Aggressiveness features and outcomes of true interval cancers

Abstract

The question of whether screen detection confers an additional survival benefit in breast cancer is unclear and subject to several biases. Our aim was to examine the role of the diagnostic method (screen-detected, symptom-detected, and true interval cancers) and the clinical-pathological features in relapse-free survival and overall survival in breast cancer patients. We included 228 invasive breast cancers diagnosed in Barcelona from 1996 to 2008 among women aged 50-69 years. Ninety-seven patients were screen detected within the screening, 34 truly arose between 2-year screening mammograms (true interval cancers), and 97 were symptom detected outside the screening. The clinical-pathological features at diagnosis were compared. The overall and disease-free survival probabilities were computed using the Kaplan-Meier method. Cox proportional hazard models were applied, with adjustment by clinical-pathological variables. At diagnosis, symptom-detected and true interval cancers were in more advanced stages and were less differentiated. The highest proportion of triple-negative cancers was detected among true interval cancers (P=0.002). At 5 years of follow-up, the disease-free survival rates for screen-detected, true interval, and symptom-detected cancers were 87.5% (95% confidence interval, 80.5-95.2%), 64.1% (46.4-88.5%), and 79.4% (71.0-88.8%), respectively, and the overall survival rates were 94.5% (89.3-99.9%), 65.5% (47.1-91.2%), and 85.6% (78.3-93.6%), respectively. True interval cancers had the highest hazard ratio for relapse prediction (1.89; 0.67-5.31) and a hazard ratio of death of 5.55 (1.61-19.15) after adjustment for tumor-node-metastasis stage and phenotype. Clinically detected tumors, especially true interval cancers, more frequently showed biological features related to worse prognosis and were associated with poorer survival even after adjustment for clinical-pathological characteristics.

The epidemiology, radiology and biological characteristics of interval breast cancers in population mammography screening

“…50 In keeping with these findings, they concluded that clinically-detected BC especially where these are true interval cancers had worse prognosis and poorer survival than screen-detected BC even after adjustment for clinical-pathological variables. 50 Porter and colleagues 48 compared the features of interval BCs by radiological classification, and although they observed differences in the histological characteristics (shown in Table 3) there was no significant survival difference between interval BC radiological types ( p  = 0.64).…”

“…Domingo and colleagues 14, 50 conducted several studies examining the characteristics of interval BCs; one of these evaluated 2245 invasive BCs and clearly showed that interval BCs had more advanced tumours than screen-detected BCs (additional details by interval BC category shown in Table 3). 14 In an earlier study of 228 invasive BCs diagnosed among Barcelona women aged 50–69 years, Domingo et al 50 also found that disease-free survival rates (at 5 year follow-up from diagnosis) for screen-detected, true interval, and symptom-detected BC were 87.5%, 64.1%, and 79.4%, respectively, and overall survival rates were 94.5%, 65.5%, and 85.6%, respectively.…”

“…14 In an earlier study of 228 invasive BCs diagnosed among Barcelona women aged 50–69 years, Domingo et al 50 also found that disease-free survival rates (at 5 year follow-up from diagnosis) for screen-detected, true interval, and symptom-detected BC were 87.5%, 64.1%, and 79.4%, respectively, and overall survival rates were 94.5%, 65.5%, and 85.6%, respectively. 50 In keeping with these findings, they concluded that clinically-detected BC especially where these are true interval cancers had worse prognosis and poorer survival than screen-detected BC even after adjustment for clinical-pathological variables. 50 Porter and colleagues 48 compared the features of interval BCs by radiological classification, and although they observed differences in the histological characteristics (shown in Table 3) there was no significant survival difference between interval BC radiological types ( p  = 0.64).…”

Racial and Ethnic Disparity in Symptomatic Breast Cancer Awareness despite a Recent Screen: The Role of Tumor Biology and Mammography Facility Characteristics

“…Breast cancer that is diagnosed in younger women tends to be more aggressive and more likely to evade detection with screening mammography than in older women (14,30). In our sample of recently screened patients, as expected, SADRS was more likely in younger women.…”

Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme

“…Interval cancers tend to have poorer stage and poorer prognosis as one would expect (Biesheuvel et al , 2011; Nagtegaal et al , 2011; Domingo et al , 2013). Interval cancer rates are in the order of 2–3 per 1 000 screened in the UK programme (Bennett et al , 2011).…”