Breast carcinoma diagnosis, treatment, and prognosis before and after the introduction of mass mammographic screening

Abstract

BACKGROUND The introduction of breast carcinoma screening leads to early detection and is believed to reduce mortality and increase the proportion of patients for whom breast‐conserving surgery is possible. METHODS In 1992, a population‐based mammographic screening program was introduced in the Dutch city of Tilburg and its surroundings; the program achieved total coverage in 1996. The authors examined the effects of this screening program by investigating disease stage, treatment, and survival among women diagnosed with breast carcinoma at a teaching hospital in Tilburg during the periods 1985–1991 and 1992–1999. RESULTS Between January 1, 1985, and December 31, 1999, 1400 patients were diagnosed with breast carcinoma. Among patients ages 50–69 years, the proportion of TNM Stage I breast carcinoma increased from 24% in 1985–1991 to 45% in 1992–1999 (P < 0.001). The proportion of patients age < 50 years with invasive breast carcinoma who underwent breast‐conserving surgery decreased from 45% to 33% (P = 0.011). Among patients ages 50–69 years, the overall survival rate during the period from 1992 to 1999 was significantly greater than the corresponding rate during the period from 1985 to 1991 (P = 0.0009). Even after adjustments were made for tumor stage and patient age, a slight reduction in mortality risk was observed in this age group. No difference in stage distribution or prognosis was found among patients age < 50 years or among patients age ≥ 70 years. Of the 168 invasive malignancies found in patients ages 50–69 years between 1997 and 1999, 68 (40%) were detected by the screening program, 47 (28%) were interval malignancies, and 53 (32%) were detected in nonparticipants or in women who did not participate in 1 or more screening rounds. Patients with screen‐detected tumors had a much more favorable prognosis than did patients with interval malignancies (P = 0.0018) or patients with clinically detected breast carcinoma (P < 0.0001). CONCLUSIONS Between 1992 and 1999, after the introduction of breast carcinoma screening, improved prognosis and more favorable tumor stage were observed among patients ages 50–69 years. Even after the screening program was fully implemented in 1996, the majority of invasive malignancies still were detected between screening rounds or in patients who did not participate in the program. Cancer 2004;100:1337–44. © 2004 American Cancer Society.

Role of mammography screening as a predictor of survival in postmenopausal breast cancer patients

“…We paid special attention to finding all the women who got a breast cancer diagnosis within 2 years after a negative screening examination. The proportion of interval cancers (31% of the cancers in the group that participated screening) in the present work is at the same level as in many previous works (Peeters et al, 1989;Everington et al, 1999;Ernst et al, 2004). This indicates that the quality of the present screening programme is at an acceptable level.…”

“…Recent evaluations have shown that service screening may be even more effective than screening in population-based trials Paci et al, 2002;Gorini et al, 2004). Information of actual participation to screening, data of incident cancers and detailed information of tumour characteristics have provided more precise information of breast cancer prognosis in the screened and not-screened patients (Ernst et al, 2004). Comparison of incident-based breast cancer mortality before and after beginning of screening has shown a significant mortality reduction (Tabar et al, 2003;Gorini et al, 2004).…”

Breast Medical Oncologists' Use of Standard Prognostic Factors to Predict a 21-Gene Recurrence Score

“…Of these, about half are early-stage, lymph node-negative, hormone receptor-positive tumors. More public health campaigns for regular mammographic screening have increased detection of tumors in early stages, before regional or distant metastasis has occurred [2]. Although adjuvant clinical trials have clearly demonstrated that adjuvant chemotherapy prolongs survival for patients with early-stage breast cancer [3], retrospective analyses of some of these trials suggest that the benefit may be restricted to a subset of patients with either poor or negative expression of estrogen receptor (ER) [4] or patients with human epidermal growth factor receptor (HER)-2 ϩ breast cancer [5].…”

Bladder Metastases from Breast Cancer: Managing the Unexpected. A Systematic Review

“…Approximately 3–10% of all BrC patients have metastatic disease at their initial diagnosis; recurrent disease or metastasis occurs in approximately 30% of patients during follow-up after initial treatment [23-26]. The distant metastatic pattern of ILC differs significantly from that of IDC, as it tends to occur as a diffuse thickening of mucosa rather than a discrete nodule.…”