LONG-TERM PROGNOSIS OF SCAR AND NON-SCAR CANCERS OF THE BREAST

The prognostic significance of histopathologic classification of ductal breast carcinoma as scar and non-scar types was studied among 311 patients with breast cancer, followed up for a minimum of 22 years after the diagnosis or until death. Ninety-six (31%) cancers were of scar type and they had a more favourable prognosis than the cancers of non-scar type (p = 0.0001). The scar cancers were more often well differentiated (p < 0.0001), had more pronounced inflammatory cell reaction (p < 0.0001), less nuclear pleomorphism (p < 0.0001), less tumor necrosis (p < 0.0001), and a lower mitotic rate (p < 0.0001) than the non-scar cancers. It was less common for patients with scar cancer to have axillary lymph node metastases (p = 0.01) and their primary tumor was smaller (p = 0.006). In flow cytometric analysis the scar cancers were more often DNA diploid (p = 0.004) with S-phase fraction below the median (p = 0.0002). In a multivariate analysis the association of cancer with a scar did not appear as an independent prognostic factor, whereas histologic grade (p < 0.001) and extent of tumor necrosis (p < 0.001) did. We conclude that the classification of breast cancer as scar and non-scar types has less prognostic value than the conventional histopathologic grading.