Screening for intraocular metastases in patients with breast carcinoma

ABSTRACT

@#ACCORDING to the Department of Health (DOH), cancer ranks third among the leading causes of morbidity and mortality in the Philippines, after infectious and cardiovascular diseases.1 The DOH–Rizal Cancer Registry and the Philippine Cancer Society–Manila Cancer Registry listed breast cancer as the most commonly diagnosed type of cancer in 2006. The Cancer Institute of the University of the Philippines–Philippine General Hospital (UP-PGH) also reported breast cancer as the most common carcinoma seen at the outpatient clinic, with more than 10,000 cases each year. Although intraocular metastasis most frequently originates from the breast,2 it was once a rarity overall. Perls was the first to describe intraocular metastasis in 1872,3 and a subsequent article by Godtfredsen reported its incidence at 0.07%.4 However, post-mortem studies have shown that among patients who died of cancer, 12.2% had histopathologic evidence of intraocular metastases.5 This was supported by another study involving donor eyes with a prevalence of 12.6%.6 Two studies determined the frequency of intraocular metastases from breast carcinoma. Mewis and Young7 examined 250 patients with breast carcinoma and detected 67 (26.8%) positive cases. They also reported that 9% of patients who were asymptomatic also had intraocular metastases. Wiegel and colleagues performed a prospective screening program for 120 asymptomatic patients with disseminated breast carcinoma and found 6 (5%) with intraocular metastases.8 These studies showed that metastases to the eye may not be as rare as once thought.