Deprivation and pathological prognostic indicators in operable breast cancer

Sharp, Catherine Margaret (2004) Deprivation and pathological prognostic indicators in operable breast cancer. MSc(R) thesis, University of Glasgow.

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Abstract

The aim of this study was to assess the effect of deprivation on pathological prognostic indicators in breast cancer and to find a population of patients with breast cancer who are unlikely to have axillary metastases and therefore be spared axillary clearance. It is well recognised that patients from deprived areas with breast cancer have a poorer outcome. The reasons for this are unclear. Some studies have found that patients from deprived areas are more likely to have oestrogen receptor negative tumours, which have a poorer prognosis. Others have found no relation between deprivation and pathological prognostic factors and suggest poorer outcome may be due to late presentation or impaired host responses secondary to, for example, co-morbidity, genetic, diet or environmental factors. Axillary clearance provides information for staging and prognosis and may also provide local control and even cure as well as aiding in the decision to give adjuvant treatment. However it carries with it significant morbidity such as lymphoedema, paraesthesia and reduced shoulder mobility. Recently much work has been done into the role of sentinel node biopsy as a means of assessing the axilla for metastases, but there is still a false negative result of up to 10% with this procedure. It has been found that sentinel node biopsy is more effective in patients at low risk of axillary spread. It has been found in other studies that the incidence of nodal metastases in patients with tumours of 10mm or less is low. Some studies of tumours of 5mm or less have had an incidence of axillary metastases of 0% and some suggest abandoning axillary clearance in these patients. Other studies of tumours up to 10mm have had as many as 27% with positive nodes. We wanted to find out whether deprivation in the Glasgow area had any effect on tumour pathology and lymph node spread which may account for poorer outcome. We also wanted to find out which patients with small tumours were least likely to have nodal spread, and therefore be spared axillary clearance or provide a target population for assessment with sentinel node biopsy. Method The data was collected prospectively from five hospitals in the Glasgow area and included all patients who had breast cancers operated on between October 1995 and March 2001. They included both screen detected and symptomatic patients. Patients were separated into three groups - affluent, intermediate and deprived according to the Carstairs index of deprivation at the time of diagnosis. This is a deprivation score based on area of residence using census data. The influence of deprivation on the pathological size of the tumour, histological grade, ER status, axillary node status and Nottingham prognostic index (NPI) were examined. Deprivation data was available for 3251 patients. In total there were 666 patients who had tumours of 10mm or less. We excluded those who had less than 4 axillary nodes excised when looking at the incidence of nodal metastases in these patients as it was assumed that some might not have had their axillae accurately assessed. Those with ungraded tumours were also excluded leaving 613 patients in this part of the study. 64% were screen detected. Deprivation scores were available for 608 of these patients. The pathological variables we examined were size, which we split into those of 5mm or less (T1a) and those of 6-10mm (T1b). We also looked at size as a continuous variable. The other variables were histological grade, the presence of lymphovascular invasion and ER status.

Item Type: Thesis (MSc(R))
Qualification Level: Masters
Additional Information: Adviser: W D George
Keywords: Oncology
Date of Award: 2004
Depositing User: Enlighten Team
Unique ID: glathesis:2004-71345
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 10 May 2019 10:49
Last Modified: 10 May 2019 10:49
URI: http://theses.gla.ac.uk/id/eprint/71345

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