Disruption of the expected positive correlation between breast tumor size and lymph node status in BRCA1‐related breast carcinoma

• Published in: Cancer 2003-10, Vol.98 (8), p.1569-1577
• Main Authors: Foulkes, William D., Metcalfe, Kelly, Hanna, Wedad, Lynch, Henry T., Ghadirian, Parviz, Tung, Nadine, Olopade, Olofunmilayo, Weber, Barbara, McLennan, Jane, Olivotto, Ivo A., Sun, Ping, Chappuis, Pierre O., Bégin, Louis R., Brunet, Jean‐Sébastien, Narod, Steven A.
• Format: Article
• Language: English
• Subjects: axillary lymph nodes; Biological and medical sciences; BRCA1; BRCA2; breast carcinoma; Breast Neoplasms - genetics; Breast Neoplasms - pathology; early diagnosis; Female; Genes, BRCA1; Genes, BRCA2; Gynecology. Andrology. Obstetrics; Heterozygote; Humans; Lymphatic Metastasis; Mammary gland diseases; Medical sciences; metastases; survival; tumor size; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.11688

BACKGROUND A positive correlation between breast tumor size and the number of axillary lymph nodes containing tumor is well established. It has been reported that patients with BRCA1‐related breast carcinoma are more likely than patients with nonhereditary breast carcinoma to have negative lymph node status. Therefore, the authors questioned whether the known positive correlation between tumor size and lymph node status also was present in women with BRCA1‐related breast carcinomas. METHODS The relation between the greatest dimension of the resected breast tumor (size) and the presence of positive axillary lymph nodes (expressed as a percentage of all lymph nodes examined) was evaluated in 1555 women with invasive breast carcinoma who were ascertained at 10 centers in North America between 1975 and 1997. There were 276 BRCA1 mutation carriers, 136 BRCA2 carriers, and 1143 women without a known mutation (208 BRCA1/BRCA2 noncarriers and 935 untested women). Patients were stratified according to tumor size, and odds ratios were estimated for the presence of positive lymph nodes with increasing tumor size. RESULTS A highly significant positive correlation between tumor size and the frequency of positive axillary lymph nodes was seen for BRCA1/BRCA2 noncarriers, for BRCA2 carriers, and for untested women (overall P < 0.0001 for each). In contrast, there was no clear correlation between tumor size and positive lymph node status in BRCA1 carriers (overall P = 0.20). CONCLUSIONS The relation between tumor size and lymph node status in patients with breast carcinoma appears to be different in BRCA1 carriers compared with BRCA2 carriers and noncarriers. These findings have important implications for estimating the route of metastatic spread and for evaluating the effectiveness of early diagnosis in patients with BRCA1‐related breast carcinoma. Cancer 2003. ©2003 American Cancer Society. DOI 10.1002/cncr.11688 Breast tumor size and the number of positive lymph nodes found at axillary dissection are related directly. This relation is much less strong in BRCA1‐related breast carcinoma compared with other types of breast carcinoma, suggesting that the pattern of metastatic spread of BRCA1‐related breast carcinoma may differ from both BRCA2‐related and nonhereditary breast carcinoma.