Angiogenesis Precedes Breast Cancer Development, Van Nuys Study Shows

SAN ANTONIO--Mammographic signs of angiogenesis and neovascularitymay identify a developing breast cancer years before the lesionbecomes visible, Parvis Gamagami, MD, said at the San AntonioBreast Cancer symposium.

At The Breast Center, Van Nuys, Calif, a review of xeromammogramsof 204 breast cancer patients, made up to 13 years before cancerdetection, showed that vascular evidence of tumor developmentpreceded the mammographic appearance of 91% of nonpalpable lesionsand 100% of advanced palpable lesions.

Signs of tumor-related angiogenesis include hypervascularity,vessel dilation or engorgement, focally convergent vessels, andespecially calcification of the nutrient artery of the carcinoma(for unknown reason). "If a single calcified vessel appearsin only one breast without evidence of malignancy, that is a strongindication of high risk," said Dr. Gamagami, a radiologistat the Van Nuys Breast Center.

He believe that mammographic evidence of angiogenesis can be usedto identify very small, early-stage lesions that otherwise couldbe missed. In their study, they identified vessel convergencein malignancies as small as 5 mm.

Evidence of tumor angiogenesis is often dismissed as benign vascularityor nonpathologic asymmetry, Dr. Gama-gami said. In some instances,the signs are simply overlooked.

Patients with evidence of breast cancer angiogenesis should befollowed closely, probably with annual mammograms, at least inthe affected breast, Dr. Gamagami advised. "We know thata preneoplastic condition exists years before malignant transformationoccurs," he said. "We don't have any criteria to helpus decide which breast or breasts will develop cancer. Angiogenesismay be helpful in that respect, so when we see a single calcifiedartery, we have to follow its itinerary to see where it ends."

Investigators at Van Nuys have begun evaluating the use of corebiopsy in women who have suspicious vessels that end in areasof parenchymal hyperdensity, one characteristic of malignancy.