MCB diagnosed from 1988 to 2004. Patient, tumor, and treatment factors were compared by univariate analysis via the Kaplan–Meier method and survival differences detected using the log-rank test. A multivariate Cox proportional hazards model controlled for patient age, race, type of surgery, radiotherapy, tumor size, number of lymph node metastases (LNM), lymph node yield (LNY), estrogen receptor (ER) and progesterone receptor (PR) status, and extent of disease. On univariate analysis of 3,348 patients, factors influencing OS included age, race, tumor size, ER status, type of surgery, radiotherapy, LNM, LNY, and extent of disease (P < 0.001). On multivariate analysis, advancing age (P < 0.001), black race (P < 0.001), regional metastases (P < 0.001), distant metastases (P < 0.001), increasing tumor size (P < 0.001), ER positivity (P = 0.003), and increasing LNM (P < 0.001) were associated with decreased OS. An OS benefit was seen in PR-positive patients (P = 0.002) and in those with increasing LNY (P < 0.001). Even among node-negative patients, increasing LNY was associated with improved OS (P < 0.001). Tumor size, LNM, regional and distant metastases, PR status, age, and race are important prognostic factors in MCB. ER positivity was associated with decreased OS, which may reflect inaccuracy in diagnosing MCB or a significant biologic variant. The improved OS seen with increasing LNY in node-negative patients suggests MCB may be currently understaged.

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Section: Discussionmentioning

confidence: 53%

Medullary carcinoma of the breast: a population-based perspective

et al. 2010

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“…1). The favorable prognosis of medullary cancer is not confirmed in all reports, and it will not be considered further (13,14). However, other data support the findings by Rosen et al (7) for tubular and mucinous cancers (15)(16)(17)(18)(19)(20)(21).…”

Section: Favorable Prognosis Subgroupsmentioning

confidence: 47%

Who Should Not Receive Chemotherapy? Data From American Databases and Trials

Morrow¹,

Krontiras²

2001

JNCI Monographs

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The demonstration of the effectiveness of chemotherapy in both premenopausal and postmenopausal women, regardless of estrogen receptor (ER) status, raises the question of whether all breast cancer patients should receive chemotherapy. Several patient groups with such a favorable longterm prognosis that they will obtain an extremely small benefit from chemotherapy can be identified. They include patients with lymph node-negative tumors of 1 cm or less in size, those with grade 1 tumors between 1.1 and 2.0 cm in size, and those with tumors of favorable histologic type (tubular and mucinous) up to 3 cm in size. A patient subgroup in which it is not clear that the benefits of chemotherapy routinely exceed the risks is postmenopausal women with ER-positive, lymph node-negative cancers receiving tamoxifen. There is a wide variation in prognosis in this group, and chemotherapy should be reserved for those at high risk of recurrence. Finally, no benefit for chemotherapy in women aged 70 years and older has been identified. The high rate of death from causes other than breast cancer may negate small survival benefits, and after adjustment for quality of life, the duration of treatment exceeds the gain in life expectancy. [J Natl Cancer Inst Monogr 2001;30:109-13]The Oxford Overview Analysis (1) has clearly demonstrated that adjuvant systemic chemotherapy reduces the risk of mortality for women with both lymph node-positive and lymph node-negative breast cancer and is effective in both premenopausal and postmenopausal women. In light of the proven benefit of chemotherapy, it is reasonable to ask whether there are any groups of breast cancer patients who should not receive this treatment. Potential patient groups who will not achieve a net benefit from chemotherapy include women with an extremely favorable prognosis, where the reduction in mortality from chemotherapy translates to an absolute survival difference of only a few percent; patients in whom the potential risks of chemotherapy outweigh the benefits; and patient subsets for which chemotherapy has not been proven to have a survival benefit. This article will discuss breast cancer patient groups who meet these criteria. FAVORABLE PROGNOSIS SUBGROUPSSubsets of lymph node-negative breast cancer patients with a favorable prognosis have usually been defined on the basis of tumor size or histologic subtype. The use of screening mammography has resulted in the increasingly frequent identification of cancers of 1 cm or less in size. Several large datasets (2-6) confirm that tumors of this size have an extremely favorable prognosis. The Breast Cancer Detection Demonstration Project (BCDDP) was one of the earlier studies to report on the favorable outcome of patients with tumors less than 1 cm in size (2). In the BCDDP, the 880 patients with stage I cancer had an 8-year survival rate of 90%, and for those with tumors less than 1 cm in size, the survival rate was 96%. This favorable prognosis was observed for both the interval and screen-detected cancers, where the survival ra...

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“…In cervical carcinomas, using antibody phage display, it was possible to show that infiltrating B cells and plasma cells represent an antigen-induced response to human papillomavirus (HPV) infection or transformation (O'Brien et ai., 2001). In medullary ductal breast carcinoma, the presence of B and plasma cells is associated with improved prognosis (Fisher et at., 1990), and this has generated considerable interest in the role of these B cells and their products in tumor progression. Several independent studies examined the hypothesis that lymphoplasmacytic infiltrates represented a host humoral response driven by tumor-derived neo-antigens (Coronella et ai., 2002;Hansen et ai., 2001;Nzula et ai., 2003).…”

Section: S B Cellsmentioning

confidence: 95%

The Role of Immune Cells in the Tumor Microenvironment

Whiteside

2006

Cancer Treatment and Research

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Abstract:Keywords:Interactions between tumor infiltrating leukocytes and tumor cells have been of great interest because of the possibility that immune cells either interfere with tumor progression or actively promote tumor growth. The tumor microenvironment is shaped by cells entering it, and their functions reflect the local conditions. Successive changes occurring at the tumor site during tumor progression resemble chronic inflammation. This chronic inflammatory reaction seems to be largely orchestrated by the tumor, and it seems to promote tumor survival. Molecular and cellular mechanisms linking the inflammatory reaction and cancer are emerging, and this review summarizes the current understanding of interactions between inflammatory and cancer cells in the tumor microenvironment.

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Medullary cancer of the breast revisited

Cited by 51 publications

References 20 publications

Medullary carcinoma of the breast: a population-based perspective

Medullary carcinoma of the breast: a population-based perspective

Who Should Not Receive Chemotherapy? Data From American Databases and Trials

The Role of Immune Cells in the Tumor Microenvironment

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