Breast Tumor Characteristics as Predictors of Mammographic Detection: Comparison of Interval- and Screen-Detected Cancers

Porter, Peggy L.; El-Bastawissi, Amira Y.; Mandelson, Margaret T.; Lin, Ming Gang; Khalid, Najma; Watney, Elizabeth A.; Cousens, Laura A.; White, Donna L.; Taplin, Stephen H.; White, Emily

doi:10.1093/jnci/91.23.2020

Cited by 244 publications

(241 citation statements)

References 37 publications

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“…Two screening programmes were counted for Italy (see Material and Methods).-2 Percentages based on specified answers (missing values omitted) and for relevant programmes only.- 3 The European Guidelines (EG) defines an interval cancer as a primary breast cancer diagnosed in a woman who had a screening test with/without further assessment, which was negative for malignancy, either before the next invitation to screening or within a time period equal to a screening interval for a woman who has reached the upper age limit for screening. 6 -4 Missing data for the United States (see Material and Methods) and Canada.- 5 Missing data for the United States (see Material and Methods) and Denmark.- 6 Missing data for the United States (see Material and Methods), Denmark and Norway.- 7 Missing data for the United States (see Material and Methods); in New Zealand, data to be collected were in the process of being identified.…”

Section: Resultsmentioning

confidence: 99%

“…They occur because of the following: rapid tumour growth leads to cancers that truly develop in the interval after screening, cancers that are present are masked by characteristics of the breast or the cancer, readers miss subtle or minimal signs on the screening mammogram, or further assessment procedures fail to diagnose the cancer radiologically detected. 4,5 From a population-based perspective, IC are a key measure of the quality of the radiology performed and of the early impact of screening programmes. 6 A high incidence of IC adversely affects the ability of a screening programme to reduce mortality from breast cancer.…”

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Methodological issues in international comparison of interval breast cancers

Bulliard

Sasieni

Klabunde

et al. 2006

Intl Journal of Cancer

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International comparisons of interval cancers (IC) are important to better understand the relationship between programmes' performance and screening practices. In this respect, differences in (i) definition, (ii) identification and (iii) quantification of IC have received little attention. To examine these 3 comparability issues and activities involving IC, an assessment was conducted among member countries of the International Breast Cancer Screening Network, and the impact of accuracy of identification and quantification practices was estimated using 1996-98 data from the Dutch breast cancer screening programme. Information was obtained from 19 screening programmes in 18 countries, 16 of which acknowledged the coexistence of opportunistic screening. IC data were collected to evaluate performance of the screening programme (100% of programmes) and the radiologists (89%); 53% of programmes had a designated review process for IC. Most programmes (84%) agreed with the European Guidelines definition of IC, but a case situation exercise evidenced substantial discrepancy in classification of cancers that occurred after a positive screen. Completeness of identification of IC appears to contribute most to international variation, and cannot be easily controlled for in methodologically rigorous comparisons. Statistically significant differences of about 4% were measured between quantification methods for IC. An operational definition of IC is proposed to enhance international comparability. Valid comparisons of IC are possible with careful attention to the definition but true differences in IC frequency across screening programmes should exceed 10% to be possibly indicative of real differences between programmes. ' 2006 Wiley-Liss, Inc.Key words: mammography; mass screening; interval cancer; international collaboration; comparative study Although mammography is currently the only proven screening method for reducing mortality from breast cancer, 1-3 some breast cancers will inevitably elude screening detection. Interval cancers (IC) are those tumours that are diagnosed in the time period between 2 screening rounds. They occur because of the following: rapid tumour growth leads to cancers that truly develop in the interval after screening, cancers that are present are masked by characteristics of the breast or the cancer, readers miss subtle or minimal signs on the screening mammogram, or further assessment procedures fail to diagnose the cancer radiologically detected. 4,5 From a population-based perspective, IC are a key measure of the quality of the radiology performed and of the early impact of screening programmes. 6 A high incidence of IC adversely affects the ability of a screening programme to reduce mortality from breast cancer. Knowledge of IC is also necessary to determine the sensitivity of the programme and of the radiologists' performance.The frequency of IC has been assessed in randomised studies and in established programmes that provide mammography to a defined target group (service screening), and compa...

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Section: Resultsmentioning

confidence: 99%

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confidence: 99%

Methodological issues in international comparison of interval breast cancers

Bulliard

Sasieni

Klabunde

et al. 2006

Intl Journal of Cancer

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“…Retrospective studies comparing interval and screen-detected cancers have shown that interval cancers are similar to cancers in unscreened women, and that screen-detected cancers generally have better prognostic indicators, with smaller tumours, fewer node-positive tumours, and a larger proportion of in situ tumours (Burrell et al, 1996;Porter et al, 1999). The current study confirms these observations, but of note is the similarity of the prognostic profile of interval cancers for those screened annually and that of interval cancers in those screened biennially, with the same being true for screen-detected cancers.…”

Section: Discussionmentioning

confidence: 99%

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography

et al. 2005

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We compared the long-term impact of 1-and 2-year screening mammography intervals using prognostic, screening, and outcome information for women aged 50 -74 years obtained from the Screening Mammography Program of British Columbia in two time periods, prior to 1997 (policy of annual mammography) and after 1997 (biennial mammography). Survival was estimated for both periods using a prognostic model and the expected rate of interval and screen-detected cancers. The likelihood of a screen-detected cancer with annual screening was 2.32 per thousand screens and with biennial screening was 3.32 per thousand screens. The prognostic profile of screen-detected cancers was better than that of interval cancers. Among both screen-detected and interval cancers, the prognostic profiles with annual and biennial screening were similar. The estimated breast cancer-specific survival rates for women undergoing annual and biennial screening mammography were 95.2 and 94.6% at 5 years, and 90.4 and 89.2% at 10 years, respectively. Annual compared to biennial mammography was associated with a 1.2% increase in the estimated 10-year breast cancer-specific survival for women aged 50 -74 years, diagnosed with invasive breast cancer after screening programme attendance.

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“…Earlier studies have shown that prognosis of the interval cancers may not differ from the clinically detected cases (Brekelmans et al 1995;Burrell et al, 1996) or it is intermediate to the screen detected and the clinically detected cancer groups (Groenendijk et al, 2003). Several studies have shown that interval cancers form a group of tumours with aggressive characteristics (Porter et al, 1999;Gilliland et al, 2000). Besides differences in stage, size and axillary lymph node status there are other biological differences between the screen-detected, interval and clinically detected cancers, which may influence the outcome of the patients.…”

Section: Discussionmentioning

confidence: 99%

Role of mammography screening as a predictor of survival in postmenopausal breast cancer patients

2005

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We examined the effect of population-based screening programme on tumour characteristics by comparing carcinomas diagnosed during the prescreening (N ¼ 341) and screening (N ¼ 552) periods. We identified screen detected (N ¼ 224), interval (N ¼ 99) and clinical cancer (N ¼ 229) cases. Median tumour size and proportion of axillary lymph node negative cases were 1.5 cm and 65% in the screen detected group, 2.0 cm and 44% in cases found outside the screening, and 3.2 cm and 41% in the cases from the prescreening period. Survival of the breast cancer patients was 66% (95% CI, 60 -71%) in the prescreening era group and 73% (95% CI, 66 -78%) in the screening era group after 10 years of follow-up. In the screening era group the survival of the screen detected cases was 86% (95% CI, 80 -90%) and that of the clinical cancer cases 73% (95% CI, 66 -78%) after 10 years. In multivariate analysis the risk of breast cancer death was not significantly different between the prescreening and screening periods (HR 0.82; 95% CI 0.59 -1.12, P ¼ 0.21). Detection by screening was not an independent prognostic factor in multivariate analysis (HR 0.75; CI 95% 0.50 -1.12; P ¼ 0.17).

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Breast Tumor Characteristics as Predictors of Mammographic Detection: Comparison of Interval- and Screen-Detected Cancers

Abstract: Our data from a large group of women in a defined population indicate that screening mammography may miss tumors of lobular or mucinous histology and some rapidly proliferating, high-grade tumors.

Cited by 244 publications

References 37 publications

Methodological issues in international comparison of interval breast cancers

Methodological issues in international comparison of interval breast cancers

Comparison of 1- and 2-year screening intervals for women undergoing screening mammography

Role of mammography screening as a predictor of survival in postmenopausal breast cancer patients

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