title: T4b breast masses: a retrospective review of 12 cases presenting to a metropolitan tertiary care center.
abstract: BACKGROUND
  Due to increased awareness of breast cancer resulting in early detection, there is a decreased incidence nationwide of late-stage breast cancer, including that which presents with skin involvement (T4b).
  
  
  METHODS
  A retrospective analysis of a 10-month period from August 2007 to May 2008 at Howard University Hospital (HUH), Washington, DC, revealed 12 patients diagnosed with T4b breast cancer and compared to similarly staged patients in the Surveillance, Epidemiology, and End Results (SEER) database. Finally, a logistic regression for the likelihood of T4b diagnosis was performed patients in the SEER database.
  
  
  RESULTS
  HUH patients with T4b tumors were more likely than SEER patients to present with predictors of poor clinical outcome, including high-grade histology (100% vs 59.4%, p = .04) and estrogen receptor- (75% vs 30.3%, p = .001) and progesterone receptor- negative (91.7% vs 43.9%, p = .001) status. Conversely, HUH patients were younger (57.8 y vs 66.3 y, p = .03) and had smaller tumors (11.1 cm vs 28.2 cm, p = .02) than SEER patients with similarly staged tumors. Older patients (OR, 2.36; 95% CI, 1.50-2.00; p < .001; 60-80 y), African American patients (OR, 1.63; 95% CI, 1.26-2.11; p < .001), and patients with high-grade (OR, 5.51; 95% CI, 3.88-6.52; p < .001) tumors were more likely to be diagnosed with T4b tumors, whereas patients who lived in an area with increased median household income (OR, 0.99; 95% CI, 0.99-0.99; p = .001) were less likely to be diagnosed with a T4b lesion.
  
  
  CONCLUSIONS
  While much research has focused on the socioeconomic causes for the development of T4b tumors, both patient and tumor biologic conditions cannot be eliminated as causative agents.
authors: Department of Surgery, Howard University College of Medicine, Washington, DC 20060, USA.
authors: Stephanie
authors: S
authors: Downing
authors: Ayorinde
authors: A
authors: Akinrinlola
authors: Suryanarayana M
authors: SM
authors: Siram
authors: Robert L
authors: RL
authors: DeWitty
authors: Henry
authors: H
authors: Paul
authors: Konrad
authors: K
authors: Dawson
authors: Wayne A I
authors: WA
authors: Frederick
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology*; D004219:District of Columbia; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D009367:Neoplasm Staging; D011203:Poverty; D012189:Retrospective Studies; D018426:SEER Program; D014505:Urban Population / Q000706:statistics & numerical data