Survival after Node-positive Breast Cancer

The goal of screening for breast cancer is to identify cancers when they are at a curable stage. The prospect for cure depends in turn on the extent to which the cancer has spread at diagnosis. If a breast cancer is entirely contained within the breast (that is, if no subclinical metastases have occurred), then complete excision through mastectomy or breastconserving surgery is expected to be curative. If the cancer has spread to regional lymph nodes, cure is still the goal, but a proportion of women with nodepositive cancer will also have subclinical metastatic disease that may or may not be cured by surgery and systemic chemotherapy. It is currently not possible to assay for the presence of subclinical metastases at diagnosis, but it is well established that the highest cure rates are achieved in women with small, lymph node-negative breast cancers1. Given the relationship between tumour size and survival, and given the conventional model of breast cancer spread, it seems logical that the principal goal of early detection should be to identify cancers when they are small and node-negative. Undoubtedly, the best outcome would be the detection of all breast cancers when they are small and node-negative. However, there may also be an advantage to identifying node-positive cancers when they are relatively small. Follow-up data from the Henrietta Banting Database in Toronto was used to evaluate the relationship between tumour size and long-term survival in ABSTRACT