Tumor Characteristics Associated With Mammographic Detection of Breast Cancer in the Ontario Breast Screening Program
Open Access
- 3 May 2011
- journal article
- research article
- Published by Oxford University Press (OUP) in JNCI Journal of the National Cancer Institute
- Vol. 103 (12), 942-950
- https://doi.org/10.1093/jnci/djr138
Abstract
Background Few studies have compared the prognostic value of tumor characteristics by type of breast cancer diagnosed in the interval between mammographic screenings with screen-detected breast cancers. Methods We conducted a case–case study within the cohort of women (n = 431 480) in the Ontario Breast Screening Program who were aged 50 years and older and were screened between January 1, 1994, and December 31, 2002. Interval cancers, defined as breast cancers diagnosed within 24 months after a negative screening mammogram, were designated as true interval cancers (n = 288) or missed interval cancers (n = 87) if they were not identified at the time of screening but were identified in retrospect. Screen-detected breast cancers (n = 450) were selected to match interval cancers. Tumors were evaluated for stage, grade, mitotic index, histology, and expression of hormone receptors and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by conditional logistic regression. Results Both true and missed interval cancers were of higher stage and grade than matched screen-detected breast cancers. However, true interval cancers had a higher mitotic index (OR = 3.13, 95% CI = 1.81 to 5.42), a higher percentage of nonductal histology (OR = 1.94, 95% CI = 1.05 to 3.59), and were more likely to be both estrogen receptor–negative (OR = 2.09, 95% CI = 1.32 to 3.30) and progesterone receptor–negative (OR = 2.49, 95% CI = 1.68 to 3.70) compared with matched screen-detected tumors. Conclusions In this study, interval cancers were of higher stage and grade compared with screen-detected cancers. True interval cancers were more likely to have additional adverse prognostic features of estrogen and progesterone receptor negativity and nonductal morphology. The findings suggest a need for more sensitive screening modalities to detect true interval breast cancers and different approaches for early detection of fast-growing tumors.Keywords
This publication has 32 references indexed in Scilit:
- Aggressiveness of ‘true’ interval invasive ductal carcinomas of the breast in postmenopausal womenLaboratory Investigation, 2010
- Phenotypic characterization and risk factors for interval breast cancers in a population-based breast cancer screening program in Barcelona, SpainCancer Causes & Control, 2010
- Mammographic features and histopathological findings of interval breast cancersActa Radiologica, 2008
- Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trialsThe Lancet, 2005
- A study of interval breast cancer within the NHS breast screening programmeJournal of Clinical Pathology, 2000
- Interval carcinomas of the breast: A group with intermediate outcomeJournal of Surgical Oncology, 1996
- Histopathology and growth rate of interval breast carcinoma: Characterization of different subgroupsCancer, 1996
- Interval breast cancers in the Screening Mammography Program of British Columbia: analysis and classification.American Journal of Roentgenology, 1994
- pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long‐term follow‐upHistopathology, 1991
- Analysis of interval breast carcinomas in a randomized screening trial in StockholmBreast Cancer Research and Treatment, 1987