Table 2

Dormancy candidates: CTCs and tumor characteristics

Patient no./Age at removal (y)Years post-mastectomy*No. of CTCsBlood volume (mL)Tumor-Node-MetastasisStagePathologyBiology of tumor
CTC-positive patients
 1/4013212.5TisN0M00High-grade DCISER+, PR+,S phase 3.9%
 2/5918112.5T1cN0M0IIDCER+, PR−
 4/518225T1aN0M0IILC, IDCER+, PR+, aneuploid
 5/63811T1bN0M0IIDCER−, PR−,S phase 3.5%, diploid
 6/4014212.5T1N1M0IIAIDCProbably ER+, PR+§
 7/4822112.5T2N0M0IIAIDCER−, PR−
 8/4613213T1cN1M0IIAILCER+, PR+
 9/46.515.5115T2N0M0IIAIDCER−, PR−,S phase 7.7%, aneuploid
 10/5718225T1cN0M0IIAILC1/17 nodes+, no ER/PR done
 11/55.513.5225T1cN0M0IIAIDCER+, PR+,S phase 0.5%, diploid, 1/33 nodes+
 12/629112.5T2N1M0IIBILCER+, PR+, Her2/neu−, S phase 4%
 13/5015212.5T3N1M0IIIAIDCER+, PR+, aneuploid, 2/28 nodes+
CTC-negative patients
 14/367015T1cN0M0IMCER+, PR+, Her2/neu−
 16/4218.5015T2N0M0IIBILCER+, PR+
 17/6516015T1cN0M0IIBIDCER+, PR+,S phase 4.3%, diploid, 2/16 nodes+
 18/7913015NANAIDCNot available
 19/768012.5T1bN0M0(R)IIDCER+, PR+
 20/6212012.5T1bN0M0IIDCER+, PR+, S phase 2.4%, diploid
 21/678012.5T1N0M0IIDCER +, PR+
 22/4518012.5T1cN0M0IIDCER+, PR+
 23/468.5010T1N0M0IIDCER−, PR−
 24/4520010T1bN0M0IIDCER, PR not done
 25/539010T1N0M0IIDCProbably ER+, PR+§
 26/548010T1bN0M0IIDCER−, PR−, tetraploid
 27/5010015T1bN0M0IIDCER+, PR+
 28/5219015T1bN0M0IIDCER+, PR+
 29/4712012.5T1bN1M0IIAIDCER−, PR−,S phase 11.3%, aneuploid, 1/19 nodes+
 30/767012.5T1N1M0IIAIDCER+, PR+,Her2/neu−, S phase 6%, diploid, 1/24 nodes+
 31/6716.5015T1cN0M0IIAIDCER+, PR+
 32/2919010T2N0M0IIAIDCER−, PR+
 33/5320015T1N0M0 (R)IIAIDCER, PR not done
 34/7114012.5T2N1M0IIBIDCER+, PR+
  • Abbreviations: IDC, infiltrating ductal carcinoma; DCIS, intraductal carcinoma in situ; ILC, infiltrating lobular carcinoma; ER, estrogen receptor; PR, progesterone receptor; NA, not available; MC, mucinous carcinoma.

  • * We have based our studies on years after mastectomy because all studies in the past have used mastectomy as the beginning time point for defining dormancy. However, patients in this study, like others reported in the literature, have received appropriate adjuvant therapy.

  • The difference in recurrence risk based on stage and grade diminishes over time. In other words, the year-to-year risk at 10 years out is very low in patients who initially were at either high or low risk. Patients at higher risk tend to have recurrence earlier, and the annual hazard of high-risk and low-risk groups tends to merge at low yearly levels as time goes on (51) .

  • Those oncologists on our staff who have had patients diagnosed with ductal carcinoma in situ who later developed recurrent breast cancer uniformly believe that areas of invasiveness were missed by the pathologist. Many of these patients had their tumors removed at small hospitals in rural areas many years ago, which may contribute to the discrepancies. Furthermore, involvement of axillary lymph nodes in up to 13% of patients with ductal carcinoma in situ underscores the fact that invasive cells can exist in small foci that evade detection even with contemporary pathological analysis (52) . Finally, the one case with ductal carcinoma in situ found to have CTCs in our series was of high nuclear grade and therefore more likely to be associated with microinvasive disease.

  • § Based on tamoxifen therapy received. For simplicity, the patients have been grouped according to CTC status and numbered sequentially.