Abstract P6-03-01: High Percentage of Triple Negative Tumors Present as Palpable Masses
Authors: ON Kalu, A Kurian, I. Wapnir
Journal: Cancer Research (2010)

Abstract Introduction: Approximately 15% of newly diagnosed breast cancers are triple negative tumors (TNT; ER-/PR-/HER2-), a subgroup with a particularly poor prognosis. This clinical-pathologic subtype corresponds to, but is not synonymous with basal-like tumors. These cancers are prevalent among African-Americans and BRCA mutation carriers. We hypothesize that TNT are more likely than other breast tumor subtypes to present as a palpable mass or appear between screening examinations. We compared the screening practices and detection modality of women with TNT at our institution. Methods: Between December 2000 to February 2010, 346 women with TNT were identified through the Stanford University Cancer Center tumor registry. Medical records were retrospectively reviewed. Breast imaging screening was compared between women whose cancers presented as a palpable mass versus those which were detected on breast imaging. Patients without prior breast imaging, screening occurring &amp;gt;5 y prior to diagnosis or unknown imaging history were grouped together (UNK). 95% confidence intervals (CT)determined by modified Wald method. Results: Mean age at diagnosis was 53y (range 25 to 97). 82 patients had BRCA mutation testing, of which 41 were positive. 58 women were &amp;lt; 40 y of age; 100 between 40-50 y; and 188 women &amp;gt; 50. 253 were detected on self exam. The rest were found on screening mammography (70), MR imaging (3), non-breast radiologic studies (9); unknown presentation (11). 54 cancers in women &amp;lt; 40 years of age were palpable. Of these, 7% (0.02- 0.18)had screening within 24m(onths), 6% (0.01-0.16)within 2 to 5y(ears) and 87% (0.75-0.94)were UNK. 74 women 40-50y of age with palpable presentations, 36%(0.26-0.48) had screening within 24m, 9%(0.04-0.19) within 2-5y and 54%(0.43-0.65)were UNK. 125 women &amp;gt;50 years of age with palpable presentations, 27%(0.21-0.36) had screening within 24m, 5% (0.02-0.10)within 2-5y and 67%(0.45-0.62) were UNK. Within this group 2 of 4 (&amp;lt;40), 23 of 27 (40-50), and 25 of 34 (&amp;gt;50) had detected masses within 12m of breast imaging. 30 patients carried BRCA mutations. 3 women &amp;lt;40 y had tumor detected on screening; 1 patient had screening at 15m, 2 were UNK. 22 in the 40-50y group were detected on screening; 41% (0.23-0.61)had screening within 24m, and 60%(0.39-0.77) were UNK. 48 women &amp;gt;50y had tumors detected on screening; 50% (0.36-0.64)had screening within 24m,8%(0.03-0.20)within 2-5y, and 42%(0.29-0.56) were ND. In this group, 5 of 9 (40-50), 16 of 24 (&amp;gt;50) had lesions detected within 12m of imaging. 8 patients with image detected tumor carried a BRCA-1 mutation. A total of 249 pts were of screening age and of those 95 were screened within 2 y; yet 65% of those presented with a palpable mass. BREAST IMAGING PRIOR TO DIAGNOSIS, N(%) Conclusion: Our data suggests that regardless of age, TNT present as palpable masses even among those undergoing breast screening. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-03-01.