Mm. Black et al., PROGNOSTIC-SIGNIFICANCE OF IN-SITU CARCINOMA-ASSOCIATED WITH INVASIVEBREAST-CARCINOMA - A NATURAL EXPERIMENT IN CANCER IMMUNOLOGY, Cancer, 78(4), 1996, pp. 778-788
BACKGROUND. Our previous studies indicate that the in situ phase of ma
mmary carcinogenesis is characteristically associated with cell-mediat
ed immunity (CMI) against an immunogen shared by most breast carcinoma
s. Such reactivity is inversely correlated with stage and appears to i
mpede in situ-to-invasive progression and lethality from invasive brea
st carcinoma. If in situ carcinomas are indeed associated with ambient
, prognostically favorable immunity against such an immunogen, one wou
ld expect lethality from invasive breast carcinoma to be reduced in pa
tients with a diagnosis of a prior, simultaneous, or subsequent in sit
u breast carcinoma. The present study provides a test of such relation
ships. METHODS. Patient survival was analyzed for 129,394 female patie
nts with invasive breast carcinoma diagnosed in areas covered by the S
urveillance, Epidemiology, and End Results (SEER) Program based at the
National Cancer Institute (NCI). Patients were classified according t
o whether they had a prior, simultaneous, or subsequent in situ breast
carcinoma and survival was examined for up to 15 years subsequent to
diagnosis using life tables and the Cox regression model. RESULTS. The
findings indicate that patients with an invasive breast carcinoma who
had a prior, simultaneous, or subsequent in situ breast carcinoma did
experience significantly better survival than comparison groups of pa
tients who either did not have an associated cancer of any type, had a
n associated invasive breast carcinoma, or had an in situ or invasive
cancer of non-breast origin.CONCLUSIONS. Our prior and current observa
tions warrant more direct studies of the prognostic, therapeutic, and
prophylactic significance of the in situ carcinoma-associated type of
specific CMI in breast cancer patients. (C) 1996 American Cancer Socie
ty.