Original Article Disruption of the expected positive correlation between breast tumor size and lymph node status in BRCA1-related breast carcinoma William D. Foulkes, M.B., Ph.D. 1 2 *, Kelly Metcalfe, Ph.D. 3 4, Wedad Hanna, M.D. 4, Henry T. Lynch, M.D. 5, Parviz Ghadirian, Ph.D. 6, Nadine Tung, M.D. 7, Olofunmilayo Olopade, M.D. 8, Barbara Weber, M.D. 9 10, Jane McLennan, M.D., Ph.D. 11, Ivo A. Olivotto, M.D. 12, Ping Sun, Ph.D. 4, Pierre O. Chappuis, M.D. 1 2, Louis R. Bégin, M.D. 13, Jean-Sébastien Brunet, M.Sc. 1 2 14, Steven A. Narod, M.D. 4 1Department of Oncology, McGill University, Montreal, Quebec, Canada 2Department of Human Genetics, McGill University, Montreal, Quebec, Canada 3Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada 4Centre for Research in Women's Health, Sunnybrook and Women's College Health Sciences Centre and The University of Toronto, Toronto, Ontario, Canada 5Department of Preventive Medicine and Public Health, Creighton University School of Medicine, Omaha, Nebraska 6Epidemiology Research Unit, Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Pavillon Masson de l'Hôtel-Dieu, Montréal, Quebec, Canada 7Division of Oncology, Beth Israel Deaconess Hospital, Boston, Massachusetts 8Department of Medicine, University of Chicago, Chicago, Illinois 9Department of Medicine, Division of Hematology/Oncology, University of Pennsylvania, Philadelphia, Pennsylvania 10Department of Genetics, University of Pennsylvania, Philadelphia, Pennsylvania 11Cancer Risk Program, University of California-San Francisco Comprehensive Cancer Center, San Francisco, California 12British Columbia Cancer Agency, Victoria, British Columbia, Canada 13Department of Pathology, Sacré Coeur Hospital, Montreal, Quebec, Canada 14Algorithme Pharma, Montreal, Quebec, Canada email: William D. Foulkes (william.foulkes@mcgill.ca) *Correspondence to William D. Foulkes, Division of Medical Genetics, Department of Medicine, Room L10-120, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec, Canada H3G 1A4 Abstract BACKGROUND A positive correlation between breast tumor size and the number of axillary lymph nodes containing tumor is well established. It has been reported that patients with BRCA1-related breast carcinoma are more likely than patients with nonhereditary breast carcinoma to have negative lymph node status. Therefore, the authors questioned whether the known positive correlation between tumor size and lymph node status also was present in women with BRCA1-related breast carcinomas. METHODS The relation between the greatest dimension of the resected breast tumor (size) and the presence of positive axillary lymph nodes (expressed as a percentage of all lymph nodes examined) was evaluated in 1555 women with invasive breast carcinoma who were ascertained at 10 centers in North America between 1975 and 1997. There were 276 BRCA1 mutation carriers, 136 BRCA2 carriers, and 1143 women without a known mutation (208 BRCA1/BRCA2 noncarriers and 935 untested women). Patients were stratified according to tumor size, and odds ratios were estimated for the presence of positive lymph nodes with increasing tumor size. RESULTS A highly significant positive correlation between tumor size and the frequency of positive axillary lymph nodes was seen for BRCA1/BRCA2 noncarriers, for BRCA2 carriers, and for untested women (overall P < 0.0001 for each). In contrast, there was no clear correlation between tumor size and positive lymph node status in BRCA1 carriers (overall P = 0.20). CONCLUSIONS The relation between tumor size and lymph node status in patients with breast carcinoma appears to be different in BRCA1 carriers compared with BRCA2 carriers and noncarriers. These findings have important implications for estimating the route of metastatic spread and for evaluating the effectiveness of early diagnosis in patients with BRCA1-related breast carcinoma. Cancer 2003. Volume 98, Issue 8 , Pages 1569 - 1577 Remember we are NOT Doctors and have NO medical training. This site is like an Encylopedia - there are many pages, many links on many topics. Support our work with any size DONATION - see left side of any page - for how to donate. You can help raise awareness of CAM.