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Invasive lobular carcinoma (ILC) is the second most reported type of breast cancer in the Danish Breast Cancer Cooperative Group (DBCG). Several histological subtypes exist, with reports of different prognosis. The aim was to present the incidence of ILC in DBCG from 1977-2004, and evaluate tumours regarding diagnosis, histological subtype and grade, and relate to prognosis. Eight hundred and sixty tumours from patients with a diagnosis of ILC or ILC/non-ILC, who underwent breast cancer surgery in the period of 1990-1998, were evaluated. The impact of histological malignancy grade on disease-free survival and overall survival was analysed using a multivariate analysis adjusting for tumour size, hormone receptor status, axillary lymph node status and patient age. The incidence of pure ILC has risen from 5 to 12%, the ILC/non-ILC is constant at 2% of all reported breast cancers in DBCG. Most of the tumours were classical ILC grade II. The majority of the grade III tumours were among the non-classical subtypes, showing a statistically significant worse disease-free and overall survival compared to grade II, regardless of type. The prognosis was the same for grade I and grade II tumours. The number of positive axillary lymph nodes and hormone receptor negative tumours increased among grade III tumours. We conclude that histological malignancy grade has an independent significant impact on the prognosis of ILC, and it should be taken into consideration when planning the postoperative treatment in this group of patients.

Purpose: To compare the efficacy of ovarian ablation versus chemotherapy in early breast cancer patients with hormone receptor-positive disease., Patients and Methods: We conducted an open, randomized, multicenter trial including premenopausal breast cancer patients with hormone receptor-positive tumors and either axillary lymph node metastases or tumors with a size of 5 cm or more. Patients were randomly assigned to ovarian ablation by irradiation or to nine courses of chemotherapy with intravenous cyclophosphamide, methotrexate, and fluorouracil (CMF) administered every 3 weeks., Results: Between 1990 and May 1998, 762 patients were randomly assigned, and the present analysis is based on 358 first events. After a median follow-up time of 8.5 years, the unadjusted hazard ratio for disease-free survival in the ovarian ablation group compared with the CMF group was 0.99 (95% CI, 0.81 to 1.22). After a median follow-up time of 10.5 years, overall survival (OS) was similar in the two groups, with a hazard ratio of 1.11 (95% CI, 0.88 to 1.42) for the ovarian ablation group compared with the CMF group., Conclusion: In this study, ablation of ovarian function in premenopausal women with hormone receptor-positive breast cancer had a similar effect to CMF on disease-free and OS. No significant interactions were demonstrated between treatment modality and hormone receptor content, age, or any of the well-known prognostic factors.

Objectives: To evaluate the effect on breast cancer mortality during the first 10 years of the mammography service screening programme that was introduced in Copenhagen in 1991., Design: Cohort study., Setting: The mammography service screening programme in Copenhagen, Denmark., Participants: All women ever invited to mammography screening in the first 10 years of the programme. Historical, national, and historical national control groups were used., Main Outcome Measures: The main outcome measure was breast cancer mortality. We compared breast cancer mortality in the study group with rates in the control groups, adjusting for age, time period, and region., Results: Breast cancer mortality in the screening period was reduced by 25% (relative risk 0.75, 95% confidence interval 0.63 to 0.89) compared with what we would expect in the absence of screening. For women actually participating in screening, breast cancer mortality was reduced by 37%., Conclusions: In the Copenhagen programme, breast cancer mortality was reduced without severe negative side effects for the participants.

In an overview, Swedish mammography screening trials demonstrated a 29% reduction in breast cancer mortality in women aged 50-69 and no effect on total mortality. Three Danish regions introduced mammography screening in the 1990s. The authors developed a method to evaluate the effect of mammography service screening on breast cancer mortality and validated it applying it to total mortality, where no effect was expected. Study groups and historical and national control groups were analysed using Poisson regression. Total mortality in the screening regions and periods was close to that expected in the absence of screening. A small (3%) excess risk, also seen in a non-screening area, probably results from regional differences changing over time. The effect of this is inseparable from the screening effect. The design is adequate for analysing the effect of mammography service screening on breast cancer mortality.

Background: Among middle-aged and older women with early breast carcinoma, breast-conserving therapy (BCT) has been shown to have an effect on survival that is similar to that of modified radical mastectomy (RM). Nonetheless, it remains to be established whether BCT also is the optimal treatment option for early breast carcinoma in young women, because these women generally have more aggressive disease and a higher frequency of local recurrence compared with older women., Methods: We investigated a cohort of 9285 premenopausal women with primary breast carcinoma who were age < 50 years at diagnosis. These women were identified from a population-based Danish breast carcinoma database containing detailed information on patient and tumor characteristics, predetermined treatment regimens, and survival., Results: In total, 7165 patients (77.2%) were treated with RM, and 2120 patients (22.8%) were treated with BCT. We calculated the relative risk of death within the first 10 years after diagnosis according to surgical treatment and age, both before and after adjustment for known prognostic factors. No increased risk of death was observed among women who received BCT compared with women who underwent RM, regardless of age at diagnosis (< 35 years, 35-39 years, 40-44 years, or 45-49 years), despite the increased risk of local recurrence among young women. Restricting the analysis to women with small tumors (size < 2 cm) yielded similar results., Conclusions: Despite having a higher rate of local recurrence, young women with breast carcinoma who receive BCT are similar to young women treated with RM in terms of survival., (Copyright 2003 American Cancer Society.)

Introduction: Biennial service mammography screening for breast cancer has been offered to women aged 50-69 years in the municipality of Copenhagen since 1991. We report the results of the first three invitation rounds., Material and Methods: Data were collected from the Copenhagen service mammography screening database and other Danish registers., Results: The average participation rate during the first three invitation rounds was 66%. The breast cancer detection rate was 10/1,000 screened in the first invitation round and 5/1,000 in the consecutive rounds. The probability of a false positive mammography was 6% at the prevalent screen, and this was reduced to 3% at incidence screens. Fifty-two cases of interval cancer were seen after the first invitation round. The expected number was 152, which gives a proportional interval cancer rate of 0.34. The sensitivity was 86% and the specificity 94% after the first round., Discussion: The detection rate of breast cancer was high, especially in the prevalence round. The trend in the incidence of breast cancer at the subsequent rounds was similar to that before screening, which indicates that mammography screening does not lead to any greater over-diagnosis. The rate of false positive mammography was high at the initial screening round, but was acceptable at subsequent rounds, and a false positive mammography does not seem to have affected participation in subsequent rounds. The Copenhagen screening programme conforms to international quality assurance guidelines for process evaluation.

Introduction: Service mammography has been offered biennially to women aged 50-69 years in the municipality of Copenhagen since 1991. The results were compared to breast cancer cases before initiation of screening. The comparison concerns prognostic factors and the treatment-related consequences., Material and Methods: Data from the Copenhagen service mammography screening were linked to data from the DBCG database., Results: Before screening, 16% of breast cancer cases had a tumour size of 10 mm or less, this percentage increased to 41 in the screen-detected cases. Sixty per cent of breast cancer cases showed no evidence of metastatic spread to axillary lymph nodes before screening; this percentage increased to 78 per cent in the screen-detected cases. Forty per cent of ductal carcinomas showed a malignancy grade I before screening, compared to 53% in the screen-detected cases. Thirteen per cent were treated with breast conserving therapy before screening, as opposed to 48% in the screen-detected cases. Forty-one per cent needed postoperative adjuvant treatment before screening, compared with 21% in the screen-detected cases., Discussion: A marked improvement was seen in the prognostic and treatment-related characteristics of the screen-detected breast cancer cases, as compared to breast cancer cases from the same area before screening was initiated.