Abstract
The natural course of early breast cancer has changed as a result of the introduction of mammographic screening. The present aim was a prospective analysis of screen-detected and symptomatic operable breast cancers in the era of mammographic service screening. The mode of detection (screen-detected, symptomatic or interval cancer), the type of mammographic image and other characteristics (the invasive tumor size, histological tumor type, grade, nodal, hormone receptor and HER2 status and the presence of lymphovascular invasion) of 569 invasive breast cancers were studied. Screen-detected cancers were significantly more frequently of grade I, <10 mm of size and node-negative (p < 0.001, respectively). Symptomatic/interval cancers were significantly more frequently of grade 3, >20 mm of size (p < 0.001), and exhibited lymphovascular invasion (p = 0.001). Screening-detection of the tumor favored breast-conserving surgery, sentinel lymph node biopsy and the avoidance of chemotherapy (p < 0.001). Cancers associated with casting-type calcifications on the mammogram were typically of ductal type (p = 0.043), of grade 2–3, estrogen receptor and progesterone receptor-negative and HER2-positive (p < 0.001). Interval cancers occurred significantly more often at a younger age and remained mammographically occult as compared with other cancers. Mammographic screen-detected cancers demonstrate more favorable prognostic features, and need less extensive treatment than symptomatic or interval cancers. The mammographic appearance of the tumor reflects its biological behavior, and this should be considered in the management optimization.
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Tabar L, Fagerberg G, Duffy SW et al. (1989) The Swedish two-county trial of mammographic screening for breast cancer: recent results and calculation of benefit. J Epidemiol Community Health 43:107–114
Tabar L, Yeng M-F, Vitak B et al. (2003) Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening. Lancet 361:1405–1410
The Swedish Organised Service Screening Evaluation Group (2006) Reduction of breast cancer mortality from organised service screening with mammography: 1. Further confirmation with extended data. Cancer Epidemiol Biomarkers Prev 15:45–51
Miller AB, Baines C, To T et al. (1992) Canadian national breast screening study. 1. Breast cancer detection and death rates among women aged 40 to 49 years. CMAJ 147:1459–1476
Kerlikowske K, Grady D, Rubin SM et al. (1995) Efficacy of screening mammography. A meta-analysis. JAMA 273:149–154
Cronin KA, Feuer EJ, Clarke LD, et al. (2006) Impact of adjuvant therapy and mammography on U.S. mortality from 1975 to 2000. Comparison of mortality results from the CISNET breast cancer base case analysis. J Natl Cancer Inst 36:112–121
Moody-Ayers SY, Wells CK, Feinstein AR (2000) ”Benign” tumors and ”early detection” in mammography-screened patients of a natural cohort with breast cancer. Arch Intern Med 160:1109–1115
Klemi PJ, Joensuu H, Tikkanen S et al. (1992) Aggressiveness of breast cancers found with and without screening. Br Med J 304:467–469
Klemi PJ, Parvinen I, Pylkkanen L et al. (2003) Significant improvement in breast cancer survival through population-based mammography screening. Breast 12:308–313
Anttinen J, Kautiainen H, Kuopo T (2006) Role of mammography screening as a predictor of survival in postmenopausal breast cancer patients. Br J Cancer 94:147–151
Joensuu H, Lehtimäki T, Holli K et al. (2004) Risk for distant recurrence of breast cancer detected by mammography screening or other methods. JAMA 292:1064–1073
Shen Y, Yang Y, Inoues LYT et al. (2005) Role of detection method in predicting breast cancer survival: Analysis of randomized screening trials. J Natl Cancer Inst 97:1195–1203
Gill PG, Farshid G, Luke CG et al. (2005) Detection by screening mammography is a powerful independent predictor of survival in women diagnosed with breast cancer. Breast 13:15–22
Ernst MF, Voogd AC, Goebergh JWW et al. (2004) Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mammographic screening. Cancer 100:1337–1344
Tabar L, Dean PB, Kaufman CS et al. (2000) A new era in the diagnosis of breast cancer. Surg Oncol Clinics NA 9:233–277
Tabar L, Chen TH, Yen AM, et al. (2004) Mammographic tumor features can predict long-term outcomes reliably in women with 1–14-mm invasive breast carcinoma. Cancer 101:1745–1759
Thurfjell E, Thurfjell MG, Lindgren A (2001) Mammographic finding as predictor of survival in 1–9 mm invasive breast cancers. Worse prognosis for cases presenting as calcifications alone. Breast Cancer Res Treat 67:177–180
Alexander MC, Yankaskas BC, Biesemier KW (2006) Association of stellate mammographic pattern with survival in small invasive breast tumors. Am J Roentgenol 187:29–73
Peacock C, Given-Wilson RM, Duffy SW (2004) Mammographic casting-type calcification associated with small screen-detected invasive breast cancers: is this a reliable prognostic indicator? Clin Radiol 59:165–170
Pálka I, Ormándi K, Gaál S et al. (in press) Casting-type calcifications on the mammogram indicate a higher probability of early relapse and death among operable high-risk breast cancer patients. Acta Oncol
Perry NM (2001) Quality assurance in the diagnosis of breast disease. EUSOMA Working Party. Eur J Cancer 37:159–172
Ravdin PM, Siminoff LA, Davis GJ et al. (2001) Computer program to assist in making decisions about adjuvant therapy for women with early breast cancer. J Clin Oncol 19:980–991
Olivotto IA, Bajdik CD, Ravdin PM, et al. (2005) Population-based validation of the prognostic model ADJUVANT! for early breast cancer. J Clin Oncol 23:2716–2725
Porter PJ, El-Bastawissi AZ, Mandelson MT et al. (1999) Breast tumor characteristics as predictors of mammographic detection: Comparison of interval- and screen-detected cancers. J Natl Cancer Inst 91:2020–2028
Gilliland FD, Joste N, Stauber PM et al. (2000) Biologic characteristics of interval and screen-detected breast cancers. J Natl Cancer Inst 92:743–749
Crosier M, Scott D, Wilson RG et al. (1999) Differences in Ki67 and c-erbB2 expression between screen-detected and true interval breast cancers. Clin Cancer Res 5:2682–2688
Porter GJ, Evans AJ, Cornford EJ et al. (2007) Influence of mammographic parenchymal pattern in screen-detected and interval invasive breast cancers on pathologic features, mammographic features, and patient survival. Am J Roentgenol 188:676–683
Porter GJ, Evans AJ, Burrell HC et al. (2007) NHSBSP type 1 interval cancers: a scientifically valid grouping? Clin Radiol 62:262–267
Zunzunegui RG, Chung MA, Oruwari J et al. (2003) Casting-type calcifications with invasion and high-grade ductal carcinoma in situ. Arch Surg 138:537–540
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The excellent technical assistance of Ms. Julianna Harkai and Ms. Zsuzsanna Hegedűs is gratefully acknowledged.
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Pálka, I., Kelemen, G., Ormándi, K. et al. Tumor Characteristics in Screen-Detected and Symptomatic Breast Cancers. Pathol. Oncol. Res. 14, 161–167 (2008). https://doi.org/10.1007/s12253-008-9010-7
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DOI: https://doi.org/10.1007/s12253-008-9010-7