title: Women with large breasts are at an increased risk of advanced breast cancer.
abstract: BACKGROUND
  The risk of nodal metastasis is higher in women with bigger breast. It is not clear if this increase is due to the size of the breast (largely related to obesity) or is the result of larger tumour size at presentation (due to delayed diagnosis). It is hypothesised that women with large breasts are more likely to have node positive disease mainly attributable to their breast size.
  
  
  METHODS
  One hundred and twenty consecutive patients who underwent mastectomy during the year 2004 and 2005 for primary breast cancers in a large Teaching Hospital were included in the study. Patient's variable and tumour variable were collected and analysed by SPSS(R) computer programme.
  
  
  RESULTS
  It was found that big breasted women (those patients with mastectomy weight greater than 800 g) had a significantly greater tumour size than those with smaller breasts (p = 0.019, Mann-Whitney test) but there was no significant difference in grade (Kendall's tau-b = 0.055, p = 0.57) or lymph node positivity (Kendall's tau-b = 0.011, p = 0.93) between the two groups. Although, the tumour size was significantly greater in those with lymph node metastases (p < 0.001) but mastectomy weight was not found to be significantly greater in those with lymph node metastases (p = 0.11). For patients with similar tumour sizes mastectomy weight was not significantly greater in those patients with lymph node metastases (p = 0.28).
  
  
  CONCLUSIONS
  It is concluded that increased incidence of lymph node positivity at presentation big-breasted women is because of larger size of the primary tumour and not due to the size of the breast alone.
authors.affiliation: Department of Surgery, Russells Hall Hospital, Dudley, UK. homepac@doctors.org.uk.
authors.forename: Chaminda
authors.initials: C
authors.lastname: Sellahewa
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: Amtul R
authors.initials: AR
authors.lastname: Carmichael