Cumulative Risk Distribution for Interval Invasive Second Breast Cancers After Negative Surveillance Mammography

Abstract

Purpose The aim of the current study was to characterize the risk of interval invasive second breast cancers within 5 years of primary breast cancer treatment. Methods We examined 65,084 surveillance mammograms from 18,366 women with a primary breast cancer diagnosis of unilateral ductal carcinoma in situ or stage I to III invasive breast carcinoma performed from 1996 to 2012 in the Breast Cancer Surveillance Consortium. Interval invasive breast cancer was defined as ipsilateral or contralateral cancer diagnosed within 1 year after a negative surveillance mammogram. Discrete-time survival models-adjusted for all covariates-were used to estimate the probability of interval invasive cancer, given the risk factors for each surveillance round, and aggregated across rounds to estimate the 5-year cumulative probability of interval invasive cancer. Results We observed 474 surveillance-detected cancers-334 invasive and 140 ductal carcinoma in situ-and 186 interval invasive cancers which yielded a cancer detection rate of 7.3 per 1,000 examinations (95% CI, 6.6 to 8.0) and an interval invasive cancer rate of 2.9 per 1,000 examinations (95% CI, 2.5 to 3.3). Median cumulative 5-year interval cancer risk was 1.4% (interquartile range, 0.8% to 2.3%; 10 to 90th percentile range, 0.5% to 3.7%), and 15% of women had ≥ 3% 5-year interval invasive cancer risk. Cumulative 5-year interval cancer risk was highest for women with estrogen receptor- and progesterone receptor-negative primary breast cancer (2.6%; 95% CI, 1.7% to 3.5%), interval cancer presentation at primary diagnosis (2.2%; 95% CI, 1.5% to 2.9%), and breast conservation without radiation (1.8%; 95% CI, 1.1% to 2.4%). Conclusion Risk of interval invasive second breast cancer varies across women and is influenced by characteristics that can be measured at initial diagnosis, treatment, and imaging. Risk prediction models that evaluate the risk of cancers not detected by surveillance mammography should be developed to inform discussions of tailored surveillance.

Facility Variability in Examination Indication Among Women With Prior Breast Cancer: Implications and the Need for Standardization

“…Performance outcomes of surveillance mammography that solely include screening indication would systematically exclude a substantial proportion of examinations in women with a PHBC (39.4% in the first 5 years), disproportionately excluding surveillance examinations from women with BCS and examinations most proximal to initial breast cancer diagnosis. Previous BCSC studies have reported surveillance mammography sensitivity from 65.6% [21] to 70.3% [22] with high-interval cancer rates (2.9 per 1,000 examinations [95% CI 2.5-3.3]) [23]. Additionally, new breast imaging modalities and supplemental imaging could result in improved outcomes, but they complicate decision making for providers, insurers, and women with a PHBC.…”

Challenges and Changes of the Breast Cancer Screening Paradigm

“…In women with a personal history of breast cancer post‐treatment changes can have an influence on the diagnostic performance of the mammography for the detection of tumor recurrence and can be an important reason for failure of early diagnosis 88,89 . With mammography follow‐up, up to 50% of cancers present in between surveillance rounds as interval cancers 90 . Kim et al analyzed 6603 MRI examinations in four screening rounds 75 .…”

“…88,89 With mammography follow-up, up to 50% of cancers present in between surveillance rounds as interval cancers. 90 Kim et al analyzed 6603 MRI examinations in four screening rounds. 75 Overall, 8.3 cancers were detected per 1000 screens (9.3 cancers per 1000 screens in the prevalence round and 7.4, 8.0 and 7.7 cancers per 1000 screens in the subsequent incident rounds).…”

Potential Role of Fourier Transform Infrared Spectroscopy as a Screening Approach for Breast Cancer

“…This results in a significant incidence of advanced disease followed by high mortality, representing a serious public global health problem that is more accentuated in underdeveloped and developing countries, as is the case of Brazil. 4,12,13 Conventionally, the gold standard for screening in Brazil without signs or symptoms is mammography. 7 In addition, ultrasonography, magnetic resonance imaging, and histological evaluation by biopsy to identify the histological type and staging are used as diagnostic methods.…”