Prognosis for mammographically occult, early-stage breast cancer patients treated with breast-conservation therapy.
OBJECTIVE
To compare mammographically occult (MamOcc) and mammographically positive (MamPos) early-stage breast cancer patients treated with breast-conservation therapy (BCT), to analyze differences between the two cohorts.


METHODS
Our two cohorts consisted of 214 MamOcc and 2168 MamPos patients treated with BCT. Chart reviews were conducted to assess mammogram reports and method of detection. All clinical-pathologic and outcome parameters were analyzed to detect differences between the two cohorts.


RESULTS
Median follow-up was 7 years. There were no differences in final margins, T stage, nodal status, estrogen/progesterone receptor status, or "triple-negative" status. Significant differences included younger age at diagnosis (p < 0.0001), more positive family history (p = 0.0033), less HER-2+ disease (p = 0.0294), and 1 degrees histology (p < 0.0001). At 10 years, the differences in overall survival, cause-specific survival, and distant relapse between the two groups did not differ significantly. The MamOcc cohort had more breast relapses (15% vs. 8%; p = 0.0357), but on multivariate analysis this difference was not significant (hazard ratio 1.0, 95% confidence interval 0.993-1.007, p = 0.9296). Breast relapses were mammographically occult in 32% of the MamOcc and 12% of the MamPos cohorts (p = 0.0136).


CONCLUSIONS
Although our study suggests that there are clinical-pathologic variations for the MamOcc cohort vs. MamPos patients that may ultimately affect management, breast relapse after BCT was not significantly different. Breast recurrences were more often mammographically occult in the MamOcc cohort; consideration should be given to closer follow-up and alternative imaging strategies (ultrasound, breast MRI) for routine posttreatment examination. To our knowledge, this represents the largest series addressing the prognostic significance of MamOcc cancers treated with BCT.
Yang
Tzu-I J
TJ
Yale University School of Medicine, New Haven, CT 06520-8040, USA.
Yang
Qifeng
Q
Haffty
Bruce G
BG
Moran
Meena S
MS
D000328:Adult; D000367:Age Factors; D001365:Axilla; D001943:Breast Neoplasms / Q000737:chemistry / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D002278:Carcinoma in Situ / Q000737:chemistry / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D018270:Carcinoma, Ductal, Breast / Q000737:chemistry / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000737:chemistry / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D015331:Cohort Studies; D005192:Family Health; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008197:Lymph Node Excision; D008327:Mammography; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging; D009367:Neoplasm Staging; D009382:Neoplasms, Unknown Primary / Q000737:chemistry / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D011379:Prognosis; D016016:Proportional Hazards Models; D011879:Radiotherapy Dosage; D016019:Survival Analysis