Invasive lobular vs. ductal breast cancer

A stage-matched comparison of outcomes

Nabil Wasif, Melinda A. Maggard, Clifford Y. Ko, Armando E. Giuliano

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Background. Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC), more difficult to detect mammographically, and usually diagnosed at a later stage. Does delayed diagnosis of ILC affect survival? We used a national registry to compare outcomes of patients with stage-matched ILC and IDC. Methods. Query of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry identified 263,408 women diagnosed with IDC or ILC between 1993 and 2003. Survival of patients matched by T and N stage was compared using Kaplan-Meier curves and log-rank analysis. Results. When compared with IDC, ILC was more likely to be >2 cm (43.1 vs. 32.6%; P<0.001), lymph node positive (36.8 vs. 34.4%; P<0.001), and ER positive (93.1 vs. 75.6%; P<0.001). The 5-year disease-specific survival (DSS) was significantly better for patients with ILC than for those with IDC, before (90 vs. 88%; P<0.001) and after matching for stage T1N0 (98 vs. 96%; P<0.001), T2N0 (94 vs. 88%; P<0.001), and T3N0 (92 vs. 83%, P<0.001). The 5-year DSS for patients with nodal metastasis of ILC vs. IDC was 89% vs. 88% (P = NS) for stage T1N1, 81 vs. 73% (P<0.001) for T2N1, and 72 vs. 56% (P<0.001) for T3N1. Multivariate analysis identified a 14% survival benefit for ILC (hazard ratio 0.86, 95% confidence interval 0.80-0.92). Conclusions. Stage-matched prognosis is better for patients with ILC than for those with IDC. Our findings support a different biology for ILC and are important for counseling and risk stratification.

Original languageEnglish (US)
Pages (from-to)1862-1869
Number of pages8
JournalAnnals of Surgical Oncology
Volume17
Issue number7
DOIs
StatePublished - Jul 2010

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Breast Neoplasms
Survival
Registries
National Cancer Institute (U.S.)
Delayed Diagnosis
Counseling
Epidemiology
Multivariate Analysis
Lymph Nodes
Confidence Intervals
Neoplasm Metastasis

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Invasive lobular vs. ductal breast cancer : A stage-matched comparison of outcomes. / Wasif, Nabil; Maggard, Melinda A.; Ko, Clifford Y.; Giuliano, Armando E.

In: Annals of Surgical Oncology, Vol. 17, No. 7, 07.2010, p. 1862-1869.

Research output: Contribution to journalArticle

Wasif, Nabil ; Maggard, Melinda A. ; Ko, Clifford Y. ; Giuliano, Armando E. / Invasive lobular vs. ductal breast cancer : A stage-matched comparison of outcomes. In: Annals of Surgical Oncology. 2010 ; Vol. 17, No. 7. pp. 1862-1869.
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title = "Invasive lobular vs. ductal breast cancer: A stage-matched comparison of outcomes",
abstract = "Background. Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC), more difficult to detect mammographically, and usually diagnosed at a later stage. Does delayed diagnosis of ILC affect survival? We used a national registry to compare outcomes of patients with stage-matched ILC and IDC. Methods. Query of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry identified 263,408 women diagnosed with IDC or ILC between 1993 and 2003. Survival of patients matched by T and N stage was compared using Kaplan-Meier curves and log-rank analysis. Results. When compared with IDC, ILC was more likely to be >2 cm (43.1 vs. 32.6{\%}; P<0.001), lymph node positive (36.8 vs. 34.4{\%}; P<0.001), and ER positive (93.1 vs. 75.6{\%}; P<0.001). The 5-year disease-specific survival (DSS) was significantly better for patients with ILC than for those with IDC, before (90 vs. 88{\%}; P<0.001) and after matching for stage T1N0 (98 vs. 96{\%}; P<0.001), T2N0 (94 vs. 88{\%}; P<0.001), and T3N0 (92 vs. 83{\%}, P<0.001). The 5-year DSS for patients with nodal metastasis of ILC vs. IDC was 89{\%} vs. 88{\%} (P = NS) for stage T1N1, 81 vs. 73{\%} (P<0.001) for T2N1, and 72 vs. 56{\%} (P<0.001) for T3N1. Multivariate analysis identified a 14{\%} survival benefit for ILC (hazard ratio 0.86, 95{\%} confidence interval 0.80-0.92). Conclusions. Stage-matched prognosis is better for patients with ILC than for those with IDC. Our findings support a different biology for ILC and are important for counseling and risk stratification.",
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N2 - Background. Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC), more difficult to detect mammographically, and usually diagnosed at a later stage. Does delayed diagnosis of ILC affect survival? We used a national registry to compare outcomes of patients with stage-matched ILC and IDC. Methods. Query of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry identified 263,408 women diagnosed with IDC or ILC between 1993 and 2003. Survival of patients matched by T and N stage was compared using Kaplan-Meier curves and log-rank analysis. Results. When compared with IDC, ILC was more likely to be >2 cm (43.1 vs. 32.6%; P<0.001), lymph node positive (36.8 vs. 34.4%; P<0.001), and ER positive (93.1 vs. 75.6%; P<0.001). The 5-year disease-specific survival (DSS) was significantly better for patients with ILC than for those with IDC, before (90 vs. 88%; P<0.001) and after matching for stage T1N0 (98 vs. 96%; P<0.001), T2N0 (94 vs. 88%; P<0.001), and T3N0 (92 vs. 83%, P<0.001). The 5-year DSS for patients with nodal metastasis of ILC vs. IDC was 89% vs. 88% (P = NS) for stage T1N1, 81 vs. 73% (P<0.001) for T2N1, and 72 vs. 56% (P<0.001) for T3N1. Multivariate analysis identified a 14% survival benefit for ILC (hazard ratio 0.86, 95% confidence interval 0.80-0.92). Conclusions. Stage-matched prognosis is better for patients with ILC than for those with IDC. Our findings support a different biology for ILC and are important for counseling and risk stratification.

AB - Background. Invasive lobular breast cancer (ILC) is less common than invasive ductal breast cancer (IDC), more difficult to detect mammographically, and usually diagnosed at a later stage. Does delayed diagnosis of ILC affect survival? We used a national registry to compare outcomes of patients with stage-matched ILC and IDC. Methods. Query of the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) tumor registry identified 263,408 women diagnosed with IDC or ILC between 1993 and 2003. Survival of patients matched by T and N stage was compared using Kaplan-Meier curves and log-rank analysis. Results. When compared with IDC, ILC was more likely to be >2 cm (43.1 vs. 32.6%; P<0.001), lymph node positive (36.8 vs. 34.4%; P<0.001), and ER positive (93.1 vs. 75.6%; P<0.001). The 5-year disease-specific survival (DSS) was significantly better for patients with ILC than for those with IDC, before (90 vs. 88%; P<0.001) and after matching for stage T1N0 (98 vs. 96%; P<0.001), T2N0 (94 vs. 88%; P<0.001), and T3N0 (92 vs. 83%, P<0.001). The 5-year DSS for patients with nodal metastasis of ILC vs. IDC was 89% vs. 88% (P = NS) for stage T1N1, 81 vs. 73% (P<0.001) for T2N1, and 72 vs. 56% (P<0.001) for T3N1. Multivariate analysis identified a 14% survival benefit for ILC (hazard ratio 0.86, 95% confidence interval 0.80-0.92). Conclusions. Stage-matched prognosis is better for patients with ILC than for those with IDC. Our findings support a different biology for ILC and are important for counseling and risk stratification.

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