Interval carcinomas in the Malmö Mammographic Screening Trial: radiographic appearance and prognostic considerations.

Ikeda, Debra M.; Andersson, Ingvar; Wattsgård, Cecilia; Janzon, Lars; Linell, F

doi:10.2214/ajr.159.2.1632342

Cited by 134 publications

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“…These results are in accordance with those of the UK trial (Moss et al, 1993) in which 28% of women aged 45-54 and 17% of those aged 55-64 were diagnosed as having interval cancer. In a study carried out in British Columbia, interval cancers were diagnosed in 37% of women aged 40-49 and in 11 % of those aged 50-79 (Burhenne et al, 1994), and similar findings have been observed in other series (Peeters et al, 1989;Ikeda et al, 1992). These findings suggest that mammography is less sensitive among women aged less than 50 years than in those older than 50 years of age, but breast cancer might also grow more rapidly in premenopausal women than in post-menopausal women, resulting in more frequent interval cancers.…”

Section: Discussionsupporting

confidence: 79%

“…Small asymptomatic cancers can be detected by mammography not only among women older than 50 years, but also among younger women aged 40-49 years (Peeters et al, 1989;Ikeda et al, 1992;Moss et al, 1993;Burhenne et al, 1994). In a meta-analysis screening mammography reduced breast cancer mortality by 26% (95% CI 17-34%) in women aged 50-74 but did not significantly reduce breast cancer mortality in women aged 40-49 (Kerlikowske et al, 1995).…”

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confidence: 99%

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Mammography screening interval and the frequency of interval cancers in a population-based screening

Klemi

Toikkanen²,

Räsänen³

et al. 1997

Br J Cancer

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Summary In a population-based mammography screening, 129 731 examinations were carried out among 36 000 women aged in the city of Turku, Finland, in the period 1987-94. Women older than 50 were screened at 2-year intervals, and those younger than 50 at either 1-year or 3-year intervals, depending on their year of birth. Screen-detected breast cancers numbered 385 and, during the same time period, 154 women were diagnosed with breast cancer outside screening in the same age group in the same city, and 100 interval cancers were detected. Two hundred and fifty (67%) of the screen-detected cancers were of post-surgical stage compared with 45 (45%) of the interval cancers and 52 (34%) of the cancers found outside screening (P<0.0001). However, among women aged 40-49 the frequency of stage cancers did not differ significantly among screen-detected cancers, interval cancers and cancers found outside screening (50%, 42% and 44% respectively; P=0.73). Invasive interval cancers were more frequent among women aged 40-49 if screening was done at either 1-year (27%) or 3-year intervals (39%) than in older women screened at 2-year intervals (18%; P=0.08 and P=0.0009 respectively). Even if adjusted for the primary tumour size, screen-detected cancers had smaller S-phase fractions than interval cancers or control cancers (P=0.01), but no difference in the S-phase fraction size was found between cancers of women younger than 50 and those older than this (P=0.13). We conclude that more interval cancers were found among women younger than 50 than among those older than 50 and that this could not be explained by the rate of cancer cell proliferation.Keywords: breast cancer; mammography; flow cytometry Mammography is currently used for population-based mass screening of breast cancer in several countries because it can detect asymptomatic breast cancer at an early stage when dissemination of cancer is still unlikely. Small asymptomatic cancers can be detected by mammography not only among women older than 50 years, but also among younger women aged 40-49 years (Peeters et al, 1989;Ikeda et al, 1992;Moss et al, 1993;Burhenne et al, 1994). In a meta-analysis screening mammography reduced breast cancer mortality by 26% (95% CI 17-34%) in women aged 50-74 but did not significantly reduce breast cancer mortality in women aged 40-49 (Kerlikowske et al, 1995). However, analysis of randomized trials on mammography screening concluded that, if the Canadian National Breast Screening Study was excluded from the analysis, a statistically significant benefit of 23% was present, in favour of the screened women . It is debatable whether or not population-based mass screening should be carried out among women younger than 50 (Fletcher et al, 1993;Kaluzny et al, 1994).Although a shorter screening interval than 2 years has been recommended and used by some (Morrison et al, 1988;Tabar et al, 1995), a meta-analysis of studies in which mammography screening at various intervals was compared with no screening failed to show that screening at 12-month in...

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Section: Discussionsupporting

confidence: 79%

mentioning

confidence: 99%

Mammography screening interval and the frequency of interval cancers in a population-based screening

Klemi

Toikkanen²,

Räsänen³

et al. 1997

Br J Cancer

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“…In order to calculate tumour growth rates in patients without visible abnormality on the previous screening mammogram, an initial 5-mm tumour size was assigned if the diagnosed tumour was located in fatty area and a 10-mm initial tumour size was assigned if the diagnosed tumour was located in dense area (5,14) . These assigned sizes represent the maximum size of a tumour that could potentially have been missed at the time of screening.…”

Section: Growth Rate Estimationmentioning

confidence: 99%

“…Several studies have estimated the volume doubling time of breast cancers based on mammograms (1,2,(5)(6)(7)(8)(9)(10)(11) , however, few have correlated tD with histopathological characteristics (2,7,(9)(10)(11) . To the best of the authors' knowledge, only one study based on ultrasound has correlated tD with tumour characteristics such as the oestrogen receptor (ER), the progesterone receptor (PR), the human epidermal growth factor receptor 2 (HER2) and Ki-67 expression (12) .…”

Section: Introductionmentioning

confidence: 99%

Estimates of Breast Cancer Growth Rate From Mammograms and Its Relation to Tumour Characteristics

Förnvik

Lång

Andersson

et al. 2015

Radiat Prot Dosimetry

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“…The biology of cancers presenting at stage 2 or 3 is different from that of screen-detected cancers (12 ). Interval cancers, for example, which present between regular screening intervals, have higher growth fractions and worse outcomes (13 ).…”

Section: Improve the Detection And Diagnosis Of Aggressive Cancers Thmentioning

confidence: 99%

Will Early Detection for Breast Cancer Ever Work?

2013

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The fundamental challenge for those who advocate for screening and early detection of breast cancer is that breast cancer is not a single disease. It is a collection of heterogeneous diseases, ranging from those that grow slowly and pose little risk, to diseases with the potential for metastatic spread, even at a very early stage.To understand how to refocus early-detection efforts in breast cancer, it is important to examine the trends in cancer incidence since the introduction of widespread screening mammography. Routine screening mammography in the US has produced an increase in the detection of early-stage disease, particularly in situ (stage 0) and early-stage (stage 1) cancers. Despite the considerable increase in the detection of ductal carcinoma in situ (DCIS), there has not been a proportional concomitant decline in the incidence of earlystage invasive cancers, which is what one would expect if DCIS were an obligate precursor to invasive breast cancer. Similarly, the overall incidence rates of stage 2 and 3 cancers have shown only a small decline over the last 20 years, despite the overall significant increase in the detection of in situ and early-stage cancer. This finding suggests a bias toward the detection of indolent rather than aggressive cancers (1, 2 ). This trend is particularly worrisome because the goal of screening is to prevent lethal, progressive disease by detecting cancer at an earlier, more treatable stage, or by detecting precursor lesions that can be removed before they develop into lethal invasive cancers. Yet epidemiologic data suggest that screening has substantially contributed to an increase in the detection of early-stage disease that may have little chance of progressing or becoming lethal over the course of a person's lifetime.The original notion behind screening, based on the excellent survival rate for stage 1 cancers, was that targeting removal at an early stage would prevent death. What we have learned is that cancer is not homogeneous and that the early-stage cancers may represent just a different pathway or tumor type than the more aggressive tumors. The facts have led us to a new hypothesis. Some cancers progress slowly or not at all. These kinds of tumors are largely hormone driven, and the outcomes for these tumors are excellent regardless of when they are detected, especially given the setting of modern adjuvant endocrine therapy. Women who develop these kinds of tumors will not benefit from screening and will likely be subjected to overtreatment. Others will develop tumors that will grow at a moderate pace; these tumors are likely to be those for which early detection is likely to be most helpful. Still other women will develop cancers that arise quickly and either present as a large mass between screens or still pose a lethal threat even when small. Screening will not hold the key to the cure for women with these kinds of tumors. The key to improving survival for these women is to focus on how to develop and effectively tailor treatments at the time of diagnosis, o...

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Interval carcinomas in the Malmö Mammographic Screening Trial: radiographic appearance and prognostic considerations.

Cited by 134 publications

References 0 publications

Mammography screening interval and the frequency of interval cancers in a population-based screening

Mammography screening interval and the frequency of interval cancers in a population-based screening

Estimates of Breast Cancer Growth Rate From Mammograms and Its Relation to Tumour Characteristics

Will Early Detection for Breast Cancer Ever Work?

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