Clinicopathological differences between interval and screen-detected breast cancers diagnosed within a screening programme in Northern Portugal

Abstract

Objective: To evaluate clinicopathological differences between screen-detected (SD) and interval (IC) breast cancers diagnosed in women enrolled in an organized breast screening programme in [2000][2001][2002][2003][2004][2005][2006][2007]. Setting: Breast Cancer Screening Programme of the north region of Portugal. Methods: Using data from the screening programme and from the population-based North Region Cancer Registry, SD and IC were identified. Information on screening history, age, date of diagnosis, tumour size, histological type and grade, lymph node status, tumour stage, biomarkers, and treatment was obtained from the cancer registry and from clinical and pathological reports. Association between mode of detection and these clinicopathological characteristics was estimated by unconditional logistic regression. Results: A total of 442 SD and 112 IC were identified in women aged 50-69. Compared with SD, IC were diagnosed in younger women (60.0 AE 5.8 years and 58.4 AE 6.0 years, respectively), were larger (tumour size >20 mm: 60.2% versus 25.1%), lobular (6.3% versus 16.1%), with a higher differentiation grade (grade 3: 17.7% versus 38.9%), had more lymph node metastases, more advanced stage, and oestrogen receptor (ER) negative (12.9% versus 29.0%) and progesterone negative, and HER2 positive. After multivariable analysis, compared with SD, IC were more likely to be larger than 20 mm, lobular, of grade 3 and negative for ER. Conclusion: Our results are consistent with other studies. IC's have a more aggressive biology than SDs. Our findings did not show any unexpected pattern requiring changes to our screening procedures, but continuous identification and characterization of IC is advisable.

Differences between screen-detected and interval breast cancers among BRCA mutation carriers

“…Mirroring reports on interval cancers among the general breast cancer population, we found that interval cancers had higher-risk features. [22,13,16,[23][24][25]20,21] The interval cancers in this population were all invasive, larger, and more likely to be node positive at presentation compared to screen-detected tumors. While the literature demonstrates that interval cancers in the general population are more likely to be triple negative or estrogen receptor negative/ progesterone negative/HER2 positive [12,13,16,25,20], we found no difference in receptor status between interval and screen-detected tumors.…”

“…Demographics associated with interval cancer development among this cohort of BRCA mutation carriers included younger age and Black race, factors reported to be associated with interval cancers among the general population. [11,13,16,23,20] Women with interval cancers were less likely to have undergone a BSO, which may be a reflection of the younger age of this cohort. A lower BMI was also significantly associated with interval cancers.…”

“…[9][10][11][12][13][14][15][16][17][18][19][20][21] Interval cancers in the general population have also been shown to exhibit worse prognostic factors such as larger tumor size, higher grade, triple negative phenotype, and lymph node involvement at diagnosis. [9,22,12,13,16,[23][24][25]20,21] There are data to suggest that interval cancers have a higher rate of recurrence and worse survival compared to screen-detected cancers. [26,27,13,28,25,20,29] However, very little is known about risk factors and outcomes of interval cancers among BRCA carriers.…”

Poor Biological Factors and Prognosis of Interval Breast Cancers: Long-Term Results of Bahçeşehir (Istanbul) Breast Cancer Screening Project in Turkey

“… 3 Many studies have found that screen-detected cancers have more favorable clinicopathologic factors and prognosis that might be associated with a different tumor biology compared with interval cancers. 8 - 16 , 25 - 36 Patients with a screen-detected cancer were more likely to have a low- or even an ultra–low-risk tumor compared with interval cancers assessed by the 70-gene signature. 25 , 26 Specific copy number imbalances were also noted in screen-detected breast cancers associated with more favorable, indolent tumor genotypes and might contribute to the survival advantage associated with screening.…”