Radiological audit of interval breast cancers: Estimation of tumour growth rates

Abstract

Introduction This multicentre, retrospective study aimed to establish correlation between estimated tumour volume doubling times (TVDT) from a series of interval breast cancers with their clinicopathological features. The potential impact of delayed diagnosis on prognosis was also explored. Materials and methods Interval cancers, where screening mammograms demonstrated changes that were retrospectively classified as either uncertain or suspicious, were reviewed from five screening units within the UK NHS Breast Screening Programme (NHSBSP). Data collected included the time interval between screening mammogram and cancer diagnosis, the size of the initial mammographic abnormality and of the subsequent cancer, demographics, mammographic density and tumour biology. We estimated volume doubling times and the estimated change in size and node status, which would have followed if these cancers had been detected at the previous screen. Results 306 interval cancers meeting the inclusion criteria were identified. Average time from screening to diagnosis was 644 days (SD 276 days). 19% were diagnosed in the first twelve months, 42% in the subsequent twelve months and 39% thereafter. Overall average estimated TVDT was 167 days (95% CI 151–186). Significant differences were noted with age (p = 0.01), grade (p < 0.001) and ER status (p < 0.001) with women under 60, grade 3 cancers and ER negative cancers having shorter TVDTs. HER2 positive tumours had shorter doubling times than HER2 negative, but this difference was not statistically significant. It was estimated that diagnosing these cancers at the previous screen would have increased ten-year survival from 82% to 86%. Conclusion High grade, ER negativity and younger age were associated with shorter durations of TVDT. The role of HER2 status on interval cancer growth rate requires further assessment. It is likely that the delayed diagnosis of interval cancers confers a 4% reduction in ten-year survival.

Breast cancer progression when definitive surgery is delayed

“…One serial ultrasound study observed size changes equivalent to a PSD of 0.1, 13 which is similar to the median PSD for our 61‐ to 120‐day group (0.13). Furthermore, multiple serial imaging studies have consistently estimated breast cancer tumor volume doubling times (TVDT) at 167–193 days, 14‐17 which is similar to the 151 days estimated from median SGR for our series of 315 tumors (TVDT = [SGR/6.931] −1 ). TVDT has previously been estimated at 185–257 days for ER(+) tumors and 103–127 days for TNBC 13‐15 .…”

“…Data on TVDT by intrinsic subtype are inconsistent. Some studies find that TNBC and HER2(+) breast cancer have the shortest TVDTs, but others do not 13,13‐15,15,17 . Among our series of primarily luminal breast cancers, only luminal B status, convincingly approximated by immunohistochemistry, predicted growth.…”

“…Early recognition of tumors at risk for size progression is challenging. Some studies record shorter TVDTs for younger patients, high‐grade tumors, and positive lymph nodes and an inverse correlation between TVDT and Ki67 14,17,23 . Data on TVDT by intrinsic subtype are inconsistent.…”

Dépistage et diagnostic du cancer du sein à la fin de période de confinement COVID-19, aspects pratiques et hiérarchisation des priorités

“…Ce taux est néanmoins plus élevé dans la classe d'âge 70-74 ans [2]. Concernant les cancers d'intervalle, leur taux augmente en fonction des caractéristiques de la population sous-jacente, mais également en fonction de l'intervalle entre deux mammographies [6,7]. Cependant, là aussi, en population générale, un retard de moins de trois mois ne devrait pas augmenter le taux de cancers d'intervalle de façon majeure [7]; le retard à la réalisation des examens d'imagerie de dépistage peut avoir un impact beaucoup plus grave chez les femmes à très haut risque de cancers du sein en rapport avec une prédisposition génétique.…”

“…Dépistage et diagnostic du cancer du sein à la fin de période de confinement COVID-19, aspects pratiques et hiérarchisation des priorités § Luc Ceugnart 1 , Suzette Delaloge 2 , Corinne Balleyguier 3 , Michel Deghaye 4 , Lucie Veron 2 , Aldis Kaufmanis 4 , Audrey Mailliez 5 , Edouard Poncelet 6 , Gregory Lenczner 7 , Laurent Verzaux 8 , Joseph Gligorov 9 , Isabelle Thomassin-Naggara 10 SARS-CoV-2 (COVID- 19) [1]. Toutes les activités de dépistage des cancers et les invitations au dépistage ont été stoppées.…”