55 Background: It has previously been demonstrated that mammographically-detected breast cancers present as earlier stage disease than those detected as a palpable finding. In addition, it is well known that the single most important prognostic indicator in breast cancer is lymph node status. The benefit of screening mammography in women age 40-49 has been questioned recently, and has led to a change in the recommendations by the United States Preventative Services Task Force (USPSTF) to begin screening mammography in the average risk woman at age 50, rather than 40. In this study, we sought to determine whether detection of breast cancer in 40-49 year old women by screening mammography is associated with negative nodal status at presentation. Methods: A prospectively collected database was reviewed to identify 460 women ages 40-49 diagnosed with invasive breast cancer from 2003-2008. The method of detection of the breast cancer was noted, and the lymph node status at presentation was identified. Results: There were 460 eligible patients with invasive breast cancer for whom information regarding nodal status was available. Of these, 205 patients were diagnosed with a mammographic finding, and 255 patients presented with a palpable abnormality. In the group whose cancers were detected on mammography, 18% presented with lymph node metastases. This is significantly lower than the 41% who presented with a palpable finding (p<0.0001). For 40-49 year old women with invasive breast cancer, the likelihood of having a positive lymph node at presentation is 3.2 times higher if her cancer is detected as a palpable abnormality rather than on mammography (odds ratio) (CI: 2.1-5.0) (Table). Conclusions: Our analysis demonstrates that a patient diagnosed with invasive breast cancer in her 40s is more likely to present with lymph node metastases if her cancer is detected as a palpable mass, compared to those detected on mammography. This has certain prognostic importance, and provides an additional rationale for performing screening mammography in women of this age group. [Table: see text]
Effect of Lump Size and Nodal Status on Prognosis in Invasive Breast Cancer: Experience from Rural India
