Comparison of the International and American Systems for the Staging of Breast Cancer2

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Abstract
Proposals by the International Union Against Cancer and the American joint CommiHee on Cancer Staging and End Results Reporting for the staging of breast cancer differ in several respects. The major differences involved are in the staging of patients with large tumors and those with involvement of the supraclavicular lymph nodes. Patients with tumors exceeding 5 em and with no evidence of spread beyond the primary tumor are assigned to stage I and to stage III under the American and International systems, respectively. Patients with supraclavicular lymph node involvement but no other distant spread are assigned to stage III under the International system and to stage IV under the American rules. A study of clinical stage assignment and survival of 2,038 breast cancer patients has been carried out to assess the importance of differences in the two systems. Approximately one third of the cases assigned to International clinical stage III were assigned to other stages under the American rules, which indicated the need for standardization. Survival analysis suggested that the International rules on tumor size were more appropriate than the American. The survival curve of a small number of cases dependent for staging on supraclavicular lymph node involvement of the subjects was intermediate between the curves for those in stage III and those in stage IV, based on other criteria. The paper also discusses the number of stages to be on eluded in a system and procedures for determining stage groups.

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