Multicentric Breast Cancer, Multifocal and Contralateral Breast Cancer

Screening will on occasion reveal the appearance of more than one tumor, and this tends to suggest a more advanced stage of disease. Where there is more than one tumor and it appears to have arisen from one original tumor, this is termed multifocality.

Multifocal breast cancer tends to develop in the same quadrant of the breast.

A multicentric tumor describes a situation where there are multiple tumors, occurring in far-separated areas of the breast.

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Frequency of multifocal and multicentric breast cancer tumors

Multifocal breast cancer tumors tend to develop in 10-12% of patients, depending upon when screening occurs. A ‘synchronous‘ contralateral tumor (synchronous meaning found within 3-12 months from the discovery of the first tumor) is found by physical exam or mammography approximately 2% of the time.

For women who present with unilateral breast cancer, a subsequent ‘metachronous‘ contralateral cancer tends to develop at a rate of 0.5-1% per year, which represents a cumulative risk of 15%.

Contralateral breast cancer screening and sensibility

Contralateral mammography is a mandatory follow-up for all patients with breast cancer. If multifocal or multicentric breast cancer is truly present, mammography examinations aren’t always able to detect it, in fact, the sensitivity for detecting this situation with mammography is between 15% to 45%, which is not entirely satisfactory. This sensitivity rate is increased to between 48% and 62% with the addition of whole-breast sonography, but magnetic resonance imaging is the most sensitive screening tool, with a detection rate of around 81%.

The sensitivity of mammography in detecting multifocal breast tumors increases in women with a ‘fatty‘ pattern of breast density. In women with dense breast, the sensitivity of mammography in detecting multifocal breast tumors droms by about 10%.

Multifocal staging: increased risk of axillary metastasis

The discovery of multifocal and multicentric breast cancer presents new challenges in terms of staging, follow-up procedures, and treatments. Of the approximately 11% of patients who have developed multifocal and multicentric tumors, approximately 52% of these will also present with axillary lymph node involvement. By contrast, axillary node involvement is discovered with unifocal breast cancers only about 38% of the time. This suggests that women with multifocal breast carcinomas have an increased ‘tumor load‘, or a more serious and aggressive kind of breast cancer. Multifocal and multicentric tumors have tended to be understaged, often leading to a false sense of assurance and denying the patient the opportunity to aggressively pursue adjuvant therapies.

Combined diameter assessments

Current research suggests that conventional breast cancer staging practices, which focus on a tumor’s diameter, or the largest tumor’s diameter in the presence of multifocality, may be innappropriate. Studies have shown that breast tumors with multiple foci have a different biology, with an increased potential to metastize to the axillary lymph nodes, regardless of their size. It has been suggested that taking the ‘combined diameters‘ of all multifocal tumors and not just the diameter of the largest nodule, may give a clearer indication of the actual breast cancer stage. However, it has been demonstrated that multifocality really has no bearing on the overall survival rate for breast cancer. The same prognostic indicators that apply to other unifocal breast cancers remain the same for multifocal breast tumors.

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Everything you need to know about Multifocality, Multicentricity and Contralateral in Breast Cancer Screening is listed above…
For further reading, I recommend you visiting this page on Mammograms.

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References

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9. Sardanelli F, Giuseppetti GM, Panizza P, Bazzocchi M, Fausto A, Simonetti G, Lattanzio V, Del Maschio A; Italian Trial for Breast MR in Multifocal/Multicentric Cancer. Sensitivity of MRI versus mammography for detecting foci of multifocal, multicentric breast cancer in Fatty and dense breasts using the whole-breast pathologic examination as a gold standard. AJR Am J Roentgenol. 2004 Oct;183(4):1149-57.
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