Higher Detection Rates of Biologically Aggressive Breast Cancers in Mammography Screening than in the Biennial Interval

Prange, Anna; Bokhof, Beate; Polzer, Philipp; Tio, Joke; Radke, Isabel; Heidinger, Oliver; Heindel, Walter; Weigel, Stefanie

doi:10.1055/a-0657-3970

Cited by 4 publications

(4 citation statements)

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“…Even though HER2 + and TN breast cancers are considered rapidly growing, the majority (59% and 57%, respectively) of them were detected by population-based screening in this age group. This is in line with a previous study [ 19 ]. In our study, SDBCs were 77% of the PSBCs.…”

Section: Discussionsupporting

confidence: 94%

Triple-negative and HER2-positive breast cancers found by mammography screening show excellent prognosis

Alanko

Tanner

Vanninen

et al. 2021

Breast Cancer Res Treat

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Purpose Our purpose was to explore the prognosis of aggressive breast cancers of the HER2 oncogene amplification (HER2 +) and triple-negative (TN) subtypes detected by screening, as well as the prognosis of interval cancers (clinically due to symptoms between screening rounds) and cancers in screening nonparticipants. Methods The study population comprised of 823 breast cancers in women aged 50–69 years from 2006–2014. Of these, 572 were found by screening mammography (69%), 170 were diagnosed between the screening rounds (21%), and 81 were diagnosed in women who did not participate in the screening program (10%). Results The majority of all HER2 + (59%) and TN cancers (57%) in this age group were detected by screening. Screen-detected HER2 + tumors were small (median 12 mm), and node-negative (84%). During a median follow-up of eight years, the distant disease-free survival of screen-detected HER2 + and TN cancers was better than that of interval and nonparticipant cancers (age-adjusted HR = 0.16, 95% CI 0.03–0.81 and HR = 0.09, 95% CI 0.01–0.79, respectively). In nonparticipants, the distant disease-free survival of these cancers was worse than in participants (age-adjusted HR = 2.52, 95% CI 0.63–10.11 and HR = 5.30, 95% 1.16–24.29, respectively). Conclusion In the 50–69 age group, the majority of HER2 + and TN cancers can be found by a quality assured population-based mammography screening. Despite their generally aggressive behavior, after a median follow-up of 8 years, distant disease-free survival was over 90% of these cancers detected by screening. The worst prognosis of these cancers was in women who did not participate in screening.

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Section: Discussionsupporting

confidence: 94%

Triple-negative and HER2-positive breast cancers found by mammography screening show excellent prognosis

Alanko

Tanner

Vanninen

et al. 2021

Breast Cancer Res Treat

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“…Based on the risk factor "age", women 50 years of age or older, even without a family risk factor, are eligible to participate in early detection imaging in the form of mammography screening every two years in Germany [20]. Decreasing rates of advanced tumor stages among participants in subsequent screening rounds [21] and incidences of aggressive subtypes [22] have been reported. The use of substitute or supplementary methods for dense breasts with the goal of improving cancer detection is discussed in the literature.…”

Section: Discussionmentioning

confidence: 99%

Stratification of Breast Cancer Risk in Terms of the Influence of Age and Mammographic density

Weigel

Heindel

Dietz

et al. 2020

Rofo

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Purpose Analysis of the influence of the singular risk factors age and breast density on the 2-year incidence of breast cancer among participants in the German mammography screening program. Materials and Methods The multicenter study includes 111 456 subsequent round digital mammographic screening examinations from four screening units with prospective visual categorization of breast density. Based on detection in screening and during the 2-year interval after negative screening participation (interval cancers), 2-year breast cancer incidences (2 YBCI) (‰) were calculated in the 5-year age groups (5 YAG) of the target group 50–69 years and in the BI-RADS density categories ACR 1–4. Multivariate statistical evaluations were carried out using logistic regression models. Results With an increase in the 5 YAG, the 2 YBCI increased by 5.0 ‰, 6.7 ‰, 8.5 ‰ to 9.7 ‰, and was significantly different among 55–59, 60–64 and 65–69-year-old women compared to the youngest reference group 50–54 years (odds ratio (OR): 1.34; 1.68; and 1.93; p-value < 0.0001). With an increase in density categories 1–4, the 2 YBCI increased from 2.6 ‰, to 5.8 ‰, 9.6 ‰, and 9.7 ‰. The 2 YBCI differed significantly in breast density categories 2, 3, 4 from reference group 1 (OR: 2.17; 3.65; and 3.76; p-value < 0.0001). Only within the two main breast density groups 2 (frequency 44.3 %) and 3 (44.7 %), a significant increase in the 2 YBCI was observed across the 5 YAG (category 2: 3.7–8.9 ‰; category 3: 5.8–11.7 ‰; p-value < 0.001 each). The 2 YBCI was above the median of 7.5 ‰ in women with breast density category 2 and aged 65–69 years, as well as in women with breast density categories 3 and 4 aged 55–69 years. A 2 YBCI below the median was seen in women between 50–54 years regardless of breast density, as well as women in category 1 in all age groups. Conclusion Within the main breast density categories 2 and 3 (almost 90 % of participants), incidences increase with age to double. A consistently low incidence is found regardless of breast density at a young screening age and in women with the lowest breast density. Key Points: Citation Format

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“…Lebensjahr auch ohne einen familiären Risikofaktor in Deutschland alle 2 Jahre Anspruch auf eine bildgebende Früherkennung in Form einer Teilnahme am Mammografie-Screening [20]. Berichtet wurden sinkende Raten fortgeschrittener Tumorstadien unter Folgerunden-Teilnehmerinnen [21] und Inzidenzen zu aggressiven Subtypen [22]. Der Einsatz ersetzender oder additiver Methoden bei dichter Brust mit dem Ziel einer Steigerung der Karzinomdetektion wird in der Literatur diskutiert; allerdings liegt für keine andere bildgebende Untersuchung, wie Tomosynthese, Sonografie oder MRT, eine Evidenz für eine Brustkrebs-Mortalitätsreduktion vor [23].…”

Section: Diskussionunclassified

Stratifizierung des Brustkrebsrisikos hinsichtlich der Einflüsse von Alter und mammografischer Dichte

Weigel

Heindel

Dietz

et al. 2020

Senologie - Zeitschrift für Mammadiagnostik und -therapie

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Zusammenfassung Ziel Analyse des Einflusses der singulären Risikofaktoren Lebensalter und Brustdichte auf die 2-Jahres-Inzidenz des Mammakarzinoms unter Teilnehmerinnen am deutschen Mammografie-Screening-Programm. Material und Methode Die multizentrische Studie umfasst 111 456 digitale mammografische Folgerunden-Untersuchungen aus 4 Screening-Einheiten mit prospektiver visueller Kategorisierung der Brustdichte. Basierend auf der Detektion im Screening und im 2-Jahres-Intervall nach negativer Screening-Teilnahme (Intervallkarzinome) wurden 2-Jahres-Brustkrebsinzidenzen (2-JBI) (‰) in den 5-Jahres-Altersgruppen (5-JAG) der Zielgruppe 50–69 Jahre und in den Dichtekategorien ACR 1–4 berechnet. Multivariate statistische Auswertungen erfolgten mit logistischen Regressionsmodellen. Ergebnisse Mit steigender 5-JAG stieg die 2-JBI von 5,0 ‰, 6,7 ‰ und 8,5 ‰ auf 9,7 ‰ und unterschied sich unter den 55–59-, 60–64- und 65–69-jährigen Frauen signifikant von der jüngsten Referenzgruppe 50–54 Jahre (Odds-Ratio (OR): 1,34, 1,68 bzw. 1,93; p < 0,0001). Mit Anstieg der ACR-Kategorien 1–4 nahm die 2 JBI von 2,6 ‰, auf 5,8 ‰, 9,6 ‰ und 9,7 ‰ zu. Die 2-JBI unterschied sich in ACR 2, 3 und 4 signifikant von der Referenzgruppe ACR 1 (OR: 2,17, 3,65 bzw. 3,76; p < 0,0001). Nur innerhalb der beiden Hauptgruppen ACR 2 (Häufigkeit 44,3 %) und ACR 3 (44,7 %) zeigte sich ein signifikanter Anstieg der 2-JBI über die 5-JAG (ACR 2: 3,7 ‰–8,9 ‰; ACR 3: 5,8 ‰–11,7 ‰; p < 0,001). 2-JBI lagen über dem Median von 7,5 ‰ bei Frauen mit ACR 2 und Alter 65–69 Jahre sowie bei ACR 3 und ACR 4 im Alter 55–69 Jahre. 2-JBI unter dem Median hatten Frauen zwischen 50–54 Jahren, unabhängig von der Brustdichte, sowie Frauen der Kategorie ACR 1 in allen Altersgruppen. Schlussfolgerung Innerhalb der Hauptkategorien ACR 2 und ACR 3 (fast 90 % der Teilnehmerinnen) steigen die Inzidenzen mit zunehmendem Alter bis zu einer Verdopplung. Eine konsistent niedrige Inzidenz findet sich unabhängig von der Brustdichte bei jungem Screening-Alter und bei Frauen mit geringster Brustdichte.

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Higher Detection Rates of Biologically Aggressive Breast Cancers in Mammography Screening than in the Biennial Interval

Abstract: · Prange A, Bokhof B, Polzer P et al. Higher Detection Rates of Biologically Aggressive Breast Cancers in Mammography Screening than in the Biennial Interval. Fortschr Röntgenstr 2018; DOI: 10.1055/a-0657-3970.

Cited by 4 publications

References 10 publications

Triple-negative and HER2-positive breast cancers found by mammography screening show excellent prognosis

Triple-negative and HER2-positive breast cancers found by mammography screening show excellent prognosis

Stratification of Breast Cancer Risk in Terms of the Influence of Age and Mammographic density

Stratifizierung des Brustkrebsrisikos hinsichtlich der Einflüsse von Alter und mammografischer Dichte

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