1
|
Nykänen A, Sudah M, Masarwah A, Vanninen R, Okuma H. Radiological features of screening-detected and interval breast cancers and subsequent survival in Eastern Finnish women. Sci Rep 2024; 14:10001. [PMID: 38693256 PMCID: PMC11063164 DOI: 10.1038/s41598-024-60740-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 04/26/2024] [Indexed: 05/03/2024] Open
Abstract
Interval breast cancers are diagnosed between scheduled screenings and differ in many respects from screening-detected cancers. Studies comparing the survival of patients with interval and screening-detected cancers have reported differing results. The aim of this study was to investigate the radiological and histopathological features and growth rates of screening-detected and interval breast cancers and subsequent survival. This retrospective study included 942 female patients aged 50-69 years with breast cancers treated and followed-up at Kuopio University Hospital between January 2010 and December 2016. The screening-detected and interval cancers were classified as true, minimal-signs, missed, or occult. The radiological features were assessed on mammograms by one of two specialist breast radiologists with over 15 years of experience. A χ2 test was used to examine the association between radiological and pathological variables; an unpaired t test was used to compare the growth rates of missed and minimal-signs cancers; and the Kaplan-Meier estimator was used to examine survival after screening-detected and interval cancers. Sixty occult cancers were excluded, so a total of 882 women (mean age 60.4 ± 5.5 years) were included, in whom 581 had screening-detected cancers and 301 interval cancers. Disease-specific survival, overall survival and disease-free survival were all worse after interval cancer than after screening-detected cancer (p < 0.001), with a mean follow-up period of 8.2 years. There were no statistically significant differences in survival between the subgroups of screening-detected or interval cancers. Missed interval cancers had faster growth rates (0.47% ± 0.77%/day) than missed screening-detected cancers (0.21% ± 0.11%/day). Most cancers (77.2%) occurred in low-density breasts (< 25%). The most common lesion types were masses (73.9%) and calcifications (13.4%), whereas distortions (1.8%) and asymmetries (1.7%) were the least common. Survival was worse after interval cancers than after screening-detected cancers, attributed to their more-aggressive histopathological characteristics, more nodal and distant metastases, and faster growth rates.
Collapse
Affiliation(s)
- Aki Nykänen
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland.
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland.
| | - Mazen Sudah
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Amro Masarwah
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
- School of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
- Cancer Center of Eastern Finland, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
| | - Hidemi Okuma
- Department of Clinical Radiology, Diagnostic Imaging Centre, Kuopio University Hospital, Puijonlaaksontie 2, 70210, Kuopio, Finland
| |
Collapse
|
2
|
Ten Velde DE, Duijm LEM, van der Sangen MJC, Schipper RJ, Tjan-Heijnen VCG, Vreuls W, Strobbe LJA, Voogd AC. Long-term trends in incidence, characteristics and prognosis of screen-detected and interval cancers in women participating in the Dutch breast cancer screening programme. Br J Cancer 2024; 130:1561-1570. [PMID: 38467826 PMCID: PMC11059155 DOI: 10.1038/s41416-024-02633-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/18/2024] [Accepted: 02/20/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND No studies are available in which changes over time in characteristics and prognosis of patients with interval breast cancers (ICs) and screen-detected breast cancers (SDCs) have been compared. The aim was to study these trends between 1995 and 2018. METHODS All women with invasive SDCs (N = 4290) and ICs (N = 1352), diagnosed in a southern mammography screening region in the Netherlands, were included and followed until date of death or 31 December 2022. RESULTS The 5-year overall survival rate of women with SDCs increased from 91.4% for those diagnosed in 1995-1999 to 95.0% for those diagnosed in 2013-2018 (P < 0.001), and from 74.8 to 91.6% (P < 0.001) in the same periods for those with ICs. A similar trend was observed for the 10-year survival rates. After adjustment for changes in tumour characteristics, the hazard ratio (HR) for overall survival was 0.47 (95% confidence interval (CI): 0.38-0.59) for women with SDCs diagnosed in the period 2013-2018, compared to the women diagnosed in the period 1995-1999. For the women with ICs this HR was 0.27 (95% CI: 0.19-0.40). CONCLUSION The prognosis of women with ICs has improved rapidly since 1995 and is now almost similar to that of women with SDCs.
Collapse
Affiliation(s)
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | | | | | | | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Luc J A Strobbe
- Department of Surgery, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, the Netherlands.
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
| |
Collapse
|
3
|
McCarthy AM, Fernandez Perez C, Beidas RS, Bekelman JE, Blumenthal D, Mack E, Bauer AM, Ehsan S, Conant EF, Wheeler BC, Guerra CE, Nunes LW, Gabriel P, Doucette A, Wileyto EP, Buttenheim AM, Asch DA, Rendle KA, Shelton RC, Fayanju OM, Ware S, Plag M, Hyland S, Gionta T, Shulman LN, Schnoll R. Protocol for a pragmatic stepped wedge cluster randomized clinical trial testing behavioral economic implementation strategies to increase supplemental breast MRI screening among patients with extremely dense breasts. Implement Sci 2023; 18:65. [PMID: 38001506 PMCID: PMC10668465 DOI: 10.1186/s13012-023-01323-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Increased breast density augments breast cancer risk and reduces mammography sensitivity. Supplemental breast MRI screening can significantly increase cancer detection among women with dense breasts. However, few women undergo this exam, and screening is consistently lower among racially minoritized populations. Implementation strategies informed by behavioral economics ("nudges") can promote evidence-based practices by improving clinician decision-making under conditions of uncertainty. Nudges directed toward clinicians and patients may facilitate the implementation of supplemental breast MRI. METHODS Approximately 1600 patients identified as having extremely dense breasts after non-actionable mammograms, along with about 1100 clinicians involved with their care at 32 primary care or OB/GYN clinics across a racially diverse academically based health system, will be enrolled. A 2 × 2 randomized pragmatic trial will test nudges to patients, clinicians, both, or neither to promote supplemental breast MRI screening. Before implementation, rapid cycle approaches informed by clinician and patient experiences and behavioral economics and health equity frameworks guided nudge design. Clinicians will be clustered into clinic groups based on existing administrative departments and care patterns, and these clinic groups will be randomized to have the nudge activated at different times per a stepped wedge design. Clinicians will receive nudges integrated into the routine mammographic report or sent through electronic health record (EHR) in-basket messaging once their clinic group (i.e., wedge) is randomized to receive the intervention. Independently, patients will be randomized to receive text message nudges or not. The primary outcome will be defined as ordering or scheduling supplemental breast MRI. Secondary outcomes include MRI completion, cancer detection rates, and false-positive rates. Patient sociodemographic information and clinic-level variables will be examined as moderators of nudge effectiveness. Qualitative interviews conducted at the trial's conclusion will examine barriers and facilitators to implementation. DISCUSSION This study will add to the growing literature on the effectiveness of behavioral economics-informed implementation strategies to promote evidence-based interventions. The design will facilitate testing the relative effects of nudges to patients and clinicians and the effects of moderators of nudge effectiveness, including key indicators of health disparities. The results may inform the introduction of low-cost, scalable implementation strategies to promote early breast cancer detection. TRIAL REGISTRATION ClinicalTrials.gov NCT05787249. Registered on March 28, 2023.
Collapse
Affiliation(s)
- Anne Marie McCarthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA.
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | | | - Rinad S Beidas
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Justin E Bekelman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Daniel Blumenthal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Elizabeth Mack
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Anna-Marika Bauer
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Sarah Ehsan
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily F Conant
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Carmen E Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Linda W Nunes
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter Gabriel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Abigail Doucette
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - E Paul Wileyto
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Alison M Buttenheim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
| | - David A Asch
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Katharine A Rendle
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Sue Ware
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| | - Martina Plag
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Steven Hyland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Tracy Gionta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Lawrence N Shulman
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
| | - Robert Schnoll
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Penn Medicine, Philadelphia, PA, USA
- Center for Interdisciplinary Research On Nicotine Addiction, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
4
|
Wu S, Liang D, Shi J, Li D, Liu Y, Hao Y, Shi M, Du X, He Y. Evaluation of a population-based breast cancer screening in North China. J Cancer Res Clin Oncol 2023; 149:10119-10130. [PMID: 37266660 PMCID: PMC10423103 DOI: 10.1007/s00432-023-04905-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 05/20/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND Despite mammography-based screening for breast cancer has been conducted in many countries, there are still little data on participation and diagnostic yield in population-based breast cancer screening in China. METHODS We enrolled 151,973 eligible women from four cities in Hebei Province within the period 2013-2021 and followed up until December 31, 2021. Participants aged 40-74 who assessed as high risk were invited to undergo breast ultrasound and mammography examination. Overall and group-specific participation rates were calculated. Multivariable analyses were used to estimate the factors associated with participation rates. The diagnostic yield of both screening and no screening groups was calculated. We further analyzed the stage distribution and molecular subtype of breast cancer cases by different modes of cancer detection. RESULTS A total of 42,547 participants were evaluated to be high risk of breast cancer. Among them, 23,009 subjects undertook screening services, with participation rate of 54.08%. Multivariable logistic regression model showed that aged 45-64, high education level, postmenopausal, current smoking, alcohol consumption, family history of breast cancer, and benign breast disease were associated with increased participation of screening. After median follow-up of 3.79 years, there were 456 breast cancer diagnoses of which 65 were screen-detected breast cancers (SBCs), 27 were interval breast cancers (IBCs), 68 were no screening cancers, and 296 were cancers detected outside the screening program. Among them, 92 participants in the screening group (0.40%) and 364 in the non-screening group (0.28%) had breast cancer detected, which resulted in an odds ratio of 1.42 (95% CI 1.13-1.78; P = 0.003). We observed a higher detection rate of breast cancer in the screening group, with ORs of 2.42 (95% CI 1.72-3.41) for early stage (stages 0-I) and 2.12 (95% CI 1.26-3.54) for luminal A subtype. SBCs had higher proportion of early stage (71.93%) and luminal A subtype (47.22%) than other groups. CONCLUSIONS The significant differences in breast cancer diagnosis between the screening and non-screening group imply an urgent need for increased breast cancer awareness and early detection in China.
Collapse
Affiliation(s)
- Siqi Wu
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Di Liang
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Jin Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Daojuan Li
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yanyu Liu
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yahui Hao
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Miaomiao Shi
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Xinyu Du
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China
| | - Yutong He
- Cancer Institute, The Fourth Hospital of Hebei Medical University and Hebei Tumor Hospital, No. 12 Jian Kang Road, Changan District, Shijiazhuang, 050011, Hebei, China.
| |
Collapse
|
5
|
Kou K, Cameron J, Youl P, Pyke C, Chambers S, Dunn J, Aitken JF, Baade PD. Severity and risk factors of interval breast cancer in Queensland, Australia: a population-based study. Breast Cancer 2023; 30:466-477. [PMID: 36809492 PMCID: PMC10119209 DOI: 10.1007/s12282-023-01439-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Interval breast cancers (BC) are those diagnosed within 24 months of a negative mammogram. This study estimates the odds of being diagnosed with high-severity BC among screen-detected, interval, and other symptom-detected BC (no screening history within 2 years); and explores factors associated with being diagnosed with interval BC. METHODS Telephone interviews and self-administered questionnaires were conducted among women (n = 3,326) diagnosed with BC in 2010-2013 in Queensland. Respondents were categorised into screen-detected, interval, and other symptom-detected BCs. Data were analysed using logistic regressions with multiple imputation. RESULTS Compared with screen-detected BC, interval BC had higher odds of late-stage (OR = 3.50, 2.9-4.3), high-grade (OR = 2.36, 1.9-2.9) and triple-negative cancers (OR = 2.55, 1.9-3.5). Compared with other symptom-detected BC, interval BC had lower odds of late stage (OR = 0.75, 0.6-0.9), but higher odds of triple-negative cancers (OR = 1.68, 1.2-2.3). Among women who had a negative mammogram (n = 2,145), 69.8% were diagnosed at their next mammogram, while 30.2% were diagnosed with an interval cancer. Those with an interval cancer were more likely to have healthy weight (OR = 1.37, 1.1-1.7), received hormone replacement therapy (2-10 years: OR = 1.33, 1.0-1.7; > 10 years: OR = 1.55, 1.1-2.2), conducted monthly breast self-examinations (BSE) (OR = 1.66, 1.2-2.3) and had previous mammogram in a public facility (OR = 1.52, 1.2-2.0). CONCLUSION These results highlight the benefits of screening even among those with an interval cancer. Women-conducted BSE were more likely to have interval BC which may reflect their increased ability to notice symptoms between screening intervals.
Collapse
Affiliation(s)
- Kou Kou
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia
| | - Jessica Cameron
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Philippa Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Woolloongabba, Australia
| | - Chris Pyke
- Mater Hospitals South Brisbane, Brisbane, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jeff Dunn
- Prostate Cancer Foundation of Australia, Sydney, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - Peter D Baade
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia. .,Centre for Data Science, Faculty of Science, Queensland University of Technology, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia.
| |
Collapse
|
6
|
In-depth Retrospective Review of Originally Negative Screening Mammograms from Women with Confirmed Breast Cancer. J Belg Soc Radiol 2022; 106:108. [DOI: 10.5334/jbsr.2796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
|
7
|
Fasano GA, Bayard S, Chen Y, Varella L, Cigler T, Bensenhaver J, Simmons R, Swistel A, Marti J, Moore A, Andreopoulou E, Ng J, Brandmaier A, Formenti S, Ali H, Davis M, Newman L. Benefit of adjuvant chemotherapy in node-negative T1a versus T1b and T1c triple-negative breast cancer. Breast Cancer Res Treat 2022; 192:163-173. [PMID: 35022867 DOI: 10.1007/s10549-021-06481-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 12/03/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE National comprehensive cancer network guidelines recommend delivery of adjuvant chemotherapy in node-negative triple-negative breast cancer (TNBC) if the tumor is > 1 cm and consideration of adjuvant chemotherapy for T1b but not T1a disease. These recommendations are based upon sparse data on the role of adjuvant chemotherapy in T1a and T1b node-negative TNBC. Our objective was to clarify the benefits of chemotherapy for patients with T1N0 TNBC, stratified by tumor size. METHODS We performed a retrospective analysis of survival outcomes of TNBC patients at two academic institutions in the United States from 1999 to 2018. Primary tumor size, histology, and nodal status were based upon surgical pathology. The Kaplan-Meier plot and 5-year unadjusted survival probability were evaluated. RESULTS Among 282 T1N0 TNBC cases, the status of adjuvant chemotherapy was known for 258. Mean follow-up was 5.3 years. Adjuvant chemotherapy was delivered to 30.5% of T1a, 64.7% T1b, and 83.9% T1c (p < 0.0001). On multivariable analysis, factors associated with delivery of adjuvant chemotherapy were tumor size and grade 3 disease. Improved overall survival was associated with use of chemotherapy in patients with T1c disease (93.2% vs. 75.2% p = 0.008) but not T1a (100% vs. 100% p = 0.3778) or T1b (100% vs. 95.8% p = 0.2362) disease. CONCLUSION Our data support current guidelines indicating benefit from adjuvant chemotherapy in node-negative TNBC associated with T1c tumors but excellent outcomes were observed in the cases of T1a and T1b disease, regardless of whether adjuvant chemotherapy was delivered.
Collapse
Affiliation(s)
- Genevieve A Fasano
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Solange Bayard
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Yalei Chen
- Department of Public Health Sciences, Henry Ford Health System, Detroit, MI, USA
| | - Leticia Varella
- Department of Medical Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Tessa Cigler
- Department of Medical Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | | | - Rache Simmons
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Alexander Swistel
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Jennifer Marti
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Anne Moore
- Department of Medical Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Eleni Andreopoulou
- Department of Medical Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - John Ng
- Department of Radiation Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Andrew Brandmaier
- Department of Radiation Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Silvia Formenti
- Department of Radiation Oncology, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Haythem Ali
- Department of Surgery, Henry Ford Health System, Detroit, MI, USA
| | - Melissa Davis
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA
| | - Lisa Newman
- Department of Surgery, New York Presbyterian - Weill Cornell Medicine, New York, NY, USA.
| |
Collapse
|
8
|
Hovda T, Hoff SR, Larsen M, Romundstad L, Sahlberg KK, Hofvind S. True and Missed Interval Cancer in Organized Mammographic Screening: A Retrospective Review Study of Diagnostic and Prior Screening Mammograms. Acad Radiol 2022; 29 Suppl 1:S180-S191. [PMID: 33926794 DOI: 10.1016/j.acra.2021.03.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 01/22/2023]
Abstract
RATIONALE AND OBJECTIVES To explore radiological aspects of interval breast cancer in a population-based screening program. MATERIALS AND METHODS We performed a consensus-based informed review of mammograms from diagnosis and prior screening from women diagnosed with interval cancer 2004-2016 in BreastScreen Norway. Cases were classified as true (no findings on prior screening mammograms), occult (no findings at screening or diagnosis), minimal signs (minor/non-specific findings) and missed (obvious findings). We analyzed mammographic findings, density, time since prior screening, and histopathological characteristics between the classification groups. RESULTS The study included 1010 interval cancer cases. Mean age at diagnosis was 61 years (SD = 6), mean time between screening and diagnosis 14 months (SD = 7). A total of 48% (479/1010) were classified as true or occult, 28% (285/1010) as minimal signs and 24% (246/1010) as missed. We observed no differences in mammographic density between the groups, except from a higher percentage of dense breasts in women with occult cancer. Among cancers classified as missed, about 1/3 were masses and 1/3 asymmetries at prior screening. True interval cancers were diagnosed later in the screening interval than the other classification categories. No differences in histopathological characteristics were observed between true, minimal signs and missed cases. CONCLUSION In an informed review, 24% of the interval cancers were classified as missed based on visibility and mammographic findings on prior screening mammograms. Three out of four true interval cancers were diagnosed in the second year of the screening interval. We observed no statistical differences in histopathological characteristics between true and missed interval cancers.
Collapse
Affiliation(s)
- Tone Hovda
- Department of Radiology, Vestre Viken Hospital Trust, PO Box 800, 3004 Drammen, Norway; Institute of Clinical Medicine, University of Oslo, PO Box 1171 Blindern, 0318 Oslo, Norway
| | - Solveig Roth Hoff
- Department of Radiology, Ålesund hospital, Møre og Romsdal Hospital Trust, Åsehaugen 5, 6017 Ålesund, Norway; NTNU, Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, PO Box 8905, 7491 Trondheim, Norway
| | - Marthe Larsen
- Section for breast cancer screening, Cancer Registry of Norway, PO Box 5313 Majorstuen, 0304 Oslo, Norway
| | - Linda Romundstad
- Department of Radiology, Vestre Viken Hospital Trust, PO Box 800, 3004 Drammen, Norway
| | - Kristine Kleivi Sahlberg
- Department of Research and Innovation, Vestre Viken Hospital Trust, PO Box 800, 3004 Drammen, Norway; Department of Tumor Biology, Institute for Cancer Research, Oslo University Hospital Trust, PO Box 4950, 0424 Oslo, Norway
| | - Solveig Hofvind
- Faculty of Health Science, Oslo Metropolitan University, PO Box 4 St. Olavs plass, 0130 Oslo, Norway.
| |
Collapse
|
9
|
Bertrand C, Bihan-Benjamin CL, Molinié F, Rogel A, Méric JB, Ifrah N, Bousquet PJ. Care pathway of women with interval breast cancer in 2016, based on medico-administrative data. Clin Breast Cancer 2021; 22:e718-e726. [DOI: 10.1016/j.clbc.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 10/26/2021] [Accepted: 12/05/2021] [Indexed: 11/16/2022]
|
10
|
Hernández-García M, Molina-Barceló A, Vanaclocha-Espi M, Zurriaga Ó, Pérez-Gómez B, Aragonés N, Amiano P, Altzibar JM, Castaño-Vinyals G, Sala M, Ederra M, Martín V, Gómez-Acebo I, Vidal C, Tardón A, Marcos-Gragera R, Pollán M, Kogevinas M, Salas D. Differences in breast cancer-risk factors between screen-detected and non-screen-detected cases (MCC-Spain study). Cancer Causes Control 2021; 33:125-136. [PMID: 34817770 PMCID: PMC8739309 DOI: 10.1007/s10552-021-01511-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 10/15/2021] [Indexed: 12/14/2022]
Abstract
Purpose The variation in breast cancer (BC)-risk factor associations between screen-detected (SD) and non-screen-detected (NSD) tumors has been poorly studied, despite the interest of this aspect in risk assessment and prevention. This study analyzes the differences in breast cancer-risk factor associations according to detection method and tumor phenotype in Spanish women aged between 50 and 69. Methods We examined 900 BC cases and 896 controls aged between 50 and 69, recruited in the multicase–control MCC-Spain study. With regard to the cases, 460 were detected by screening mammography, whereas 144 were diagnosed by other means. By tumor phenotype, 591 were HR+, 153 were HER2+, and 58 were TN. Lifestyle, reproductive factors, family history of BC, and tumor characteristics were analyzed. Logistic regression models were used to compare cases vs. controls and SD vs. NSD cases. Multinomial regression models (controls used as a reference) were adjusted for case analysis according to phenotype and detection method. Results TN was associated with a lower risk of SD BC (OR 0.30 IC 0.10–0.89), as were intermediate (OR 0.18 IC 0.07–0.44) and advanced stages at diagnosis (OR 0.11 IC 0.03–0.34). Nulliparity in postmenopausal women and age at menopause were related to an increased risk of SD BC (OR 1.60 IC 1.08–2.36; OR 1.48 IC 1.09–2.00, respectively). Nulliparity in postmenopausal women was associated with a higher risk of HR+ (OR 1.66 IC 1.15–2.40). Age at menopause was related to a greater risk of HR+ (OR 1.60 IC 1.22–2.11) and HER2+ (OR 1.59 IC 1.03–2.45) tumors. Conclusion Reproductive risk factors are associated with SD BC, as are HR+ tumors. Differences in BC-risk factor associations according to detection method may be related to prevailing phenotypes among categories. Supplementary Information The online version contains supplementary material available at 10.1007/s10552-021-01511-4.
Collapse
Affiliation(s)
- Marta Hernández-García
- Cancer and Public Health Area, Foundation for the Promotion of Health and Biomedical Research of Valencia Region(FISABIO), Avda. Catalunya 21, 46020, Valencia, Spain
| | - Ana Molina-Barceló
- Cancer and Public Health Area, Foundation for the Promotion of Health and Biomedical Research of Valencia Region(FISABIO), Avda. Catalunya 21, 46020, Valencia, Spain.
| | - Mercedes Vanaclocha-Espi
- Cancer and Public Health Area, Foundation for the Promotion of Health and Biomedical Research of Valencia Region(FISABIO), Avda. Catalunya 21, 46020, Valencia, Spain
| | - Óscar Zurriaga
- Preventive Medicine and Public Health, Food Sciences, Toxicology and Forensic Medicine Department, University of Valencia, Avda. Vicent Andrés Estellés, s/n, 46100, Burjassot, Valencia, Spain
- Joint Research Unit on Rare Diseases, FISABIO-UVEG, Avda. Catalunya 21, 46020, Valencia, Spain
- Directorate General of Public Health, Avda. Catalunya 21, 46020, Valencia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Beatriz Pérez-Gómez
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Department of Epidemiology of Chronic Diseases, National Center of Epidemiology, Carlos III Health Institute (ISCIII), Avda. Monforte de Lemos 5, 28029, Madrid, Spain
| | - Nuria Aragonés
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology Section, Public Health Division, Department of Health of Madrid, C/San Martín de Porres, 6, 28035, Madrid, Spain
| | - Pilar Amiano
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, Doctor Begiristain, s/n, 20014, San Sebastián, Spain
- Sub Directorate for Public Health and Addictions of Gipuzkoa, Ministry of Health of the Basque Government, 2013, San Sebastian, Spain
| | - Jone M Altzibar
- Epidemiology of Chronic and Communicable Diseases Group, Biodonostia Health Research Institute, Doctor Begiristain, s/n, 20014, San Sebastián, Spain
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
| | - Gemma Castaño-Vinyals
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain
| | - María Sala
- IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - María Ederra
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Navarra Public Health Institute, C/ Leyre, 15, 31003, Navarra, Spain
- IdiSNA, Navarra Institute for Health Research, C/Irunlarrea, 3, 31008, Pamplona, Spain
| | - Vicente Martín
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- The Research Group in Gene - Environment and Health Interactions (GIIGAS), Biomedicine Institute (IBIOMED), University of León, Vegazana Campus, s/n, 24071, León, Spain
| | - Inés Gómez-Acebo
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Cantabria University- IDIVAL, C/Cardenal Herrera Oria, s/n, Santander, 39011, Cantabria, Spain
| | - Carmen Vidal
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Cancer Screening Unit, Catalan Institute of Oncology, Duran I Reynals Hospital, Avda. de La Gran Via de L'Hospitalet, 199-203, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Program, Bellvitge Biomedical Research Institute, Avda. de La Granvia de L'Hospitalet, 199, L'Hospitalet de Llobregat, 08908, Barcelona, Spain
| | - Adonina Tardón
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Oncology Institute (IUOPA), University of Oviedo, Edificio Santiago Gascón, Campus El Cristo B, 33006, Oviedo, Spain
| | - Rafael Marcos-Gragera
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology. Sant Ponç, Avda de França, 0, 17007, Girona, Spain
- Descriptive Epidemiology, Genetics and Cancer Prevention Group, [Girona Biomedical Research Institute] IDIBGI, C/ del Dr. Castany, s/n, Salt, 17190, Girona, Spain
| | - Marina Pollán
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- National Center of Epidemiology Directorate, Carlos III Health Institute (ISCIII), Avda. Monforte de Lemos 5, 28029, Madrid, Spain
| | - Manolis Kogevinas
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- ISGlobal, Barcelona Institute for Global Health, Doctor Aiguader 88, 08003, Barcelona, Spain
- IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Plaça de la Mercè, 10-12, 08002, Barcelona, Spain
| | - Dolores Salas
- Cancer and Public Health Area, Foundation for the Promotion of Health and Biomedical Research of Valencia Region(FISABIO), Avda. Catalunya 21, 46020, Valencia, Spain
- Directorate General of Public Health, Avda. Catalunya 21, 46020, Valencia, Spain
- Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| |
Collapse
|
11
|
The Role of Screening Mammography in Addressing Disparities in Breast Cancer Diagnosis, Treatment, and Outcomes. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
12
|
Alanko J, Tanner M, Vanninen R, Auvinen A, Isola J. Triple-negative and HER2-positive breast cancers found by mammography screening show excellent prognosis. Breast Cancer Res Treat 2021; 187:267-274. [PMID: 33420595 PMCID: PMC8062374 DOI: 10.1007/s10549-020-06060-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/15/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Our purpose was to explore the prognosis of aggressive breast cancers of the HER2 oncogene amplification (HER2 +) and triple-negative (TN) subtypes detected by screening, as well as the prognosis of interval cancers (clinically due to symptoms between screening rounds) and cancers in screening nonparticipants. METHODS The study population comprised of 823 breast cancers in women aged 50-69 years from 2006-2014. Of these, 572 were found by screening mammography (69%), 170 were diagnosed between the screening rounds (21%), and 81 were diagnosed in women who did not participate in the screening program (10%). RESULTS The majority of all HER2 + (59%) and TN cancers (57%) in this age group were detected by screening. Screen-detected HER2 + tumors were small (median 12 mm), and node-negative (84%). During a median follow-up of eight years, the distant disease-free survival of screen-detected HER2 + and TN cancers was better than that of interval and nonparticipant cancers (age-adjusted HR = 0.16, 95% CI 0.03-0.81 and HR = 0.09, 95% CI 0.01-0.79, respectively). In nonparticipants, the distant disease-free survival of these cancers was worse than in participants (age-adjusted HR = 2.52, 95% CI 0.63-10.11 and HR = 5.30, 95% 1.16-24.29, respectively). CONCLUSION In the 50-69 age group, the majority of HER2 + and TN cancers can be found by a quality assured population-based mammography screening. Despite their generally aggressive behavior, after a median follow-up of 8 years, distant disease-free survival was over 90% of these cancers detected by screening. The worst prognosis of these cancers was in women who did not participate in screening.
Collapse
Affiliation(s)
- Johanna Alanko
- Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Screening Clinic of Terveystalo, Tampere University, Tampere, Finland.
| | - Minna Tanner
- Department of Oncology, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, School of Medicine, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - Jorma Isola
- Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Jilab Inc., Tampere University, Tampere, Finland
| |
Collapse
|
13
|
Corradini AG, Cremonini A, Cattani MG, Cucchi MC, Saguatti G, Baldissera A, Mura A, Ciabatti S, Foschini MP. Which type of cancer is detected in breast screening programs? Review of the literature with focus on the most frequent histological features. Pathologica 2021; 113:85-94. [PMID: 34042090 PMCID: PMC8167395 DOI: 10.32074/1591-951x-123] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/12/2020] [Indexed: 12/20/2022] Open
Abstract
Breast cancer is the most frequent type of cancer affecting female patients. The introduction of breast cancer screening programs led to a substantial reduction of mortality from breast cancer. Nevertheless, doubts are being raised on the real efficacy of breast screening programs. The aim of the present paper is to review the main pathological type of cancers detected in breast cancer screening programs. Specifically, attention will be given to: in situ carcinoma, invasive carcinoma histotypes and interval cancer.
Collapse
Affiliation(s)
- Angelo G Corradini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Anna Cremonini
- Unit of Anatomic Pathology, Department of Oncology, Bellaria Hospital, Bologna, Italy
| | - Maria G Cattani
- Unit of Anatomic Pathology, Department of Oncology, Bellaria Hospital, Bologna, Italy
| | - Maria C Cucchi
- Unit of Breast Surgery, Department of Oncology, Bellaria Hospital, Bologna Italy
| | - Gianni Saguatti
- Unit of Senology, Department of Oncology, Bellaria Hospital, Bologna, Italy
| | | | - Antonella Mura
- Department of Medical Oncology, Azienda USL, Bologna, Italy; IRCCS Institute of Neurological Sciences, Bologna, Italy
| | | | - Maria P Foschini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy.,Unit of Anatomic Pathology, Department of Oncology, Bellaria Hospital, Bologna, Italy
| |
Collapse
|
14
|
Cortet M. Sous-types moléculaires de cancers du sein : quels enjeux pour faire évoluer le dépistage en France. IMAGERIE DE LA FEMME 2021. [DOI: 10.1016/j.femme.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
15
|
Chen Y, Susick L, Davis M, Bensenhaver J, Nathanson SD, Burns J, Newman LA. Evaluation of Triple-Negative Breast Cancer Early Detection via Mammography Screening and Outcomes in African American and White American Patients. JAMA Surg 2021; 155:440-442. [PMID: 32074266 DOI: 10.1001/jamasurg.2019.6032] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Yalei Chen
- Henry Ford Cancer Institute, Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Laura Susick
- Henry Ford Cancer Institute, Department of Public Health Sciences, Henry Ford Health System, Detroit, Michigan
| | - Melissa Davis
- Department of Surgery, Weill Cornell Medicine, New York, New York
| | - Jessica Bensenhaver
- Henry Ford Cancer Institute, Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - S David Nathanson
- Henry Ford Cancer Institute, Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Jessica Burns
- Henry Ford Cancer Institute, Department of Surgery, Henry Ford Health System, Detroit, Michigan
| | - Lisa A Newman
- Department of Surgery, Weill Cornell Medicine, New York, New York
| |
Collapse
|
16
|
Abstract
ABSTRACT Triple-negative breast cancer accounted for 12% of breast cancers diagnosed in the United States from 2012 to 2016, with a 5-year survival 8% to 16% lower than hormone receptor-positive disease. However, preventive and screening strategies remain tailored to the demographics of less lethal luminal cancers. This review examines the ethnic, genetic, and modifiable risk factors associated with triple-negative breast cancer, which providers must recognize to address the societal disparities of this deadly disease. Most notable is that triple-negative cancers disproportionately affect African American women and carriers of germline BRCA and PALB2 mutations. Even controlling for treatment delays, stage, and socioeconomic factors, African Americans with triple-negative breast cancer remain nearly twice as likely to die of their disease. To level the playing field, we must integrate genomic predictors of disease and epidemiologic characteristics of molecular breast cancer subtypes to provide personalized risk assessment, screening, and treatment for each patient.
Collapse
|
17
|
Lee JS, Kim HA, Cho SH, Lee HB, Park MH, Jeong J, Park HK, Oh M, Yi O. Five-Year Overall Survival of Interval Breast Cancers is Better than Non- Interval Cancers from Korean Breast Cancer Registry. Asian Pac J Cancer Prev 2019; 20:1717-1726. [PMID: 31244292 PMCID: PMC7021595 DOI: 10.31557/apjcp.2019.20.6.1717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 04/05/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: Interval breast cancer (IC) is a limitation of breast cancer screening. We investigated data from a large scaled breast cancer dataset of patients with breast cancer who underwent breast cancer screening in order to recapitulate the overall survival (OS) of patients with ICs compared to those with non-ICs. Methods: A total of 27,141 patients in the Korean breast cancer registry with breast cancer who had ever participated in biannual national breast cancer screening programs between 2009 and 2013 were enrolled. We compared the social, pregnancy-associated, and pathologic characteristics between the IC and non-IC groups and identified the significant prognostic factors for OS. Results: The proportion of ICs was 1.3% (370/27,141) in this study population. ICs were correlated with age 45-55 years at diagnosis, higher levels of education, early menopause (<50 years), hormone replacement therapy, specific provinces (Kangwon, Kyungnam, Jeju, and Dae-jeon), and family history of breast cancer. Low-to-intermediate nuclear grade, early stage (stage 0-I), and low Ki-67 level were also correlated with IC proportion. Non-ICs were associated with an increased risk of five-year mortality (hazard ratio [HR] 7.4; 95% confidence interval [CI]:1.85-29.66; p = 0.005) compared to ICs. Lymph node metastasis, residence (Kyung-nam province), low education status, high histologic grade, and asymptomatic cancers increased the HR of five-year OS. Conclusion: ICs occurred unequally in specific province and relatively high-educated women in Korea. They were also diagnosed with early-stage breast cancer with a favorable recurrence risk, and their outcome was better than those of patients with other breast cancers in breast cancer screening.
Collapse
Affiliation(s)
- Jung Sun Lee
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Korea.
| | - Hyun-Ah Kim
- Department of Surgery, Korea Cancer Center Hospital, Korea Institute of Radiological and Medical Sciences, Seoul, Korea
| | - Se-Heon Cho
- Department of Surgery, College of Medicine, Dong- A University, Busan, Korea
| | - Han-Byoel Lee
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Min Ho Park
- Department of Surgery, Chonnam National University Hwasun Hospital, Chonnam, Korea
| | - Joon Jeong
- Department of Surgery, Gangnam Severance Hospital, Yonsei University Medical College, Seoul, Korea
| | - Heung Kyu Park
- Department of Surgery, Breast Cancer Center, Gachon University Gill Medical Center, Incheon, Korea
| | - Minkyung Oh
- Department of Pharmacology, Inje University College of medicine, Clinical Trial Center, Inje University Busan Paik Hospital, Busan, Korea
| | - Onvox Yi
- Department of Surgery, Dongnam Institution of Radiological and Medical Science, Busan, Korea
| |
Collapse
|
18
|
Lawrenson R, Lao C, Jacobson G, Seneviratne S, Scott N, Sarfati D, Elwood M, Campbell I. Outcomes in different ethnic groups of New Zealand patients with screen-detected vs. non-screen-detected breast cancer. J Med Screen 2019; 26:197-203. [PMID: 31068074 DOI: 10.1177/0969141319844801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare characteristics and survival of New Zealand European, Māori, and Pacific women with screen-detected vs. non-screen-detected breast cancer. Methods Women aged 45–69 diagnosed with invasive breast cancer between January 2005 and May 2013 were identified from the Waikato and Auckland Breast Cancer Registries. Patient demographics and tumour characteristics were described by detection mode and ethnicity. Kaplan–Meier method was used to estimate the five-year breast cancer-specific survival of women with stage I–III breast cancer by ethnicity and detection mode. Results Women with screen-detected cancers were older, had smaller tumours, fewer stage IV (0.8% vs. 7.6%), fewer high grade (16.8% vs. 39.0%), and fewer lymph node positive diseases (26.3% vs. 51.5%) than women with non-screen-detected cancers. There were more Luminal A (70.0% vs. 54.0%), fewer human epidermal growth factor receptor 2 positive non-Luminal (4.4% vs. 8.8%), and fewer triple negative cases (7.0% vs. 13.8%) in screen-detected than non-screen-detected cancers. If not screen detected, 22.7% of breast cancers in Pacific women were stage IV compared with 2.4% if screen detected. If not screen detected, the five-year breast cancer-specific survival was 91.1% for New Zealand European women, 84.2% for Māori women, and 80.2% for Pacific women (p-value <0.001). For screen-detected breast cancer, survival between different ethnic groups was similar. Conclusions Breast cancers detected through screening are diagnosed at an earlier stage and have a greater proportion of subtypes, with better outcome. Variations in survival for Māori and Pacific women are only found in women with non-screen-detected breast cancer.
Collapse
Affiliation(s)
- Ross Lawrenson
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Chunhuan Lao
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Gregory Jacobson
- Department of Biological Science, The University of Waikato, Hamilton, New Zealand
| | | | - Nina Scott
- Waikato District Health Board, Hamilton, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Mark Elwood
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Ian Campbell
- School of Medicine, The University of Auckland, Auckland, New Zealand
| |
Collapse
|
19
|
Cheasley D, Li N, Rowley SM, Elder K, Mann GB, Loi S, Savas P, Goode DL, Kader T, Zethoven M, Semple T, Fox SB, Pang JM, Byrne D, Devereux L, Nickson C, Procopio P, Lee G, Hughes S, Saunders H, Fujihara KM, Kuykhoven K, Connaughton J, James PA, Gorringe KL, Campbell IG. Molecular comparison of interval and screen-detected breast cancers. J Pathol 2019; 248:243-252. [PMID: 30746706 DOI: 10.1002/path.5251] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/15/2019] [Accepted: 01/30/2019] [Indexed: 01/22/2023]
Abstract
Breast cancer (BC) diagnosed after a negative mammogram but prior to the next screening episode is termed an 'interval BC' (IBC). Understanding the molecular differences between IBC and screen-detected BCs (SDBC) could improve mammographic screening and management options. Therefore, we assessed both germline and somatic genomic aberrations in a prospective cohort. Utilising the Lifepool cohort of >54 000 women attending mammographic screening programs, 930 BC cases with screening status were identified (726 SDBC and 204 IBC). Clinico-pathological and family history information were recorded. Germline and tumour DNA were collected where available and sequenced for BC predisposition and driver gene mutations. Compared to SDBC, IBCs were significantly associated with a younger age at diagnosis and tumour characteristics associated with worse prognosis. Germline DNA assessment of BC cases that developed post-enrolment (276 SDBCs and 77 IBCs) for pathogenic mutations in 12 hereditary BC predisposition genes identified 8 carriers (2.27%). The germline mutation frequency was higher in IBC versus SDBC, although not statistically significant (3.90% versus 1.81%, p = 0.174). Comparing somatic genetic features of IBC and SDBC matched for grade, histological subtype and hormone receptor revealed no significant differences, with the exception of higher homologous recombination deficiency scores in IBC, and copy number changes on chromosome Xq in triple negative SDBCs. Our data demonstrates that while IBCs are clinically more aggressive than SDBC, when matched for confounding clinico-pathological features they do not represent a unique molecular class of invasive BC, but could be a consequence of timing of tumour initiation and mammographic screening. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.
Collapse
Affiliation(s)
- Dane Cheasley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Na Li
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Simone M Rowley
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kenneth Elder
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia.,The Edinburgh Breast Unit, Western General Hospital, Edinburgh, UK
| | - G Bruce Mann
- Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.,The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia
| | - Sherene Loi
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Peter Savas
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - David L Goode
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Tanjina Kader
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Magnus Zethoven
- Bioinformatics Consulting Core, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Tim Semple
- Genomics Core, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Stephen B Fox
- Department of Pathology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia
| | - Jia-Min Pang
- Department of Pathology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia
| | - David Byrne
- Department of Pathology, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne, Victoria, Australia
| | - Lisa Devereux
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Lifepool, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carolyn Nickson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Pietro Procopio
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grant Lee
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Siobhan Hughes
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Hugo Saunders
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Kenji M Fujihara
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Keilly Kuykhoven
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Jacquie Connaughton
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Paul A James
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Kylie L Gorringe
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.,Cancer Genetics and Genomics Program, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Ian G Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
20
|
Tumour characteristics of bilateral screen-detected cancers and bilateral interval cancers in women participating at biennial screening mammography. Eur J Radiol 2018; 108:215-221. [PMID: 30396659 DOI: 10.1016/j.ejrad.2018.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Unilateral interval breast cancers show less favourable prognostic features than unilateral screen-detected cancers, but data on tumour characteristics of bilateral interval cancers in a systematically screened population are sparse. Therefore, we compared tumour characteristics of bilateral interval cancers with those of bilateral screen-detected cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all recalled women and of all women who presented with interval breast cancer. In women with synchronous bilateral breast cancer, the tumour with the highest tumour stage was defined as the index cancer. For comparison of data between both groups Fisher exact test and Chi-square test were used. RESULTS Synchronous bilateral cancer was diagnosed in 2.2% of screen-detected cancers (64/2947) and in 3.2% of interval cancers (24/753) (P = 0.1). Index tumours of bilateral screen-detected cancers and interval cancers showed similar characteristics, except for a larger proportion of T-stage 2 or worse (T2+) cancers among interval cancers (16/24 (66.7%) versus 23/58 (39.7%) (P = 0.03). Index cancers, compared to contralateral cancers, were less frequently stage T1 in both bilateral screen-detected cancers and bilateral interval cancers (35/64 (60.3%) versus 40/64 (88.9%) (P = 0.001) and 8/24 (33.3%) versus 18/24 (85.7%) (P < 0.001), respectively). In bilateral screen-detected cancers, contralateral cancers were more often stage 1a-c (P < 0.001) compared to index cancers. In bilateral index cancers, index cancers were more often of the lobular subtype (P < 0.001). CONCLUSION Index cancers of bilateral screen-detected cancers and bilateral interval cancers show significant differences in tumour size, whereas nodal status, receptor status and final surgical treatment are comparable. In bilateral screen-detected cancer, index cancers had a significantly higher tumour stage. In bilateral screen-detected cancer, index cancers were more often the ductal invasive subtype compared to contralateral cancers.
Collapse
|
21
|
Panourgias E, Bourgioti C, Koureas A, Koutoulidis V, Metaxas G, Moulopoulos LA. MR imaging features and tumor biomarkers of screen-detected and non-screen detected breast cancers: preliminary results of a comparative study. Clin Imaging 2018; 52:350-355. [PMID: 30245390 DOI: 10.1016/j.clinimag.2018.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 07/30/2018] [Accepted: 08/14/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE To investigate differences in clinical features, MRI findings and tumor biomarker characteristics in screen-detected (SCD) and non-screendetected (NSCD) cancers. MATERIAL AND METHODS A total of 62 women (mean age, 48.4 years; range, 33-68 years) with biopsy confirmed breast cancer who underwent preoperative breast MRI were retrospectively evaluated by two expert radiologists. The women were divided into two groups according to the mode of cancer detection (Group A: screen- detected, Group B: non-screen/symptomatic cancer) and clinical, histopathological, MRI characteristics and biomarker features in each group were evaluated. RESULTS NSCD tumors had significantly greater size (3.5 cm vs. 2.1 cm) and Ki-67 expression (68.4% vs. 41.7%) in comparison to SCD cancers. NSCD cancers were less likely to have strongly positive progesterone receptors (Pr) and more likely to have Ki-67 > 15% or positive nodal status (47.4% vs. 8.3%). Increased breast density (ACR C and D: 78.9% vs. 50%ACR A and B) and intense background parenchymal enhancement (BPE, moderate/marked: 42.1% vs. 8.3% minimal/mild) were significantly more frequent in NSCD cases. CONCLUSION NSCD cancers had higher prevalence of poor prognostic characteristics in comparison to SCD tumors, including larger tumor size, higher Ki-67 index, and positive nodes. Increased fibroglandular tissue and intense BPE were both strongly associated with NSCD cancers, supporting their use as potential MR biomarkers in breast cancer risk models.
Collapse
Affiliation(s)
- Evangelia Panourgias
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vassilisis Sofias Ave., Athens 11528, Greece.
| | - Charis Bourgioti
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vassilisis Sofias Ave., Athens 11528, Greece
| | - Andreas Koureas
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vassilisis Sofias Ave., Athens 11528, Greece
| | - Vassilis Koutoulidis
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vassilisis Sofias Ave., Athens 11528, Greece.
| | - Georgios Metaxas
- 2nd Surgical Department, Helena Venizelou, General and Maternity District Hospital, 2 Helena Venizelou Square, Athens 115 21, Greece
| | - Lia Angela Moulopoulos
- Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Aretaieion Hospital, 76 Vassilisis Sofias Ave., Athens 11528, Greece
| |
Collapse
|
22
|
Is the high proportion of young age at breast cancer onset a unique feature of Asian breast cancer? Breast Cancer Res Treat 2018; 173:189-199. [DOI: 10.1007/s10549-018-4947-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 08/27/2018] [Indexed: 11/26/2022]
|
23
|
Screening status, tumour subtype, and breast cancer survival: a national population-based analysis. Breast Cancer Res Treat 2018; 172:133-142. [PMID: 30006795 DOI: 10.1007/s10549-018-4877-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE We examined whether demographic and tumour characteristics (including subtype) were different for women with breast cancer diagnosed via mammography screening compared with women with interval breast cancers, lapsed attenders of the screening programme and non-participants of the screening programme. In addition, we explored whether there were survival differences between the groups, taking into account lead time bias. METHODS We used linked data from National Cancer Registry Ireland and the national breast screening programme BreastCheck. Multinomial logistic regression was used to test the association of covariates with screening status. For survival analysis, we corrected the survival time for screen-detected cases for lead time bias, examined Kaplan-Meier curves and then used Cox regression to investigate differences in survival by screening status. RESULTS Subtype (HER2 over-expressing, triple negative), stage (III/IV), grade (poor), having co-morbidities, area of deprivation, smoking status and age were associated with having interval cancer or being a non-participant of the screening programme in the multivariable model. After correcting for lead time bias, and adjusting for variables associated with screening status, there was no evidence that risk of breast-cancer death for women with screen-detected cancer was different from women with interval cancer (HR = 0.76, 95% CI 0.56-1.03), non-participants (HR = 1.07, 95% CI 0.84-1.37) and lapsed attenders (HR = 0.97, 95% CI 0.65-1.45). CONCLUSIONS Screening status was strongly associated with subtype and this association persisted after adjustment for covariates including tumour stage and grade. After correcting for lead-time bias and adjusting for stage, subtype, grade and socio-demographic variables, no significant survival difference was demonstrated for women with screen-detected cancer in the 5-year period post-diagnosis. Since we are adjusting for stage, subtype and other variables, the lack of difference between these groups would be expected but has not been demonstrated in studies which do not correct for lead time bias.
Collapse
|
24
|
Caughran J, Braun TM, Breslin TM, Smith DR, Kreinbrink JL, Parish GK, Davis AT, Bacon-Baguley TA, Silver SM, Henry NL. The Effect of the 2009 USPSTF breast cancer screening recommendations on breast cancer in Michigan: A longitudinal study. Breast J 2018; 24:730-737. [PMID: 29785764 DOI: 10.1111/tbj.13034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 09/10/2017] [Accepted: 09/13/2017] [Indexed: 11/29/2022]
Abstract
In 2009, the revised United States Preventive Services Task Force (USPSTF) guidelines recommended against routine screening mammography for women age 40-49 years and against teaching self-breast examinations (SBE). The aim of this study was to analyze whether breast cancer method of presentation changed following the 2009 USPSTF screening recommendations in a large Michigan cohort. Data were collected on women with newly diagnosed stage 0-III breast cancer participating in the Michigan Breast Oncology Quality Initiative (MiBOQI) registry at 25 statewide institutions from 2006 to 2015. Data included method of detection, cancer stage, treatment type, and patient demographics. In all, 30 008 women with breast cancer detected via mammogram or palpation with an average age of 60.1 years were included. 38% of invasive cancers were identified by palpation. Presentation with palpable findings decreased slightly over time, from 34.6% in 2006 to 28.9% in 2015 (P < .001). Over the 9-year period, there was no statistically significant change in rate of palpation-detected tumors for women age <50 years or ≥50 years (P = .27, .30, respectively). Younger women were more likely to present with palpable tumors compared to older women in a statewide registry. This rate did not increase following publication of the 2009 USPSTF breast cancer screening recommendations.
Collapse
Affiliation(s)
- Jamie Caughran
- Comprehensive Breast Center, Mercy Health Saint Mary's, Grand Rapids, MI, USA
| | - Tom M Braun
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Tara M Breslin
- Comprehensive Breast Program, Mercy Health St. Joseph, Ann Arbor, MI, USA
| | - Daniel R Smith
- Physician Assistant Studies, Grand Valley State University, Allendale, MI, USA
| | | | - Grace K Parish
- Physician Assistant Studies, Grand Valley State University, Allendale, MI, USA
| | - Alan T Davis
- Physician Assistant Studies, Grand Valley State University, Allendale, MI, USA
| | | | - Samuel M Silver
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Norah L Henry
- Division of Oncology, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
25
|
van Bommel RMG, Voogd AC, Nederend J, Setz-Pels W, Louwman MWJ, Strobbe LJ, Venderink D, Tjan-Heijnen VCG, Duijm LEM. Incidence and tumour characteristics of bilateral and unilateral interval breast cancers at screening mammography. Breast 2018; 38:101-106. [PMID: 29306176 DOI: 10.1016/j.breast.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/23/2017] [Accepted: 12/26/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Detected by screening mammography, bilateral breast cancer has a different pathological profile compared to unilateral breast cancer. We investigated the incidence of bilateral interval breast cancers and compared their characteristics with those of unilateral interval breast cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all referred women and of all women who presented with interval breast cancer. The tumour with the highest tumour stage (index cancer) was used for comparison with unilateral interval cancers. RESULTS A total of 753 interval cancers were detected, of which 24 (3.2%) were bilateral. Among the invasive interval cancers, bilateral cancers more frequently showed a lobular histology than unilateral cancers (37.5% (9/24) vs. 16.1% (111/691), P = .01). There is a trend towards a larger proportion of bilateral than unilateral interval cancers graded 1 (45.8% (11/24) vs. 27.8% (192/691), P = .08). There were no other statistically significant differences in tumour characteristics. Also, the proportion of interval cancers showing significant mammographic abnormalities at the latest screen was comparable for unilateral and bilateral interval cancers (23.0% vs. 25.0%, P = .9). DISCUSSION Bilateral interval cancers comprise a small proportion of all interval cancers. Except of a higher proportion of invasive lobular cancers and a more favourable histological grade of invasive cancers, tumour characteristics are comparable for bilateral and unilateral interval breast cancers.
Collapse
Affiliation(s)
- Rob M G van Bommel
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands
| |
Collapse
|