Pa. Holland et al., A COMPARISON OF AXILLARY NODE STATUS BETWEEN CANCERS DETECTED AT THE PREVALENCE AND FIRST INCIDENCE BREAST SCREENING ROUNDS, British Journal of Cancer, 74(10), 1996, pp. 1643-1646
Screen-detected breast cancers are smaller than those detected in symp
tomatic populations and, for any given size, they are associated with
fewer lymph node metastases. The management of axillary lymph nodes in
patients with screen-detected breast cancer remains controversial. We
have previously reported that prevalence (initial screen)-detected ca
ncers are associated with nodal metastases in 17.4% of cases overall.
Cancers less than or equal to 10 mm, of any grade, are associated with
metastases in only 5% of cases, and grade I cancers <30 mm are not as
sociated with metastases. This led to our recommendation that axillary
surgery is unnecessary for these groups of women. The present study c
ompared the nodal status of cancers detected at the prevalence and fir
st incidence (second) screens in order to determine whether our recomm
endation is appropriate for cancers detected at the first incidence sc
reen. Overall, 30.1% of cancers detected in the first incidence screen
presented axillary nodal metastases. At all size ranges, cancers dete
cted at the first incidence screen were associated with significantly
more lymph node metastases than prevalence-detected cancers. In partic
ular, cancers less than or equal to 10 mm were associated with metasta
ses in 14.3% of cases. With the possible exception of grade I cancers,
we believe that surgical staging of the axilla is essential for cance
rs detected at the first incidence screen, irrespective of size.