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Tumor size and survival in breast cancer—a reappraisal

Nature Reviews Clinical Oncology volume 7, pages 348–353 (2010)Cite this article

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Abstract

The size of a breast cancer at diagnosis has conventionally been thought of as a fundamental and critical determinant of clinical outcome. However, the tendency of some subtypes of breast cancer to behave aggressively, despite being small (≤1 cm in diameter), questions the premise that cancer size should always be considered in treatment decisions. Although there is an association between tumor size and lymph-node involvement for most tumor types, this pattern is not invariable. We speculate that the uncoupling of tumor size, lymph-node status and prognosis in some subtypes of breast cancers might reflect an underlying disproportionate relationship between the number of cancer cells with metastatic potential and the size of the cancer. Alternatively, some small cancers might harbor cells that are inherently aggressive and are likely to metastasize. These observations have implications for the screening and treatment of breast cancers, particularly for women with basal-like and BRCA1-related breast cancers.

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Figure 1: Tumor size and survival: associations with molecular subtypes, genetic instability and the stem cell hypothesis.

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Acknowledgements

W. D. Foulkes and S. A. Narod are funded by the Canadian Breast Cancer Research Alliance. J. S. Reis-Filho is funded by Breakthrough Breast Cancer, UK.

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Authors and Affiliations

  1. Departments of Oncology and Human Genetics, Program in Cancer Genetics, McGill University, Montreal, H2W 1S6, QC, Canada

    William D. Foulkes

  2. The Breakthrough Breast Cancer Research Center, Institute of Cancer Research, SW3 6JB, London, UK

    Jorge S. Reis-Filho

  3. Women's College Hospital Research Institute, Toronto, M5G 1N8, ON, Canada

    Steven A. Narod

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  1. William D. Foulkes
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Correspondence to William D. Foulkes.

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Foulkes, W., Reis-Filho, J. & Narod, S. Tumor size and survival in breast cancer—a reappraisal. Nat Rev Clin Oncol 7, 348–353 (2010). https://doi.org/10.1038/nrclinonc.2010.39

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