Comparison Of Overall Survival Between Invasive Lobular Breast Carcinoma And Invasive Ductal Breast Carcinoma: A Propensity Score Matching Study Based On Seer Database
- 1Department of Breast Cancer, Cancer Center, Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- 2Department of Breast and Thyroid Surgery, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
Objective: Invasive lobular carcinoma and invasive ductal carcinoma account for most breast cancers. However, the overall survival differences between ILC and IDC remain controversial. This study aimed to compare nonmetastatic ILC to IDC in terms of survival and prognostic factors for ILC.
Methods: This retrospective cohort study used data from the Surveillance, Epidemiology and End Results Cancer Database . Women diagnosed with nonmetastatic ILC and IDC between 2006 and 2016 were included. A propensity score matching method was used in our analysis to reduce baseline differences in clinicopathological characteristics and survival outcomes. Kaplan-Meier curves and log-rank test were used for survival analysis.
Our results demonstrated that ILC and IDC patients had similar OS after PSM. However, ILC patients with high risk indicators had worse OS compared to IDC patients by subgroup analysis.
Outlook For Invasive Lobular Carcinoma
Cancer affects everyone differently. Your outlook may depend on things like how early youâre diagnosed and how well your body responds to treatment.
In general, about 90% of all women with breast cancer live at least 5 years after diagnosis. While there isnât much information about specific types of breast cancer, these survival rates are tracked by stage at diagnosis or how far the cancer has spread:
- Localized : 98.9% live at least 5 years.
- Regional : 85.7% live at least 5 years.
- Distant : 28.1% live at least 5 years.
Breastcancer.org: âLobular carcinoma in situ ,â âInvasive lobular carcinoma,â âBone Scans,â âLCIS and Breast Cancer Risk,â âTreatments for LCIS,â âTest for Diagnosing ILC,â and âSystemic Treatments for ILC: Chemotherapy, Hormonal Therapy, Targeted Therapies,â âSigns and Symptoms of ILC,â âLocal Treatments for ILC: Surgery and Radiation Therapy.â
Breast Cancer Network of Strength: âLobular carcinoma in situâ and âInfiltrating lobular carcinoma.â
National Cancer Institute: âLobular carcinoma in situ,â âCancer Stat Facts: Female Breast Cancer.â
American Cancer Society: âWhat is breast cancer?â and “Special Section: Breast Carcinoma in Situ,” âChemotherapy for Breast Cancer,â âRadiation for Breast Cancer.â
College of American Pathologists: âLobular carcinoma in situ,â “Invasive lobular carcinoma.â
Comparison Of Excess Mortality Rate Ratio In Ilc And Idc
The median follow-up for the patient-cohort was 19 years with interquartile range between 16 and 24 years for alive patients of the cohort.
We noticed an improved RS for the patients with ILC during the first years of observation. Five years after diagnosis the RS rate was 0.93 for ILC and 0.90 for IDC, EMRR 0.64 . This was shifted to a significantly higher EMRR for ILC compared to IDC in the interval 1015 years after diagnosis, EMRR 1.49 . Twenty years after diagnosis, the RS rate was almost equal for patients with ILC, 0.72 and 0.73 for patients with IDC .
Relative survival rate for patients with ILC and IDC in the whole study population.
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Less Common Types Of Invasive Breast Cancer
There are some special types of breast cancer that are sub-types of invasive carcinoma. They are less common than the breast cancers named above and each typically make up fewer than 5% of all breast cancers. These are often named after features of the cancer cells, like the ways the cells are arranged.
Some of these may have a better prognosis than the more common IDC. These include:
- Adenoid cystic carcinoma
- Low-grade adenosquamous carcinoma
- Medullary carcinoma
Some sub-types have the same or maybe worse prognoses than IDC. These include:
- Metaplastic carcinoma
- Micropapillary carcinoma
- Mixed carcinoma
In general, all of these sub-types are still treated like IDC.
What Is Lobular Cancer
Asked by: Shanelle Wisoky
Invasive lobular carcinoma is a type of breast cancer that begins in the milk-producing glands of the breast. Invasive cancer means the cancer cells have broken out of the lobule where they began and have the potential to spread to the lymph nodes and other areas of the body.
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What Causes Invasive Lobular Carcinoma
Experts know that ILC occurs when cells in your breast develop mutations in their DNA. But they arent exactly sure what causes those mutations to occur. There are factors that could increase your risk for invasive lobular carcinoma, including:
- Age. Most people who are diagnosed with invasive lobular carcinoma are over the age of 55.
- Sex. Women are more likely to develop ILC.
- Hormone therapy. Women who use hormone therapy after menopause may have an increased risk of invasive lobular carcinoma.
- Genetic factors. Certain inherited genes could play a role in whether or not you get breast cancer. A rare condition called hereditary diffuse gastric cancer syndrome can increase your risk for both invasive lobular carcinoma and stomach cancer.
What Causes One Breast To Be Heavier Than The Other
Breast asymmetry is very common and affects more than half of all women. There are a number of reasons why a woman’s breasts can change in size or volume, including trauma, puberty, and hormonal changes. Your breast tissue can change when you’re ovulating, and can often feel more full and sensitive.
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What Are The Symptoms Of Invasive Lobular Breast Cancer
Possible symptoms of invasive lobular breast cancer include:
- A lump or an area that feels thicker or harder than the rest of the breast
- A change in the shape or size of the breast
- Changes in skin texture such as puckering or dimpling
- Changes to the nipple
- Pain in the breast and armpit that’s there all of the time
- A lump or swelling under the arm
Invasive lobular breast cancer may not cause any obvious changes to the breast, like a definite lump.
In some people it’s found during routine breast screening before any symptoms are noticed, but lobular breast cancer can sometimes be more difficult to see on a mammogram than other types of breast cancer.
Find out more about the signs and symptoms of breast cancer and how to check your breasts.
Patient Characteristics Between Ilc And Idc
The SEER tumor registry database was used to identify 1,097,908 patients diagnosed with ILC and IDC. After selecting patients based on specific inclusion and exclusion criteria, the remaining 318,406 patients were included in our research. Table 1 shows the patient selection process. Finally, 30,190 patients were assigned to the ILC group and 288,216 patients were assigned to the IDC group. Table 2 summarizes the clinical characteristics of the ILC and IDC groups.
Table 2 Comparison of clinical characteristics between invasive lobular carcinoma and invasive ductal carcinoma group in unmatched population.
People diagnosed with ILC tended to be older , exhibit poorly differentiated and larger lesions, be ER/PR positive and were administered less radiation therapy and chemotherapy.
Given the surgical procedures, ILC had a higher percent of mastectomy compared to IDC cases . A lower rate of radiation therapy and chemotherapy was observed in the ILC group .
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Grade Type And Prognosis
FigureFigure22 shows BCSS for ILC grade 2 compared to IDC grades 1, 2 and 3. ILC grade 2 had poorer BCSS compared to IDC grade 2 .There was no significant difference in BCSS between ILC grade 2 and IDC grade 3 . TableTable44 shows the risk of death from breast cancer according to type. ILC grade 2 was compared to IDC grades 1, 2 and 3 separately. HRs were similar for ILC grade 2 and IDC grade 3, whereas IDC grade 2 had a significantly better survival than ILC grade 2 . Adjustment for age, stage and time of diagnosis did not influence the results.
How Is Invasive Lobular Carcinoma Diagnosed
In most cases, invasive lobular carcinoma is detected during a routine mammogram or by physical exam. During this exam, your healthcare provider will feel for lumps, bumps, skin thickening or other abnormalities in your breast. They may also order other tests, including:
- Ultrasound. This imaging test uses sound waves to capture pictures of your breast tissue. Ultrasound may be used as a standalone test or in combination with mammography.
- Magnetic resonance imaging . Your healthcare provider may request an MRI, which uses radio waves and magnets to take detailed pictures inside your body.
- Biopsy. In order to confirm that the cancer is present, your healthcare provider may take a small sample of breast tissue and send it to a pathology lab for analysis.
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About Invasive Lobular Breast Cancer
Invasive lobular breast cancer is the second most common type of breast cancer. Around 15 in every 100 breast cancers are invasive lobular carcinoma. This type can develop in women of any age. But it is most common in women between 45 and 55 years old.
Breast cancer is very rare in men. It is also very unusual for a man to have an invasive lobular type of breast cancer.
What Is The Most Aggressive Form Of Breast Cancer
Triple-negative breast cancer is considered an aggressive cancer because it grows quickly, is more likely to have spread at the time it’s found and is more likely to come back after treatment than other types of breast cancer. The outlook is generally not as good as it is for other types of breast cancer.
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Survival Outcomes Between Idc And Ilc Groups In The Subgroup Analysis
Overall survival of patients in the entire cohort and subgroups is shown in a Forest plot . ILC patients were associated with higher risk of mortality compared to IDC patients who were HR-negative, AJCC stage III, N2/N3 stage, or in those who received radiotherapy. Matched patients were divided into different subtypes to further examine factors affecting prognosis. In patients with positive hormone receptor, ILC and IDC groups exhibited similar OS . However, in patients with negative hormone receptor, the ILC group exhibited reduced OS compared to IDC patients . ILC presented a similar OS compared to IDC in AJCC stage I and II but had worse OS in AJCC stage III . ILC had similar OS compared to IDC in N0 and N1 stage but had worse OS in N2 and N3 stage . ILC had similar OS compared to IDC in patients who did not receive radiotherapy but had worse OS in patients who received radiotherapy .
Figure 2 Forest plot of overall survival for patients in the entire cohort and subgroups.
HER2 status is a very important prognostic and predictive factor in breast cancer. Therefore, we extracted patients with available HER2 status from the matched population, obtaining 39,684 patients in the HER2 cohort, of which 19,442 were IDC patients and 20,237 were ILC patients. Among these, there were 2,241 HER2+ patients and 17,206 HER2- patients in the IDC group and 981 HER2+ patients and 192,566 HER2- patients in the ILC group.
Multivariate Analysis Of Luminal Type
Multivariate analysis was performed using Cox regression models to determine the independent prognostic factors of luminal type breast cancer. Factors in this analysis were pathological type , age, tumor size, lymph node status, histological grade, endocrine therapy, and chemotherapy. Pathological type, tumor size, lymph node status, histological grade, and endocrine therapy were prognostic factors independently associated with recurrence of luminal type breast cancer . Moreover, tumor size and lymph node status were the prognostic factors for better survival in luminal type breast cancer.
Table 4 Multivariate analysis for luminal types
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Symptoms Of Invasive Lobular Carcinoma
In many cases, invasive lobular carcinoma causes no symptoms and is found after your doctor sees a suspicious area on a screening mammogram.
In other cases, you or your doctor may feel a thick or swollen area in your breast. ILC is less likely than other breast cancers to cause a hard lump. Any of the following unusual changes in the breast can be a first sign of invasive lobular carcinoma:
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Generally, the stage of invasive lobular carcinoma is described as a number on a scale of I through IV. Stages I, II, and III describe early-stage cancers and stage IV describes cancers that have spread outside the breast to other parts of the body, such as the bones or liver.
Once a diagnosis of invasive lobular carcinoma has been made, your doctor will do more testing to collect information on the characteristics of the cancer. These tests, as well as the results of your biopsy, make up the parts of your pathology report.
Information commonly collected as part of a pathology report include:
Treatments for invasive lobular carcinoma may include:
Symptoms Of Lobular Breast Cancer
Lobular breast cancer sometimes begins without symptoms. It may show as an abnormal area on a mammogram, which leads to further examination.
Spotting ILC on a mammogram can be difficult because the cancer cells spread in a line rather than in a distinctive lump, as in IDC. Magnetic resonance imaging imaging is reported to provide more sensitive images that may show the cancer better.
The first symptom of ILC is sometimes a thickening or hardening of a portion of the breast. This thickening can be felt by touch, but it feels different from the classic lump associated with IDC, the more common breast cancer.
Other symptoms of ILC may include:
- swelling or fullness in a part of the breast, or in the whole breast
- a change in the skin texture in a part of the breast
- dimpling in the breast
The exact cause of ILC is currently unknown. But there are some risk factors that are associated with ILC. These can include:
- taking hormone replacements, for menopause for example
Although people can be diagnosed with lobular breast cancer at any age, its most common in women ages 55 years and older. Research suggests that hormone replacement therapy after menopause, especially with progesterone, may increase the risk of this type of cancer.
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Treatment For Invasive Lobular Breast
The treatment for invasive lobular breast cancer is the same as for the more common type of breast cancer .
Usually, you have surgery to remove the area of cancer and a surrounding area of healthy tissue. This operation is called breast conserving surgery, or a wide local excision or lumpectomy
Invasive lobular breast cancer is sometimes found in more than one area within the breast. In that case, it might not be possible to remove just the area of the cancer. Your doctor may then recommend removal of the whole breast .
If you choose to, you can have a new breast made at the same time as mastectomy or some time afterwards.
After the surgery you might have:
- drugs that help prevent or slow down bone thinning or bone damage
- a combination of these treatments
You may have surgery to your armpit called a sentinel lymph node biopsy. This means having about 3-5 lymph nodes removed. Sometimes surgeons have to remove more lymph nodes. Your doctor will let you know whether you need this.
You might have chemotherapy or hormone therapy before surgery called neoadjuvant therapy. The aim is to shrink the cancer down. This means that some people may be able to have breast conserving surgery, who may have needed removal of the breast .
Your doctor considers many things before deciding the best treatment for you. This is why your treatment may be different from other people with breast cancer.
Univariate Analysis Of Luminal Type
The prognosis of luminal ILC was significantly worse than that of luminal IDC. The 5-year DFS was 91.9 % and 88.4 % for patients with luminal IDC and luminal ILC, respectively , while the 5-year OS was 97.6 % and 93.1 %, respectively, for patients with luminal IDC and luminal ILC .
Patient outcomes of luminal IDC and luminal ILC disease-free survival overall survival, IDC invasive ductal carcinoma, ILC invasive lobular carcinoma
The survival curves for luminal IDC and luminal ILC after stratification by tumor size are shown in Fig. . There were no significant differences in DFS between the two groups However, the 5-year DFS of luminal ILC tended to be worse than that of luminal IDC in cases with large tumors . The survival curves for luminal IDC and luminal ILC after stratification by lymph node status are shown in Fig. . There were no significant differences in DFS between the two groups in the node negative population . However, the 5-year DFS of luminal ILC was significantly worse than that of luminal IDC in the node positive population . Furthermore, the 5-year OS of luminal ILC was also significantly worse than that of luminal IDC in the node-positive population .
Patient outcomes of luminal IDC and luminal ILC stratified according to tumor size T1 T2 T3, IDC invasive ductal carcinoma, ILC invasive lobular carcinoma
Fig. 3Table 2 Univariate analysis for luminal types Fig. 4
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Invasive Lobular Carcinoma: Ilc Diagnosis
Invasive lobular breast cancer is slow-growing compared to other breast cancers, she says, but because it is difficult to detect on a mammogram, these tumors can be large by the time they are diagnosed.
Following up on an area of concern on a mammogram or your reported symptoms, your doctor may recommend additional screening studies such as:
- Breast magnetic resonance imaging : Following a mammogram, a breast MRI produces detailed images of inside the breast, which can detect additional tumors and the spread of the tumor or cancer in the breast.
- Ultrasound of the breast: Using painless sound waves directed through the skin by a transducer, ultrasound can identify tumors.
- Breast needle biopsy: After numbing the breast area, a radiologist removes a small amount of breast tissue using a needle. The sample is sent to a pathologist , who looks at the tissue under a microscope and can confirm or rule out cancer cells.