Survival and Disease-Free Survival by Breast Density and Phenotype in Interval Breast Cancers

Sala, María; Domingo, Laia; Louro, Javier; Torà-Rocamora, Isabel; Baré, Marisa; Ferrer, Joana; Carmona-García, Maria Carmen; Barata, Teresa; Román, Marta; Macià, Francesc; Castells, Xavier

doi:10.1158/1055-9965.epi-17-0995

Cited by 11 publications

(12 citation statements)

References 38 publications

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“…We used Cox regression with time since diagnosis as the time variable to estimate hazard ratios (HRs) with 95% CIs for the risk of death from all causes in true, minimal signs, and missed cancers. We adjusted for age at diagnosis and included tumour diameter, grade, and subtype as confounders based on a priori knowledge of their relationship with the exposure and outcome in interval cancers [17][18][19][20][21][22]. All analyses were conducted separately for screen-detected and interval cancers due to the potential for lead time bias in combined analyses.…”

Section: Discussionmentioning

confidence: 99%

“…The literature suggests that true interval cancers are more likely to be smaller [17,18,[20][21][22] and histologic grade 3 [17-19, 21, 22] than missed interval cancers. Our results confirmed that true interval cancers are more likely to be grade 3, but found no more than a 1 mm difference in the median histopathologic tumour diameter of true, minimal signs, and missed cancers.…”

Section: Discussionmentioning

confidence: 99%

“…The histopathology of true, minimal signs, and missed screen-detected breast cancers is not well described [9,16]. True interval breast cancers have more often been histopathologic grade 3 with a smaller tumour diameter than missed breast cancers, but other aspects of histopathology have not demonstrated consistent results [17][18][19][20][21][22]. It has been hypothesised that the short sojourn time of true breast cancers indicates that they are more aggressive than missed breast cancers [9,23].…”

Section: Introductionmentioning

confidence: 99%

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Survival among women diagnosed with screen-detected or interval breast cancer classified as true, minimal signs, or missed through an informed radiological review

et al. 2020

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Objectives “True” breast cancers, defined as not being visible on prior screening mammograms, are expected to be more aggressive than “missed” cancers, which are visible in retrospect. However, the evidence to support this hypothesis is limited. We compared the risk of death from any cause for women with true, minimal signs, and missed invasive screen-detected (SDC) and interval breast cancers (IC). Methods This nation-wide study included 1022 SDC and 788 IC diagnosed through BreastScreen Norway during 2005–2016. Cancers were classified as true, minimal signs, or missed by five breast radiologists in a consensus-based informed review of prior screening and diagnostic images. We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of death from any cause associated with true, minimal signs, and missed breast cancers, adjusting for age at diagnosis, histopathologic tumour diameter and grade, and subtype. Separate models were created for SDC and IC. Results Among SDC, 463 (44%) were classified as true and 242 (23%) as missed; among IC, 325 (39%) were classified as true and 235 (32%) missed. Missed SDC were associated with a similar risk of death as true SDC (HR = 1.20, 95% CI (0.49, 2.46)). Similar results were observed for missed versus true IC (HR = 1.31, 95% CI (0.77, 2.23)). Conclusions We did not observe a statistical difference in the risk of death for women diagnosed with true or missed SDC or IC; however, the number of cases reviewed and follow-up time limited the precision of our estimates. Key Points • An informed radiological review classified screen-detected and interval cancers as true, minimal signs, or missed based on prior screening and diagnostic mammograms. • It has been hypothesised that true cancers, not visible on the prior screening examination, may be more aggressive than missed cancers. • We did not observe a statistical difference in the risk of death from any cause for women with missed versus true screen-detected or interval breast cancers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Survival among women diagnosed with screen-detected or interval breast cancer classified as true, minimal signs, or missed through an informed radiological review

et al. 2020

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“…The hospitals involved were all in Spain––in the Costa del Sol (Marbella), the Canary Islands, Sabadell, and Gerona––and the diagnoses and surgical interventions all took place during the period 2000‐2008, with follow‐up to 2014. The women in the study population were mainly derived from the retrospective cohort of the CAMISS study (n = 1086) and the rest had been diagnosed within the screening program provided at the Costa del Sol Hospital, Marbella …”

Section: Methodsmentioning

confidence: 99%

“…The women in the study population were mainly derived from the retrospective cohort of the CAMISS study (n = 1086) and the rest had been diagnosed within the screening program provided at the Costa del Sol Hospital, Marbella. 12 The following inclusion criteria were applied:…”

Section: Study Populationmentioning

confidence: 99%

Impact of adjuvant chemotherapy on the survival of patients with breast cancer diagnosed by screening

Zarcos‐Pedrinaci

Redondo

Louro³

et al. 2019

Cancer Medicine

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The aim of this study is to determine the survival of patients with breast cancer treated with adjuvant chemotherapy (ACh) after the diagnosis by screening, taking comorbidity into account. This multicenter cohort study examined a population of patients taking part in four national screening programs for the early detection of breast cancer (localized or locally advanced), during the period 2000‐2008. Of the 1248 cancers detected, 266 were prevalent (21.3%), 633 were incident (50.7%), and 349 were interval (27.9%). No significant differences were detected between the three groups in terms of the distribution of comorbidity according to the CCI. After a median follow‐up of 102 months, 22.1% of the patients with interval cancer had died. The corresponding figures for the incident and prevalent cancers were 10.4% and 7.9%, respectively (P < .001). The adjusted Cox regression analysis by the stage, CCI and group revealed no differences in the risk of recurrence between the different groups according to the ACh performed. However, there were significant differences in the overall survival; for the interval cancer group without ACh, the risk of death was higher (Hazard ratio: 2.5 [1.0‐6.2]) than for the other two groups. However, for the prevalent and incident groups that did not receive ACh, there was no greater risk of death. This study shows that adjuvant chemotherapy seems to benefit patients with interval breast cancer, who have a poorer prognosis than those with prevalent or incident cancer. However, the role of ACh is unclear with respect to prevalent and incident cancers when comorbidity is taken into account.

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Comparison of Mortality Among Participants of Women’s Health Initiative Trials With Screening-Detected Breast Cancers vs Interval Breast Cancers

et al. 2020

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IMPORTANCE Interval breast cancers (IBCs) are cancers that emerge after a mammogram with negative results but before the patient's next scheduled screening. Interval breast cancer has a worse prognosis than cancers detected by screening; however, it is unknown whether the length of the interscreening period is associated with prognostic features and mortality.OBJECTIVE To compare the prognostic features and mortality rate of women with IBCs diagnosed within 1 year or between 1 and 2.5 years of a mammogram with negative results with the prognostic features and mortality rate of women with breast cancers detected by screening. DESIGN, SETTING, AND PARTICIPANTSThis cohort study used mammography data, tumor characteristics, and patient demographic data from the Women's Health Initiative study, which recruited participants from 1993 to 1998 and followed up with participants for a median of 19 years. The present study sample for these analyses included women aged 50 to 79 years who participated in the Women's Health Initiative study and includes data collected through March 31, 2018. There were 5455 incidents of breast cancer; only 3019 women compliant with screening were retained in analyses. Statistical analysis was performed from October 25, 2018, to November 24, 2019. Breast cancers detected by screening and IBCs were defined based on mammogram history, date of last mammogram, type of visit, and results of examination. Interval breast cancers were subdivided into those occurring within 1 year or between 1 and 2.5 years after the last protocol-mandated mammogram with negative results. MAIN OUTCOMES AND MEASURESThe primary outcome of this study was breast cancer-specific mortality for each case of breast cancer detected by screening and IBCs detected within 1 year or between 1 and 2.5 years from a mammogram with negative results. Secondary outcomes included prognostic and tumor characteristics for each group. Comparisons between groups were made using the t test, the χ 2 test, and Fine-Gray multivariable cumulative incidence regression analyses. RESULTS Among the 3019 participants in this analysis, all were women with a mean (SD) age of 63.1 (6.8) years at enrollment and 68.5 (7.1) years at diagnosis. A total of 1050 cases of IBC were identified, with 324 (30.9%) diagnosed within 1 year from a mammogram with negative results and 726 (69.1%) diagnosed between 1 and 2.5 years after last mammogram with negative results. The remaining 1969 cases were breast cancers detected by screening. Interval breast cancers diagnosed within 1 year from a mammogram with negative results had significantly more lobular histologic characteristics (13.0% vs. 8.1%), a larger tumor size (1.97 cm vs 1.43 cm), a higher clinical stage (28.4% vs 17.3% regional and 3.7% vs 0.6% distant), and more lymph node involvement (27.1% vs 17.0%) than cancers detected by screening. Unadjusted breast cancer-specific mortality hazard ratios were significantly higher for IBCs diagnosed within 1 year from a mammogram with negative results compared with breast ...

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Survival and Disease-Free Survival by Breast Density and Phenotype in Interval Breast Cancers

Cited by 11 publications

References 38 publications

Survival among women diagnosed with screen-detected or interval breast cancer classified as true, minimal signs, or missed through an informed radiological review

Survival among women diagnosed with screen-detected or interval breast cancer classified as true, minimal signs, or missed through an informed radiological review

Impact of adjuvant chemotherapy on the survival of patients with breast cancer diagnosed by screening

Comparison of Mortality Among Participants of Women’s Health Initiative Trials With Screening-Detected Breast Cancers vs Interval Breast Cancers

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