Age at diagnosis in relation to survival following breast cancer: a cohort study.

BACKGROUND: Age is an important risk factor for breast cancer, but previous data has been contradictory on whether patient age at diagnosis is also related to breast cancer survival. The present study evaluates age at diagnosis as a prognostic factor for breast cancer on a large cohort of patients at a single institution. METHODS: All 4,453 women diagnosed with breast cancer in Malmö University Hospital, Sweden between 1961 and 1991 were followed up on for 10 years with regards to breast cancer-specific mortality (BCSM) in different age groups. Corresponding relative risks (RR), with 95% confidence intervals, were obtained using Cox's proportional hazards analysis. All analyses were adjusted for potential confounders and stratified for axillary lymph node involvement (ALNI) and diagnostic period. RESULTS: As compared to women aged 40 to 49 years, those who were aged under 40 (RR: 1.40; 95% CI: 1.04 to 1.88) and 80 or more years (RR: 1.80; 95% CI: 1.45 to 2.25) had a statistically significant higher 10-year mortality rate. When adjusted for potential confounders, including stage at diagnosis, the associations only remained statistically significant for women aged 80 years or more. In the analyses stratified on ALNI, ALNI-negative women under 40 years had a statistically significant higher five-year mortality rate (RR: 2.65; 95% CI: 1.23 to 5.70). In the analyses stratified on diagnostic period, the positive association between women aged under 40 or aged 80 or more years and high BCSM rate remained, with statistically significant results for women aged 80 years or more in all periods. CONCLUSIONS: Women under 40 years of age had a poor prognosis, and this association was strongest among young women with axillary lymph node negative breast cancer. An age of 80 years or more was a prognostic factor for poor survival, independent of stage at diagnosis and diagnostic period.

Clinical assessment of axillary lymph nodes and tumor size in breast cancer compared with histopathological examination: a population-based analysis of 2,537 women.

BACKGROUND: The clinical assessment of axillary lymph nodes status and tumor size is important for the management of patients with breast cancer. The first goal of this study was to determine the accuracy of axillary lymph node status in relation to the presence of metastases as revealed by histopathological examination. The second goal was to compare the tumor size as assessed by physical examination, with the size obtained by histopathological examination. METHODS: This study was based on a consecutive series of 2,537 patients diagnosed with breast cancer in Malmö, Sweden, between 1987 and 2002. These patients had available information in the South Swedish Breast Cancer Group registry, corresponding to 97 %. The axillary lymph nodes status was compared with the results of the histopathological examination for the presence of metastases. Tumor size by physical examination was compared with the tumor size after histopathological examination. RESULTS: There were 674 women with axillary lymph nodes metastases according to histological examination; only 206 of these cases had palpable lymph nodes at clinical examination. The sensitivity was 30 % and the specificity 93 %. There were 812 tumors measured to be larger than 20 mm according to histopathological examination, but only 665 of these tumors were considered larger than 20 mm by clinical examination. This corresponded to a sensitivity of 81 % and a specificity of 80 %. CONCLUSIONS: We conclude that the possibility of axillary metastases estimated by clinical examination is subjected to a large proportion of false-positive and false-negative results. Similarly, tumor size estimated by clinical examination is subject to under- and overestimation in comparison to histopathological examination.

Overweight in relation to tumour size and axillary lymph node involvement in postmenopausal breast cancer patients-differences between women invited to vs. not invited to mammography in a randomized screening trial.

OBJECTIVES: Overweight is associated with advanced stage at diagnosis in breast cancer patients. This could be explained by specific tumour characteristics or tumour promoting factors in the obese, but a diagnostic delay could also be of importance. Mammographic screening has caused a change towards diagnosis of less advanced tumours. This study investigates invitation to mammographic screening and the association between overweight and tumour size/axillary lymph node involvement at breast cancer diagnosis in postmenopausal women. METHODS: In 1976 a randomized mammographic screening trial, inviting 50% of all women aged 45-69 was set up in Malmö, Sweden. The present analysis examined overweight (body mass index >or=25) as a determinant for large tumours (>20mm) and axillary lymph node involvement in postmenopausal women. These associations were studied separately in patients diagnosed prior to the mammographic screening trial, in invited women and in non-invited subjects (controls). In all, 2478 postmenopausal women were diagnosed with invasive breast cancer in these groups between 1961 and 1991. Logistic regression analysis allowed adjustment for other potential determinants of tumours size and axillary lymph node involvement. RESULTS: In women diagnosed before the onset of the screening trial and in women not invited to mammography in the trial (controls), overweight was positively associated with large tumour size and axillary node involvement. There was no statistically significant association between overweight and these factors in women invited to mammographic screening. CONCLUSION: Invitation to mammographic screening may be particularly important for overweight postmenopausal women in order to detect breast tumours early.