Clinicopathological differences between asymptomatic vs symptomatic breast cancer: a 30-year single-center retrospective study
Related Experiment Videos
Bomi Yi1,2, Cholong Kim1,3, Young-Jin Lee1
1Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
Purpose:
Although early-stage breast cancer incidence has increased following Korea's National Cancer Screening Program, the number of breast cancer-related deaths continues to rise, and many patients still present with symptoms. We investigated the clinicopathological characteristics and long-term prognosis of symptomatic versus asymptomatic breast cancer to determine whether symptomatic presentation serves as an independent prognostic factor.
Methods:
In this single-center, retrospective cohort study, we analyzed 38,050 women who underwent surgery for primary invasive breast cancer (1994-2021). Patients were categorized into symptomatic (N = 24,305) and asymptomatic (N = 13,745) groups. We used multivariable Cox models to adjust for confounders and conducted interaction analyses to assess prognostic factors and the impact of symptom presentation.
Results:
Symptomatic patients were significantly younger than asymptomatic patients and presented with more advanced stages and aggressive biological features. Symptomatic presentation was associated with a significantly lower 10-year recurrence-free interval (P < 0.001). In multivariable analysis, symptomatic status remained an independent predictor of worse outcomes (hazard ratio for recurrence, 1.44; 95% confidence interval, 1.33 to 1.57). Interaction analyses across subgroups defined by operation period, molecular subtype, and pathologic stage consistently showed that symptomatic presentation conferred a significantly higher risk of recurrence.
Conclusion:
Symptomatic breast cancer represents a clinically distinct presentation associated with adverse clinicopathologic features and persistently poorer long-term outcomes, even after adjustment for established prognostic factors. Despite the benefits of screening, the persistent burden of symptomatic disease underscores the need for public health strategies focused on early symptom awareness and regular breast self-examination.
