Micrometastases Affect Breast Cancer Prognosis

Among women with early breast cancer, those with very small areas of cancer (micrometastases) in the axillary lymph nodes tend to have a higher risk of recurrence than those whose lymph nodes are completely free of cancer. These results were published in the Journal of Clinical Oncology.

Evaluation of the axillary (under the arm) lymph nodes for the presence of cancer is an important part of breast cancer staging. To assess the axillary lymph nodes, a surgeon will perform either an axillary lymph node dissection, in which many lymph nodes are surgically removed and evaluated, or a less extensive procedure known as a sentinel lymph node biopsy.

For some women, evaluation of the lymph nodes will reveal very small areas of cancer. Areas of cancer that measure between 0.2 mm and 2.0 mm are referred to as “micrometastases.” Even smaller areas of cancer are referred to as “isolated tumor cells.” The clinical significance of lymph node micrometastases and isolated tumor cells has been uncertain but was evaluated in a study conducted in Sweden.

The study collected information about the treatment and outcomes of 3,369 breast cancer patients. A total of 2,383 were node-negative, 107 had isolated tumor cells in the axillary lymph nodes, 123 had micrometastases, and 756 had macrometastases (larger areas of cancer in the lymph nodes).

Five-year survival without cancer recurrence was 87.1% among women with no lymph node metastases, 88.9% among women with isolated tumor cells, 79.6% among women with micrometastases, and 80.1% among women with macrometastases. Compared with node-negative women, overall survival was not significantly worse among women with micrometastases or isolated tumor cells, but was worse among women with macrometastases.

These results suggest that women with lymph node micrometastases have a higher risk of breast cancer recurrence than women with cancer-free lymph nodes. Isolated tumor cells in the lymph nodes did not appear to affect outcomes in this population.

Reference:?

Andersson Y, Frisell J, Sylvan M, de Boniface J, Bergkvist L. Breast cancer survival in relation to the metastatic tumor burden in axillary lymph nodes. Journal of Clinical Oncology [early online publication]. May 10, 2010.

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Study Explores Breast Cancer Prognosis By Race

Breast cancer prognosis may be worse among black women than among white women regardless of the subtype of breast cancer. These results were presented at the 2013 annual meeting of the American Association for Cancer Research (AACR).?

It’s long been known that breast cancer prognosis varies by race among women in the United States, with black women tending to have worse outcomes than white women. Some of this variability has been attributed to the fact that black women have higher rates of triple-negative breast cancer than women of other races. How race affects prognosis among women with certain subtypes of breast cancer, however, has been uncertain.?

To explore the relationship between race and prognosis by subtype of breast cancer, researchers evaluated 1,688 breast cancer survivors who participated in the Life After Cancer Epidemiology and Pathways studies. Women have been followed for more than six years.??

Consisted with previous studies, black women had higher rates of breast cancer mortality overall, and were also more likely to be diagnosed with triple-negative breast cancer. ?Differences in survival between black and white women were seen in all subtypes of breast cancer. Among women with triple-negative breast cancer, mortality rates were 30% higher in black women than in white women. Among women with other types of breast cancer, mortality rates were more than twice as high among black women.?

These results suggest that variability in breast cancer prognosis by race is not due entirely to the more frequent diagnosis of triple-negative breast cancer in black women. A better understanding of the reasons for the variability may suggest ways to improve treatment.?

Reference: Kroenke C, Kwan M, Bernard P et al. Race and breast cancer prognosis by PAM50 subtype in the LACE and Pathways Studies. Presented at the 2013 annual meeting of the American Association for Cancer Research. Washington, DC, April 6-10, 2013. Abstract 131.?

Posted April 11, 2013???

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