Breast Cancer Screening: Significance of Minimal Breast Cancers

PURPOSE The Turkish Bahçeşehir Breast Cancer Screening Project was a 10-year, organized, population-based screening program carried out in Bahçeşehir county, Istanbul. Our aim was to examine the biologic features and outcome of screen-detected and interval breast cancers during the 10-year study period. METHODS Between 2009 and 2019, 2-view mammograms were obtained at 2-year intervals for women aged 40 to 69 years. Clinicopathological characteristics including ER, PR, HER2-neu, and Ki-67 status were analyzed for those diagnosed with breast cancer. RESULTS In 8,758 screened women, 131 breast cancers (1.5%) were detected. The majority of patients (82.3%) had prognostic stage 0-I disease. Contrarily, patients with interval cancers (n = 15; 11.4%) were more likely to have a worse prognostic stage (II-IV disease; odds ratio [OR], 3.59, 95% CI, 0.9 to 14.5) and high Ki-67 scores (OR, 3.14; 95% CI, 0.9 to 11.2). Interval cancers detected within 1 year were more likely to have a luminal B (57.1% v 31.9%) and triple-negative (14.3% v 1%) subtype and less likely to have a luminal A subtype (28.6% v 61.5%; P = .04). Patients with interval cancers had a poor outcome in 10-year disease-specific (DSS) and disease-free survival (DFS) compared with those with screen-detected cancers (DSS: 68.2% v 98.1%, P = .002; DFS: 78.6% v 96.5%, P = .011). CONCLUSION Our findings suggest the majority of screen-detected breast cancers exhibited a luminal A subtype profile with an excellent prognosis. However, interval cancers were more likely to have aggressive subtypes such as luminal B subtype or triple-negative cancers associated with a poor prognosis requiring other preventive strategies.

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Changing trends in proportional incidence and net survival of screened and nonscreened breast cancers among women in England

10.1101/19003202 ◽

2019 ◽

Author(s):

Haiyan Wu ◽

Kwok Wong ◽

Shou-En Lu ◽

John Broggio ◽

Lanjing Zhang

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Invasive Breast Cancer ◽

Temporal Trends ◽

Breast Cancers ◽

Upward Trend ◽

Net Survival ◽

Survival Difference ◽

Proportional Incidence

AbstractBackgroundUptake of breast cancer screening has been decreasing in England since 2007, and may increase proportional incidence of nonscreened cancers. However, recent trends in proportional incidence and net-survivals of screened and nonscreened breast cancers are unclear.MethodsWe extracted population-based proportional incidence and age-standardized 5-year net-survivals from Public Health England, for English women with invasive breast cancer diagnosed during 1995-2011 (linked to death certificates, followed through 2016). Piecewise log-linear models with change-point/joinpoint were used to estimate temporal trends. We conducted a quasi-experimental study to test the hypothesis that the trend-change year of proportional incidence coincided with that of 5-year net-survival.ResultsAmong 254,063 women in England with invasive breast cancer diagnosed during 1995-2011, there was downward-to-upward trend-change in proportional incidence of nonscreened breast cancers (annual percent change[APC]=5.6 after 2007 versus APC=-3.5 before 2007, P<0.001) in diagnosis-year 2007, when steeper upward-trend in age-standardized 5-year net survival started (APC=5.7 after 2007/2008 versus APC=0.3 before 2007/2008, P<0.001). Net-survival difference of screened versus nonscreened cancers also significantly narrowed (18% in 2007/2008 versus 5% in 2011). Similar associations were found in all strata of race, cancer stage, grade and histology, except in Black patients or patients with stage I, stage III, or grade I cancer.ConclusionsThe downward-to-upward trend-change in proportional incidence of nonscreened breast cancers is associated with steeper upward-trend in age-standardized 5-year net survival among English women in recent years. Survival benefits of breast cancer screening appear decreasing in recent years. The data support reduction of breast cancer screening in some patients.

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Breast Cancer Screening and Impalpable Breast Cancers – Our Experience

Journal of Medical and Scientific Research ◽

10.17727/jmsr.2013/1-009 ◽

2013 ◽

Vol 1 (1) ◽

pp. 40-44

Author(s):

Jwala Srikala M

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Breast Cancers

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Overcoming Overdiagnosis: Women´s Preferences for Improving Breast Cancer Screening

Journal of Global Oncology ◽

10.1200/jgo.18.50800 ◽

2018 ◽

Vol 4 (Supplement 2) ◽

pp. 38s-38s

Author(s):

H.L. Bromley ◽

T.E. Roberts ◽

D. Petrie ◽

B.G. Mann ◽

D. Rea ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Ductal Carcinoma ◽

Low Risk ◽

Breast Cancers ◽

Active Monitoring ◽

The Impact

Background: Breast cancer screening is effective in reducing breast cancer mortality, but there is increasing concern that it may also lead to overdiagnosis; the detection and treatment of a cancer that would never have presented symptomatically during the woman's lifetime. Conservative management of low-risk breast cancer may reduce the harm of overdiagnosis resulting from mammographic screening programs, yet little is known about how such strategies might impact upon quality of life. Aim: To quantify women's preferences for managing low risk breast cancers identified by breast cancer screening. Methods: Utilities (measures of preference) were obtained from women with and without a history of breast cancer for seven health states reflecting low risk screen detected ductal carcinoma in situ (DCIS) using standard gambles. Demographics and a history of prior screening participation or breast cancer diagnosis were examined as predictors of screening and treatment pathway preferences. Results: Utilities were lower for breast cancers treated with mastectomy or invasive adjuvant treatment. The impact of active monitoring on quality of life was comparable to breast conserving surgery, although women in both patient and general population groups rated active monitoring more favorably as the risk of disease spread was decreased. There was some variation in ratings across patients suggesting that individual risk aversion does affect preferences for the type of conservative management valued. Conclusion: Overdiagnosis remains a challenge for improving the current breast cancer screening program. Active monitoring of low risk ductal carcinoma in situ may provide an acceptable solution for reducing the impact of overdiagnosis and overtreatment resulting from breast cancer screening on quality of life.

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Molecular profiles of screen-detected breast cancers from a Turkish breast cancer screening program.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.e12545 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. e12545-e12545

Author(s):

Neslihan Cabioglu ◽

Sibel Ozkan Gurdal ◽

Arda Kayhan ◽

Nilufer Ozaydin ◽

Erkin Aribal ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Triple Negative ◽

Ductal Carcinoma ◽

Screening Program ◽

Breast Conservation ◽

Breast Cancers ◽

Luminal A ◽

Screening Programs

e12545 Background: TurkishBahcesehir Breast Cancer Screening Project is a 10-year organized population based screening program carried out in one of the largest counties in Istanbul, Turkey. The aim of this study is to determine the biological features of screen detected breast cancers detected during the initial 4-year study period as an interim analysis. Methods: Between January 2009 and December 2012, a total of 5938 women with ages 40–69 years were recruited in this prospective study. Two-view mammographies were obtained by 2-year intervals, and classified according to Breast Imaging Reporting and Data System of the American College of Radiology (ACR). Patient and tumor characteristics were analysed for those diagnosed with breast cancer. Tumors were stained for estrogen (ER) and progesterone receptors (PR), HER2-neu and Ki-67 by immunohistochemistry. Results: A total of 49 breast cancers (% 0.83) were detected during the study period. The median age was 50 (40-70). The majority of patients (78%) were stage 0 or 1, whereas 23 patients (47%) were <50 age. Of 49 tumors, 38 (78%) were invasive cancers and 11 (22%) were ductal carcinoma in situ. Forty-four patients (90%) underwent breast conservation, whereas 35 patients (75%) had sentinel lymph node biopsy. Of 38 invasive cancers, 24 (63%) were ductal carcinoma and 8 (21%) were lobular cacinoma. Among 31 invasive cancers stained for ER, PR, HER2-neu and Ki67, the majority of them (92%) were hormone receptor positive, whereas 13% were HER2-neu positive and 58% had low Ki67 levels (<14). As molecular subtypes, the majority of them were found to be either luminal A (48%) or luminal B type (42%), whereas other nonluminal HER2 (7%) and triple negative cancers (3%) were less frequently detected. Conclusions: Our findings suggest that the majority of screen-detected breast cancers exhibit either luminal A or B subtype. However, more aggressive subtypes such as nonluminal HER2-neu or triple negative cancers are less likely to be detected by mammographic screening programs, requiring other preventive strategies.

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Age-related variations: A retrospective analysis of 851 prospectively collected patient samples to determine the benefit of combining combinatorial protein biomarker assay for risk assessment in women with dense breast.

Journal of Clinical Oncology ◽

10.1200/jco.2015.33.28_suppl.27 ◽

2015 ◽

Vol 33 (28_suppl) ◽

pp. 27-27

Author(s):

David Emery Reese ◽

Michael Silver ◽

Meredith C. Henderson ◽

Sherri Borman ◽

Christa Corn ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Sensitivity And Specificity ◽

Dense Breast ◽

Patient Specific ◽

Screening Methods ◽

Breast Lesions ◽

Breast Cancers ◽

Age Related

27 Background: Clinicians often experience difficulty in differentiating benign lesions from invasive breast cancers in patients designated as dense breast. A major limitation of radiological breast cancer screening methods involves a decrease in sensitivity and specificity in women with dense breast. Thus, we sought to test whether Klarify Breast, a combinatorial protein-based biomarker panel could improve early detection of significant breast lesions in a controlled fashion. Clearly, a diagnostic assay that would provide biochemical evidence in the patient’s clinical course is greatly needed. Methods: We have conducted two independent, multi-center, prospective clinical trials to establish the clinical validity of Klarify Breast – an assay that uses multiple Serum Protein Biomarkers (SPBs), Tumor-Associated Autoantibodies (TAAbs), patient specific clinical data and develop a score to differentiate patients with benign breast disease from those with invasive breast cancer. Independent panels of biomarkers and associated algorithms were developed using prospectively collected samples from women under age 50 (n = 351) and from women ages 25-75 (n = 500). Here, we present the benefit of integrating the results of Klarify Breast test with patient imaging to best assess risk in women with dense breast. Results: While performance of the assay was somewhat age dependent (women under the age of 50 demonstrated a higher sensitivity and specificity than women over the age of 50). Here we present data that both groups of women clearly benefit from the addition of a biomarker assay combined with standard of care imaging in identifying invasive breast lesions. Conclusions: Clearly, in women with dense breast, where radiologic studies alone do not permit full assessment in women with a dense breast finding. The biomarker test here, comprised of TAAbs and SPBs, offers a clear advantage in terms of NPV, PPV, Sensitivity and specificity. The results argue strongly for the use of appropriate biomarkers to augment imaging based breast cancer screening in women with dense breast or those who are at high risk. Clinical trial information: NCT01839045, NCT02078570.

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