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

Anttinen, Jorma; Kautiainen, Hannu; Kuopio, Teijo

doi:10.1038/sj.bjc.6602895

Cited by 17 publications

(10 citation statements)

References 21 publications

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“…Although our early analysis does not provide patient follow-up data, the computed 10-year risks of relapse and death probably afford a realistic insight concerning the outcome depending on the mode of detection in our patients. These data accord well with the important findings of a good number of studies [7][8][9][10][11][12][13][14], and notably the superior outcome of screen-detected breast cancers as compared with their symptomatic counterparts. Moreover, the analyses by Joensuu et al [11] and Gill et al [13] suggest that screening-detection itself is an independent favorable prognostic factor that should be taken into consideration when the adjuvant therapy is to be specified.…”

Section: Discussionsupporting

confidence: 89%

“…An appreciable number of studies have clearly indicated that the introduction of mammographic screening has been followed by a shift to tumors with better prognostic factors. [7][8][9][10][11][12][13][14] Thus, screen-detected breast cancers are smaller, more frequently lymph node-negative, [7][8][9][10][11][12][13][14] of lower grade, [9,11,13] and consequently need less oncological treatment than their symptomatic counterparts. [11,13] In addition to this stage shift stemming from the earlier detection, the better outcome is explained by the different biological behavior of these early cancers, since the detection by mammographic screening has been shown to be an independent favorable prognostic factor as regards distant metastasis-free survival and overall survival relative to that in symptomatic tumors.…”

Section: Introductionmentioning

confidence: 98%

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Tumor Characteristics in Screen-Detected and Symptomatic Breast Cancers

Pálka

Kelemen

Ormándi

et al. 2008

Pathol. Oncol. Res.

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The natural course of early breast cancer has changed as a result of the introduction of mammographic screening. The present aim was a prospective analysis of screen-detected and symptomatic operable breast cancers in the era of mammographic service screening. The mode of detection (screen-detected, symptomatic or interval cancer), the type of mammographic image and other characteristics (the invasive tumor size, histological tumor type, grade, nodal, hormone receptor and HER2 status and the presence of lymphovascular invasion) of 569 invasive breast cancers were studied. Screen-detected cancers were significantly more frequently of grade I, < 10 mm of size and node-negative (p < 0.001, respectively). Symptomatic/interval cancers were significantly more frequently of grade 3, >20 mm of size (p < 0.001), and exhibited lymphovascular invasion (p = 0.001). Screening-detection of the tumor favored breast-conserving surgery, sentinel lymph node biopsy and the avoidance of chemotherapy (p < 0.001). Cancers associated with casting-type calcifications on the mammogram were typically of ductal type (p = 0.043), of grade 2-3, estrogen receptor and progesterone receptor-negative and HER2-positive (p < 0.001). Interval cancers occurred significantly more often at a younger age and remained mammographically occult as compared with other cancers. Mammographic screen-detected cancers demonstrate more favorable prognostic features, and need less extensive treatment than symptomatic or interval cancers. The mammographic appearance of the tumor reflects its biological behavior, and this should be considered in the management optimization.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 98%

Tumor Characteristics in Screen-Detected and Symptomatic Breast Cancers

Pálka

Kelemen

Ormándi

et al. 2008

Pathol. Oncol. Res.

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“…Patients who had their diagnosis mammography performed within the screening framework had better survival of 13.3% at 5 years, and 18.6% at 7 years (Po0.001), whereas the others who had mammography after the onset of clinical symptoms, or because they belonged to a high risk group, had an increased death risk hazard of 2.2 (95% CI ¼ [1.5 -3.2]; Po0.001). Other studies have also found that screening detected smaller tumours with a more favourable prognosis compared with those clinically detected (Fracheboud et al, 2004;Anttinen et al, 2006). However, to our knowledge, mammography itself as a mode of detection has rarely been demonstrated as an independent prognostic factor in women who all had a diagnosis mammography, and in a population-based study, that is to say without any intervention or evaluation.…”

Section: Discussionmentioning

confidence: 79%

The influence of socio-economic and surveillance characteristics on breast cancer survival: a French population-based study

Gentil-Brevet

Colonna²,

Danzon

et al. 2008

Br J Cancer

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Survival data on female invasive breast cancer with 9-year follow-up from five French cancer registries were analysed by logistic regression for prognostic factors of cancer stage. The Kaplan -Meier method and log-rank test were used to estimate and compare the overall survival probability at 5 and 7 years, and at the endpoint. The Cox regression model was used for multivariate analysis. County of residence, age group, occupational status, mammographic surveillance, gynaecological prevention consultations and the diagnosis mammography, whether within a screening framework or not, were independent prognostic factors of survival. Moreover, for the same age group, and only for cancers T2 and/or N þ (whether 1, 2 or 3) and M0, the prognosis was significantly better when the diagnosis mammography was done within the framework of screening. Socio-economic and surveillance characteristics are independent prognostic factors of both breast cancer stage at diagnosis and of survival. Screening mammography is an independent prognostic factor of survival.

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“…Th e proportion of in situ and <15 mm invasive carcinomas amongst all screen-detected breast cancers varies in the range of 30-60% [3,16,28], and depends on the time interval since the introduction and the quality and other features of the mammographic screening. Th e fi ndings of numerous comparative analyses are concordant in that screen-detected cancers are smaller, more frequently lymph node-negative and of low grade [17,[28][29][30][31][32][33][34][35]. Some have reported more frequent hormone receptor positivity [4,28,30,[33][34][35]37], HER2 negativity (30,34) and lower proliferation activity by means of Ki67 expression [28,30,32, 34] among screen-detected tumours.…”

mentioning

confidence: 91%

New approaches for the classification of early breast cancer, a heterogeneous disease entity

Kahán

2011

memo

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memo Breast cancer classifi cation 3/2011 leading article 135 © Springer-VerlagTh e proportion of breast cancers detected in the very early stages (in situ and invasive breast cancers <15 mm) in daily practice has signifi cantly increased, thanks to breast screening, breast awareness and improved detection methods. Most of these tumours show less aggressive biological phenotype than their more advanced counterparts, and have an excellent long-term prognosis without applying oncological treatments. Th e identifi cation of the minority of cancers with a poor prognosis and their appropriate therapy is the real challenge. In fact, neither the fi rst-generation prognostic factors (the tumour size, the lymph node status and the histology grade), nor the usual additional parameters (the receptor status and proliferation markers) are reliable enough for the estimation of the outcome. Likewise, the conventional predictive factors such as the ER, PR and HER2 status are not suffi cient for the individualization of therapy in those cases that need oncological therapy. Th is overview points to the pressing need and the emerging elements of a potential new classifi cation system of early breast cancer including the consideration of the mammographic appearance, the extent of the disease instead of just the largest dimension of the main invasive focus and the mode of detection or the use of molecular tests.Keywords: Early breast cancer, classifi cation system, individualized therapy, predictive factor, prognostic factor.Signifi cant new achievements have been made in the fi eld of breast cancer in recent decades. Th e world-wide implementation of mammographic breast screening has shed light on the progressive and heterogeneous nature of breast cancer, and opened up a completely new era [1][2][3]. Th e proportion of breast cancers detected in the very early stages (in situ and invasive breast cancers <15 mm) in daily practice is steadily increasing, thanks to breast screening, heightened breast awareness and improved detection methods [4]. Most of these screen-detected cancers are non-palpable, need less radical therapy and have an excellent long-term outcome.Furthermore, a signifi cant proportion are being cured by surgery alone, and any other therapy would therefore comprise overtreatment in many cases. Th e identifi cation of the minority of cancers with a poor prognosis and their appropriate therapy is the real challenge. Th e diff erence in the outcome of the low-risk versus the high-risk breast cancer cases seems more striking in the very early stages than in the advanced stages. Nevertheless, the fi rst-generation prognostic factors (the tumour size, lymph node status and grade, which are obviously dependent on the stage of tumour progression) do not appropriately refl ect the diversity of this heterogeneous group [5,6]. Th us, new tools are needed for the characterization, and for the implementation of a new classifi cation system that could distinguish between the low-risk and the high-risk cases [3,7]. Th e experience t...

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

Cited by 17 publications

References 21 publications

Tumor Characteristics in Screen-Detected and Symptomatic Breast Cancers

Tumor Characteristics in Screen-Detected and Symptomatic Breast Cancers

The influence of socio-economic and surveillance characteristics on breast cancer survival: a French population-based study

New approaches for the classification of early breast cancer, a heterogeneous disease entity

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