Reduction in rate of node metastases with breast screening: consistency of association with tumor size
- 23 December 2012
- journal article
- research article
- Published by Springer Science and Business Media LLC in Breast Cancer Research and Treatment
- Vol. 137 (3), 653-663
- https://doi.org/10.1007/s10549-012-2384-y
Abstract
Population screening has brought about changes in both the incidence and mortality rates of patients with breast cancer. Large numbers of small screen-detected tumors have inspired discussions about overdiagnosis based on potential biological differences between screen-detected and symptomatic cancers. In the current systematic review, we analyzed the relation and the interaction of tumor size and nodal status in correlation with screening. Smaller tumors were more frequently screen detected (pT1 78.5 %) than symptomatic (pT1 61.7 %, p < 0.001), with a RR of 1.6 (95 % CI 1.4–1.8, n = 41,209). In the screened population, pT1 tumors were also more frequent (68.5 vs 49.9 %, n = 51,171, p < 0.001). Positive lymph nodes were less frequent in screen-detected tumors (26.8 vs 46.3 %, n = 43,705, p < 0.001) as well as in screened populations as a whole (24.1 vs 44.9 %, n = 49,581, p < 0.001). The relation between size and nodal status was not different between the screen-detected and the symptomatic tumors [pT2+N+ OR 2.42 (95 % CI 1.69–3.48) vs OR 2.91 (95 % CI 2.41–3.51)], suggesting that biological differences, if present, are small. In this systematic review, we confirmed both the association of screening with smaller tumor size at presentation and the consequent reduction in lymph node metastases.Keywords
This publication has 47 references indexed in Scilit:
- Independent Prognostic Value of Screen Detection in Invasive Breast CancerJNCI Journal of the National Cancer Institute, 2011
- Phenotypic characterization and risk factors for interval breast cancers in a population-based breast cancer screening program in Barcelona, SpainCancer Causes & Control, 2010
- First Epidemiological Analysis of Breast Cancer Incidence and Tumor Characteristics after Implementation of Population-Based Digital Mammography ScreeningRöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2009
- Molecular characteristics of screen-detected vs symptomatic breast cancers and their impact on survivalBritish Journal of Cancer, 2009
- Overdiagnosis, Sojourn Time, and Sensitivity in the Copenhagen Mammography Screening ProgramThe Breast Journal, 2006
- Improvements in survival for women with breast cancer in Scotland between 1987 and 1993: impact of earlier diagnosis and changes in treatmentEuropean Journal of Cancer, 2004
- The frequency of breast cancer screening: results from the UKCCCR Randomised TrialEuropean Journal Of Cancer, 2002
- What modifies the relation between tumour size and lymph node metastases in T1 breast carcinomas?Journal of Clinical Pathology, 2000
- Predictors of axillary lymph node metastases in patients with T1 breast carcinomaCancer, 1997
- Mammographic screening for breast cancer. What cancers do we find?European Journal of Cancer, 1997