Breast conserving therapy in breast cancer patients presenting with nippledischarge

Purpose: To retrospectively review the outcome of conservatively treated br east cancer patients who present with nipple discharge at initial diagnosis . Methods and Materials: The charts of 1097 patients undergoing conservative surgery and radiation therapy between January 1970 and December 1990 were r eviewed. All patient data, including clinical, pathologic, treatment, and o utcome variables were entered onto a computerized database, For the current study, specific attention was directed to the initial presenting symptoms and patients were divided into two groups: those presenting at initial diag nosis with nipple discharge (D/C-YES, n = 17), and those presenting without nipple discharge (D/C-NO, n = 1080). Results: As of August 1998, with a median follow-up of 12 years, the 10-yea r actuarial survival, distant metastasis-free survival, and breast relapse- free survival rates for the overall population were 73%, 78%, and 83%, resp ectively. Although the D/C-YES and D/C-NO groups were well balanced with re spect to the majority of clinical factors, the D/C-YES patients had a highe r percentage of DCIS histology (7.3% vs 1.2%, p < 0.01), were less likely t o undergo reexcision (12% vs 35%), and were more frequently under age 40 (3 5% vs 12%) than the D/C-NO patients. Over the time span of this study, stat us of the final surgical margin was indeterminate in the majority of cases, Local relapses occurred in 6 of the 17 patients in the D/C-YES group, resu lting in a 10-year actuarial breast relapse-free survival rate of 50%, whic h was significantly lower than the 10-year breast relapse-free survival rat e of 86% in the D/C-NO population. Among the patients presenting with nippl e discharge, those with sacrifice of the nipple areolar complex had a lower local relapse rate than those patients who had conservation of the nipple areolar complex (20% vs 42%), although this difference did not reach statis tical significance. Conclusions: Although patients presenting with nipple discharge may be suit able candidates for radiation therapy, local relapse rates were higher than those presenting without nipple discharge, The limitations of the study an d implications regarding breast conserving management in patients presentin g with nipple discharge are discussed. (C) 2000 Elsevier Science Inc.