Case-Control Study of Factors Associated With Failure to Detect Breast Cancer by Mammography

Ma, Lingjun; Fishell, Eve; Wright, Barbara; Hanna, Wedad; Allan, Simon; Boyd, Norman F.

doi:10.1093/jnci/84.10.781

Cited by 181 publications

(89 citation statements)

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“…Hormone replacement therapy use has been reported to increase breast density (Berkowitz and Gatewood, 1990) and potentially affect screening efficacy (Ma et al, 1992). Hormone replacement therapy was not recorded in the present study, but a previous study in the adjacent district of Siena reported a 27.7% HRT use in postmenopausal screening attenders (age 50 -59 years), and confirmed an increased probability of dense breast in HRT users (density 425% ¼ þ 17%, density 450% ¼ þ 7%) as compared to nonusers (Ciatto et al, 2001).…”

Section: Discussionmentioning

confidence: 99%

Breast density as a determinant of interval cancer at mammographic screening

et al. 2004

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The association of breast density (% of breast volume involved by fibro-glandular densities) with the risk of interval cancer (IC) was investigated by reviewing a consecutive series of 346 cancers detected at screening (SDC) during 1996 -1999 and of 90 ICs, reported as negative in the same period and diagnosed in the following 2 years, and comparing them to a random sample of 360 healthy controls. The probability of IC was significantly associated with breast density, whatever grouping (0/ Multivariate analysis confirmed the independent association of breast density to IC, the highest risk being observed for 474% density class (OR vs 0% class ¼ 13.4, 95% CI 2.7 -65.6, OR vs all other density classes ¼ 5.1, 95% CI 2.6 -10.0). Age showed an independent association too, older women having a lower risk of IC (OR ¼ 0.52 95% CI 0.3 -09). Breast density (474%) resulted as being a major determinant of IC. Special screening protocols (shorter rescreening interval, routine use of ultrasonography) might be suggested for these subjects in order to improve screening sensitivity and efficacy. Mammographic screening is effective in reducing breast cancer mortality (Wald et al, 1993), although its sensitivity is not high. Based on interval cancer (IC) proportional incidence, biennal screening sensitivity has been estimated to be as low as 75% (Paci et al, 1990;Zappa et al, 2002). Thus, efforts should be made to reduce IC frequency, and determining the causes of screening faults is a baseline condition for further action.At retrospective review (Egan and Mosteller, 1977; Ciatto et al, 1995a, b), most ICs are classified as 'occult' or 'true interval', a relevant proportion as 'minimal sign' and a minority as 'screening error'. The corresponding frequencies determined for the Florence District Programme were 61.9, 26.1 and 11.9%, respectively (Ciatto et al, 1995a, b). Breast radiological density may have a masking effect on small cancer lesions; it is likely to be a determinant of false-negative mammography (Peeters et al, 1989), and might be associated with IC, particularly in cases reviewed as 'occult'. Other variables, such as age (Wald et al, 1993), use of single or double view (Bryan et al, 1995) and use of single or double reading (Ciatto et al, 1995a, b) have been shown to be associated with mammography sensitivity and might also be associated to IC.In Florence District, mammographic screening has been ongoing at the Centro per lo Studio e la Prevenzione Oncologica (CSPO) since 1970, being extended to Florence City in 1990.Screening efficacy has been demonstrated by means of a casecontrol study (Palli et al, 1986), and the proportional IC rate in women aged 50 -69 years has been reported to be 18% (95% CI 10 -24) and 42% (95% CI 29 -59) in the first or second year of the interval, respectively: the sensitivity of biennal screening, estimated on the basis of proportional IC incidence, was 75% (Paci et al, 1990).In the present study, a consecutive series of IC was compared to screen-detected cancers (SDC), and the associa...

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Section: Discussionmentioning

confidence: 99%

Breast density as a determinant of interval cancer at mammographic screening

et al. 2004

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“…'Masking' of breast cancer by dense breast tissue confounds initial mammographic readings and is associated with an increased risk of breast cancer upon subsequent examinations. (Ma et al 1992). Masking might inflate the risks associated with mammographic density in cohort studies, as cancers missed in the first mammogram, because of dense tissue, would eventually be detected during the subsequent follow-up.…”

Section: Pitfallsmentioning

confidence: 99%

Critical assessment of new risk factors for breast cancer: considerations for development of an improved risk prediction model

Santen

Boyd

Chlebowski

et al. 2007

Endocr Relat Cancer

176

129

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The majority of candidates for breast cancer prevention have not accepted tamoxifen because of the perception of an unfavorable risk/benefit ratio and the acceptance of raloxifene remains to be determined. One means of improving this ratio is to identify women at very high risk of breast cancer. Family history, age, atypia in a benign biopsy, and reproductive factors are the main parameters currently used to determine risk. The most powerful risk factor, mammographic density, is not presently employed routinely. Other potentially important factors are plasma estrogen and androgen levels, bone density, weight gain, age of menopause, and fracture history, which are also not currently used in a comprehensive risk prediction model because of lack of prospective validation. The Breast Cancer Prevention Collaborative Group (BCPCG) met to critically examine and prioritize risk factors that might be selected for further testing by multivariate analysis using existing clinical material. The BCPCG reached a consensus that quantitative breast density, state of the art plasma estrogen and androgen measurements, history of fracture and height loss, BMI, and waist-hip ratio had sufficient priority for further testing. As a practical approach, these parameters could be added to the existing Tyrer-Cuzick model which encompasses factors included in both the Claus and Gail models. The BCPCG analyzed potentially available clinical material from previous prospective studies and determined that a large case/control study to evaluate these new factors might be feasible at this time.

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“…True intervals are those without visible tumor signs at screening and account for 65% to 75% of all intervals (6,8). These cancers could have existed at the time of screening but were ''masked'' from detection as result of a lobular histology, an absence of calcifications, or an increased breast density, or these cancers could be incident tumors with a high tumor growth rate (8,10,11).…”

Section: Introductionmentioning

confidence: 99%

“…High mammographic density has been found to decrease the accuracy of screening mammography, and accordingly, has been associated more often with interval breast cancers as compared with screen-detected tumors (24)(25)(26)(27). Women with extremely dense breasts were found to have a 6-to 9-fold increased risk of an interval cancer (11,27).…”

Section: Introductionmentioning

confidence: 99%

Influence of Patterns of Hormone Replacement Therapy Use and Mammographic Density on Breast Cancer Detection

Chiarelli

Kirsh

Klar

et al. 2006

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: There is evidence that factors such as current hormone replacement therapy (HRT) use and mammographic density may each lower the sensitivity of mammography and are associated with a greater risk of developing an interval cancer. This study explores this relationship further by examining the influence of patterns of HRT use and the percentage of mammographic density on the detection of breast cancer by classification of interval cancer. Methods: This study uses a case-case design nested within a cohort of women screened by the Ontario Breast Screening Program between 1994 and 2002. Interval cancers, both those missed at screening but seen on retrospective review (n = 87) or true intervals without visible tumor signs at screening (n = 288) were matched to 450 screen-detected cancers. The association between the percentage of mammographic density, measured by radiologists and a computer-assisted method, and HRT use, ascertained from a mailed questionnaire, and the risk of being diagnosed with

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Case-Control Study of Factors Associated With Failure to Detect Breast Cancer by Mammography

Abstract: Our results indicate that biologic factors are associated with failure to detect some breast cancers by mammography and indicate directions for future research in breast imaging.

Cited by 181 publications

References 0 publications

Breast density as a determinant of interval cancer at mammographic screening

Breast density as a determinant of interval cancer at mammographic screening

Critical assessment of new risk factors for breast cancer: considerations for development of an improved risk prediction model

Influence of Patterns of Hormone Replacement Therapy Use and Mammographic Density on Breast Cancer Detection

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