Mammographic and clinical characteristics of different phenotypes of screen-detected and interval breast cancers in a nationwide screening program

Baré, Marisa; Torà, Núria; Salas, Dolores; Sentís, Melcior; Ferrer, Joana; Ibáñez, Josefa; Zubizarreta, Raquel; Sarriugarte, Garbiñe; Barata, Teresa; Domingo, Laia; Castells, Xavier; Sala, María

doi:10.1007/s10549-015-3623-9

Cited by 43 publications

(28 citation statements)

References 26 publications

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“…For example, if a cancer is presented with a spiculated mass on mammogram and found to be HER2 overexpressing, a flag can be raised to indicate a discordant result. As HER2 overexpressing cancers almost never present as spiculated masses, it might be worthwhile to repeat pathology testing of the receptors (615). …”

Section: Discussionmentioning

confidence: 99%

Is There a Correlation between the Presence of a Spiculated Mass on Mammogram and Luminal A Subtype Breast Cancer?

Liu

et al. 2016

Korean J Radiol

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ObjectiveTo determine whether the appearance of a spiculated mass on a mammogram is associated with luminal A subtype breast cancer and the factors that may influence the presence or absence of the spiculated mass.Materials and MethodsThree hundred seventeen (317) patients who underwent image-guided or surgical biopsy between December 2014 and April 2015 were included in the study. Radiologists conducted retrospective assessments of the presence of spiculated masses according to the criteria of Breast Imaging Reporting and Data System. We used combinations of estrogen receptor (ER), progesterone receptor (PR), human epithelial growth factor receptor 2 (HER2), and Ki67 as surrogate markers to identify molecular subtypes of breast cancer. Pearson chi-square test was employed to measure statistical significance of correlations. Furthermore, we built a bi-variate logistic regression model to quantify the relative contribution of the factors that may influence the presence or absence of the spiculated mass.ResultsSeventy-one percent (71%) of the spiculated masses were classified as luminal A. Masses classified as luminal A were 10.3 times more likely to be presented as spiculated mass on a mammogram than all other subtypes. Patients with low Ki67 index (< 14%) and HER2 negative were most likely to present with a spiculated mass on their mammograms (p <0.001) than others. The hormone receptor status (ER and PR), pathology grade, overall breast composition, were all associated with the presence of a spiculated mass, but with less weight in contribution than Ki67 and HER2.ConclusionWe observed an association between the luminal A subtype of invasive breast cancer and the presence of a spiculated mass on a mammogram. It is hypothesized that lower Ki67 index and HER2 negativity may be the most significant factors in the presence of a spiculated mass.

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Section: Discussionmentioning

confidence: 99%

Is There a Correlation between the Presence of a Spiculated Mass on Mammogram and Luminal A Subtype Breast Cancer?

Liu

et al. 2016

Korean J Radiol

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“…Electronic medical records were reviewed for patient age, BI-RADS final assessment categories, pathology results from core biopsy and/or surgical excision, tumor size at surgical excision, larger size, estrogen receptor-negative status, and positive lymph node involvement (10,(14)(15)(16)(17)(18). Thus, interval cancers often manifest with a poorer prognosis than do screening-detected cancers.…”

Section: Data Collection and Statistical Analysismentioning

confidence: 99%

Breast Cancer Characteristics Associated with 2D Digital Mammography versus Digital Breast Tomosynthesis for Screening-detected and Interval Cancers

et al. 2018

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Purpose To determine whether the rates and tumor characteristics of screening-detected and interval cancers differ for two-dimensional digital mammography (DM) versus digital breast tomosynthesis (DBT) mammography. Materials and Methods Consecutive screening mammograms from January 2009 to February 2011 (DM group, before DBT integration) and from January 2013 to February 2015 (DBT group, after complete DBT integration) were reviewed. Cancers were considered screening detected if diagnosed within 365 days of a positive screening examination and interval if diagnosed within 365 days of a negative screening examination. Z tests were used to compare cancers on DM versus DBT examinations. Results A total of 948 breast cancers were diagnosed after 78 385 DM and 76 896 DBT examinations. Although the overall rate of screening-detected cancers was similar with DM and DBT (5.0 vs 5.0 per 1000 examinations, P = .98), a higher proportion of screening-detected cancers were invasive rather than in situ with DBT (74.2% [287 of 387] vs 66.0% [260 of 394], P = .01). There were no significant differences in tumor characteristics, including size at pathologic examination, grade, hormone receptor status, and nodal status, between the screening-detected invasive cancers on DM versus DBT (P = .09-.99). The rate of interval cancers was similar with DM and DBT (1.1 vs 1.1 per 1000 examinations, P = .84). Compared with symptomatic interval cancers, magnetic resonance imaging-detected interval cancers were more likely to be minimal cancers. Conclusion The overall rates of screening-detected and interval cancers are similar with DM and DBT, but a higher proportion of screening-detected cancers are invasive rather than in situ with DBT. RSNA, 2017.

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“…First, interval cancers may be cancers that existed at the time of screening but were not detected (false negatives). Some missed tumors are believed to be caused by masking bias, wherein high mammographic density can conceal a tumor from being detected(16,17); it is also possible that radiographic features of the cancer may influence detection(18). Second, interval cancers may represent cancers that were not present at the time of screening, but possess aggressive tumor characteristics that enable them to grow to a detectable level before the next screening.…”

Section: Introductionmentioning

confidence: 99%

PAM50 and Risk of Recurrence Scores for Interval Breast Cancers

Puvanesarajah

Nyante

Kuzmiak

et al. 2018

Cancer Prevention Research

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Breast cancers detected after a negative breast screening examination and prior to the next screening are referred to as interval cancers. These cancers generally have poor clinical characteristics compared to screen-detected cancers, but associations between interval cancer and genomic cancer characteristics are not well understood. Mammographically-screened women diagnosed with primary invasive breast cancer from 1993-2013 (n=370) were identified by linking the Carolina Breast Cancer Study and the Carolina Mammography Registry. Among women with a registry-identified screening mammogram 0-24 months before diagnosis, cancers were classified as screen-detected (N=165) or interval-detected (N=205). Using logistic regression, we examined the association of mode of detection with cancer characteristics (clinical, IHC, and genomic), overall, and in analyses stratified on mammographic density and race. Interval cancer was associated with large tumors (> 2 cm) (OR=2.3; 95% C.I.: 1.5, 3.7), positive nodal status (OR=1.8; 95% C.I.: 1.1, 2.8), and triple negative subtype (OR=2.5; 95% C.I.: 1.1, 5.5). Interval cancers were more likely to have non-Luminal A subtype (OR=2.9; 95% C.I.: 1.5, 5.7), while screen-detected cancers tended to be more indolent (96% had low risk of recurrence genomic scores; 71% were PAM50 Luminal A). When stratifying by mammographic density and race, associations between interval detection and poor prognostic features were similar by race and density status. Strong associations between interval cancers and poor-prognosis genomic features (non-Luminal A subtype and high risk of recurrence score) suggest that aggressive tumor biology is an important contributor to interval cancer rates.

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Mammographic and clinical characteristics of different phenotypes of screen-detected and interval breast cancers in a nationwide screening program

Cited by 43 publications

References 26 publications

Is There a Correlation between the Presence of a Spiculated Mass on Mammogram and Luminal A Subtype Breast Cancer?

Is There a Correlation between the Presence of a Spiculated Mass on Mammogram and Luminal A Subtype Breast Cancer?

Breast Cancer Characteristics Associated with 2D Digital Mammography versus Digital Breast Tomosynthesis for Screening-detected and Interval Cancers

PAM50 and Risk of Recurrence Scores for Interval Breast Cancers

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