A COMPARISON OF AXILLARY NODE STATUS BETWEEN CANCERS DETECTED AT THE PREVALENCE AND FIRST INCIDENCE BREAST SCREENING ROUNDS

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.