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

  1. William D. Foulkes M.B., Ph.D.1,2,§,*,
  2. Kelly Metcalfe Ph.D.3,4,
  3. Wedad Hanna M.D.4,
  4. Henry T. Lynch M.D.5,
  5. Parviz Ghadirian Ph.D.6,
  6. Nadine Tung M.D.7,
  7. Olofunmilayo Olopade M.D.8,
  8. Barbara Weber M.D.9,10,
  9. Jane McLennan M.D., Ph.D.11,
  10. Ivo A. Olivotto M.D.12,
  11. Ping Sun Ph.D.4,
  12. Pierre O. Chappuis M.D.1,2,‡,
  13. Louis R. Bégin M.D.13,
  14. Jean-Sébastien Brunet M.Sc.1,2,14,
  15. Steven A. Narod M.D.4

Article first published online: 8 SEP 2003

DOI: 10.1002/cncr.11688

Issue

Cancer

Cancer

Volume 98, Issue 8, pages 1569–1577, 15 October 2003

Additional Information

How to Cite

Foulkes, W. D., Metcalfe, K., Hanna, W., Lynch, H. T., Ghadirian, P., Tung, N., Olopade, O., Weber, B., McLennan, J., Olivotto, I. A., Sun, P., Chappuis, P. O., Bégin, L. R., Brunet, J.-S. and Narod, S. A. (2003), Disruption of the expected positive correlation between breast tumor size and lymph node status in BRCA1-related breast carcinoma. Cancer, 98: 1569–1577. doi: 10.1002/cncr.11688

Author Information

  1. 1

    Department of Oncology, McGill University, Montreal, Quebec, Canada

  2. 2

    Department of Human Genetics, McGill University, Montreal, Quebec, Canada

  3. 3

    Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada

  4. 4

    Centre for Research in Women's Health, Sunnybrook and Women's College Health Sciences Centre and The University of Toronto, Toronto, Ontario, Canada

  5. 5

    Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, Nebraska

  6. 6

    Epidemiology Research Unit, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Pavillon Masson de l'Hôtel-Dieu, Montréal, Quebec, Canada

  7. 7

    Division of Oncology, Beth Israel Deaconess Hospital, Boston, Massachusetts

  8. 8

    Department of Medicine, University of Chicago, Chicago, Illinois

  9. 9

    Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania

  10. 10

    Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania

  11. 11

    Cancer Risk Program, University of California–San Francisco Comprehensive Cancer Center, San Francisco, California

  12. 12

    British Columbia Cancer Agency, Victoria, British Columbia, Canada

  13. 13

    Department of Pathology, Sacré Coeur Hospital, Montreal, Quebec, Canada

  14. 14

    Algorithme Pharma, Montreal, Quebec, Canada

  1. ‡

    Division of Oncology, University Hospitals of Geneva, Geneva, Switzerland; and Division of Medical Genetics, University Hospitals of Geneva, Geneva, Switzerland

  1. §

    Fax: (514) 934-8273

*Division of Medical Genetics, Department of Medicine, Room L10-120, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4

  1. †

    The opinions expressed herein do not necessarily reflect the views of the U.S. Government.

  2. §

    Fax: (514) 934-8273

Publication History

  1. Issue published online: 3 OCT 2003
  2. Article first published online: 8 SEP 2003
  3. Manuscript Accepted: 8 JUL 2003
  4. Manuscript Revised: 4 JUL 2003
  5. Manuscript Received: 1 MAY 2003

Funded by

  • Canadian Genetic Diseases Network
  • Susan G. Komen Foundation
  • Fonds de la recherche en Santé du Québec
  • National Institutes of Health

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Keywords:

  • BRCA1;
  • BRCA2;
  • breast carcinoma;
  • tumor size;
  • axillary lymph nodes;
  • metastases;
  • survival;
  • early diagnosis

Abstract

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

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