Recurrence-free survival in patients with small breast cancer. An analysis of cancers 10 mm or less detected clinically and by screening

Abstract

Objective: To evaluate survival of women with small breast cancers (10 mm or less in diameter) in a series almost unaffected by adjuvant medical treatment.

Design: Prospective study from a population who were randomly allocated to be screened by mammography.

Setting: University Hospital.

Subjects: 324 patients with breast cancers 10 mm or less in diameter who were operated on between 1978-85 (230 detected by screening, 21 interval cases and 73 from the control group).

Main outcome measures: Recurrence free survival, recurrence rate, and breast cancer mortality alone and in relation to node involvement during a median follow up of 7 years (range 4 months-12.5 years).

Results: Survival without distant metastases in life table analyses was 98.7% in 254 node negative cases and 79.3% in 30 node positive cases (p < 0.001). For the whole series survival without distant recurrence was 96.8%. There was no significant difference in recurrence free survival between cancers detected by screening and those detected clinically. Lymph nodes were involved in 9% of the 221 detected by screening compared with 20% of the 89 detected clinically (p < 0.03).

Conclusion: There was a very low risk of recurrence in small node negative breast cancers (irrespective of the method of detection) indicating that adjuvant treatment may not be necessary for patients with small node negative breast tumours. The good prognosis of these patients also implies that the need for follow up programmes must be discussed because they are probably unnecessary.