BackgroundInterval cancers are primary breast cancers diagnosed in women after a negative screening test and before the next screening invitation. Our aim was to evaluate risk factors for interval cancer and their subtypes and to compare the risk factors identified with those associated with incident screen-detected cancers.MethodsWe analyzed data from 645,764 women participating in the Spanish breast cancer screening program from 2000–2006 and followed-up until 2009. A total of 5,309 screen-detected and 1,653 interval cancers were diagnosed. Among the latter, 1,012 could be classified on the basis of findings in screening and diagnostic mammograms, consisting of 489 true interval cancers (48.2%), 235 false-negatives (23.2%), 172 minimal-signs (17.2%) and 114 occult tumors (11.3%). Information on the screening protocol and women's characteristics were obtained from the screening program registry. Cause-specific Cox regression models were used to estimate the hazard ratios (HR) of risks factors for interval cancer and incident screen-detected cancer. A multinomial regression model, using screen-detected tumors as a reference group, was used to assess the effect of breast density and other factors on the occurrence of interval cancer subtypes.ResultsA previous false-positive was the main risk factor for interval cancer (HR = 2.71, 95%CI: 2.28–3.23); this risk was higher for false-negatives (HR = 8.79, 95%CI: 6.24–12.40) than for true interval cancer (HR = 2.26, 95%CI: 1.59–3.21). A family history of breast cancer was associated with true intervals (HR = 2.11, 95%CI: 1.60–2.78), previous benign biopsy with a false-negatives (HR = 1.83, 95%CI: 1.23–2.71). High breast density was mainly associated with occult tumors (RRR = 4.92, 95%CI: 2.58–9.38), followed by true intervals (RRR = 1.67, 95%CI: 1.18–2.36) and false-negatives (RRR = 1.58, 95%CI: 1.00–2.49).ConclusionThe role of women's characteristics differs among interval cancer subtypes. This information could be useful to improve effectiveness of breast cancer screening programmes and to better classify subgroups of women with different risks of developing cancer.

ResumenEn 1997, la Red Oncológica Nacional (National Comprehensive Cancer Network, NCCN) creó una comisión multidisciplinar para examinar cómo integrar los cuidados psicosociales de los enfermos oncológicos en la valoración de rutina y observó que el concepto de distrés, entendido como sufrimiento, era el mejor término genérico para representar la variedad de preocupaciones que experimentan los pacientes y no conllevaba el estigma de otras palabras usadas para los síntomas emocionales. El presente trabajo expone la implantación del Programa Primer Impacto, un proceso de asistencia psicosocial que pretende abordar las necesidades bio-psico-sociales del enfermo recién diagnosticado de cáncer y sus familiares de manera integral e inmediata. La utilización un método sencillo de screnning de distrés (entrevista semiestructurada y termó-metro de distrés) nos permite realizar un triage de necesidades, decidir las prioridades en la asistencia y realizar las primeras medidas de atención psicosocial. Revisamos la bibliografía actual en esta disciplina, en base a una exhaustiva revisión de la literatura y aportamos nuestra propia experiencia en la implantación de un modelo de detección de distrés estructurado, en cuanto a los recursos necesarios para una adecuada implantación, así como AbstractThe National Comprehensive Cancer Network created in 1997 a multidisciplinar comission whit the aim to examine how integrate the psychosocial attention of cancer patient into the routine assessment of this patients. This group noted that distress, treated as emotional suffer was the best construct to show the variety of concerns experimented by the cancer patients free from the stigma of others concepts used to define emotional symptoms. This paper show the develop of a program called First Impact (Primer Impacto), consisting a psychosocial attention program which intends to respond immediately to all bio-psycho-social needs of newly diagnosed patient and their relatives. The assessment by a simple screening tool (semi-structured interview and the Distress Thermometer) lets us to give the first psychosocial cares. An exhaustive review of the available literature, our experience to present the necessary resources to an adequate implantation of a structured detection of distress protocol, and the results obtained from its implementation in different hospitals and the Spanish Association Against Cancer centers are provided.

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