Pathology of mammographically discovered breast cancer. Clinical implications of size and histologic differentiation

The management of breast cancer is becoming increasingly complex, almost year by year. Previous paradigms have held that issues were dichotomous (e.g., good versus bad). These are being challenged constantly by more complex models that demand more than a duality of choice in therapeutic decision making. Most importantly, the determinants of local failure after conservative treatment are quite different from the determinants of survival. While we develop enhanced chemotherapy for immediate life-threatening disease, we also accepting subtypes of breast cancer that are of little threat to life and need little treatment. With the establishment of the efficacy of systemic chemotherapy, the question of whether some patients may be helped with chemotherapy becomes extremely important. The list of possible clinically useful subcategories is growing and is under active development. However, the prognostic factors in use have been validated repeatedly. The two major elements of anatomic staging--size and lymph node status--interact powerfully with histologic categories of grade and special type. In the area of small tumors, these associations indicate lesions that have almost no likelihood of association with distant failure, at least within 5 years.