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What can National Registry data tell us about occult breast cancer?
| Content Provider | Semantic Scholar |
|---|---|
| Author | Wild, John Benjamin Thrush, Steven Vidya, R. |
| Copyright Year | 2019 |
| Abstract | Axillary metastasis from an undetectable carcinoma of the breast is known as occult breast cancer (OBC) and accounts for less than 1% of all breast cancer (1-3). Management of OBC initially favoured axillary lymph node dissection (ALND) with mastectomy (4). However, there have also been series reporting the use of ALND with breast conserving surgery (BCS), whole breast radiotherapy (WBRT) and observation of the breast (5-7). Due to its rarity, data on OBC is often from small series collected over long periods of time. National registry provides the opportunity to accrue larger numbers, determining more accurate incidence, and where possible generating epidemiological and clinicopathological data. The Surveillance, Epidemiological and End Results (SEER) database is a project of the American National Cancer Institute, the function of which is to routinely collect various cancer data on patients from various American states, covering 28% of the population. The new analysis presented by Ge et al. reports the clinicopathological data within the SEER database on OBC (8). The authors compared characteristics of 479 patients with OBC and 115,739 non-OBC patients. Findings from the analysis demonstrated increased rates of stage III disease, N3 disease, oestrogen receptor (ER) and Progesterone Receptor (PR) negativity and Her2 receptor positivity. Furthermore, Ge et al. analysed survival and found that both overall survival (OS) and breast cancer specific survival (BCSS) were similar to the non-OBC group. However, in the 1:1 matched case control analysis of OBC and non-OBC cases there was significantly better overall and BCSS in the OBC group. This is the second time data from the SEER database relating to OBC has been utilised, however the previous publication did not undertake the propensity matching in order to draw novel conclusions on survival (3). These novel findings clearly raise some interesting questions—if there is a higher rate of ER negativity and Her 2 positivity why would these patients have improved survival in the 1:1 matched analysis? Ge et al. considered that discordance between primary tumours and nodal metastases may account for this. However, in the OBC there is not a primary lesion to analyse and therefore the nodal and receptor status may not reflect that of the initial lesion. As there has been limited evidence published on OBC there remains uncertainty on optimum treatment strategy. Halsted advocated mastectomy and ALND in the initial report of OBC (9). This remained the mainstay of treatment for many years, however there are reports of utilising BCS, performing an upper-outer quadrantectomy as this was felt to represent the most likely location to find an OBC (10). The Korean Breast Cancer Society data showed that ALND & BCS & WBRT had comparable survival to Mastectomy & ALND (1). A third interventional option is to utilise WBRT in addition to ALND (6). A survey of American breast surgeons conducted in 2005 demonstrated that in order to treat OBC 43% opted for mastectomy, 37% whole breast radiation and 6% would not treat the breast (11). Ge and colleagues were able to perform survival analysis dependent upon treatment. BCSS and OS where found to be similar when patients were treated with BCS & ALND and WBRT or with mastectomy & ALND (8). The authors assert that this is evidence that BCS with WBRT may be superior to mastectomy in the treatment of OBC. However, the BCSS and OS was also similar when Editorial |
| File Format | PDF HTM / HTML |
| DOI | 10.21037/cco.2019.02.03 |
| Alternate Webpage(s) | http://cco.amegroups.com/article/download/24167/22768 |
| PubMed reference number | 30823847 |
| Alternate Webpage(s) | https://doi.org/10.21037/cco.2019.02.03 |
| Journal | Chinese clinical oncology |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
