Interval Breast Cancers in the NHS Breast Screening Programme: Does the Current Definition Exclude Too Many?

1997 ◽  
Vol 4 (3) ◽  
pp. 169-173 ◽  
Author(s):  
A M Faux ◽  
D C Richardson ◽  
G M Lawrence ◽  
M E Wheaton ◽  
M G Wallisconsultant
Keyword(s):  
Breast Screening ◽  
Interval Cancer ◽  
Breast Cancers ◽  
Interval Cancers ◽  
Exclusion Criteria ◽  
National Statistics ◽  
Screening Unit ◽  
Cancer Rates ◽  
Definition Of ◽  
The Impact

Objectives— To examine the impact of the definition of interval breast cancers on interval cancer rates arising from the prevalent (first) screening round. Design— Interval breast cancers arising from the prevalent (first) screening round at the Warwickshire, Solihull and Coventry Breast Screening Unit (17 April 1989 to 31 March 1992) were identified by comparison of data held at the unit with records at the West Midlands Cancer Intelligence Unit. Exclusion criteria used in National statistics were applied to this sample to quantify their impact on achieved interval cancer rates. The round lengths experienced by individual women at the unit were determined from the prevalent and incident invitation dates for 155 women with incident (re-screen) breast cancers detected in the second round. Setting— Warwickshire, Solihull and Coventry Breast Screening Unit. Subects—59 017 women screened between 17 April 1989 and 31 March 1992 with a negative screening result and 155 women with incident screen detected cancers. Results— A total of 278 interval cancers were identified, giving an overall rate from the prevalent screening round of 47.1/10 000 women screened. Of these, 213 met the criteria used in the definition of interval cancers for National statistics and were termed “core” interval cancers. The overall “core” interval rate was 36.1/10 000 women screened, similar to interval cancer rates found in the north west of United Kingdom. Thus applying commonly used exclusion criteria produced a 23.4% reduction in the apparent interval cancer rate, with the largest decrease resulting from the exclusion of cancers arising at 36 months or more from the last screen. Conclusions— The exclusion criteria used in the definition of interval cancers have a significant impact on observed interval cancer rates. Of particular concern is the exclusion in the current National definitions of cancers arising at 36 months or more from the last screen, which may mask a problem with significant implications for the success of the NHSBSP.

scholarly journals Breast Density and Risk of Interval Cancers: The Effect of Annual Versus Biennial Screening Mammography Policies in Canada

2021 ◽  
pp. 084653712110279
Author(s):  
Jean Morag Seely ◽  
Susan Elizabeth Peddle ◽  
Huiming Yang ◽  
Anna M. Chiarelli ◽  
Megan McCallum ◽  
...  
Keyword(s):  
Screening Program ◽  
Breast Cancer Mortality ◽  
Interval Cancer ◽  
Screening Mammography ◽  
Dense Breast ◽  
Breast Cancers ◽  
Interval Cancers ◽  
Screening Programs ◽  
Dense Breasts ◽  
Cancer Rates

Regular screening mammography reduces breast cancer mortality. However, in women with dense breasts, the performance of screening mammography is reduced, which is reflected in higher interval cancer rates (ICR). In Canada, population-based screening mammography programs generally screen women biennially; however, some provinces and territories offer annual mammography for women with dense breast tissue routinely and/or on recommendation of the radiologist. This study compared the ICRs in those breast screening programs with a policy of annual vs. those with biennial screening for women with dense breasts. Among 148,575 women with dense breasts screened between 2008 to 2010, there were 288 invasive interval breast cancers; screening programs with policies offering annual screening for women with dense breasts had fewer interval cancers 63/70,814 (ICR 0.89/1000, 95% CI: 0.67-1.11) compared with those with policies of usual biennial screening 225/77,761 (ICR 1.45 /1000 (annualized), 95% CI: 1.19-1.72) i.e. 63% higher (p = 0.0016). In screening programs where radiologists’ screening recommendations were able to be analyzed, a total of 76,103 women were screened, with 87 interval cancers; the ICR was lower for recommended annual (65/69,650, ICR 0.93/1000, 95% CI: 0.71, 1.16) versus recommended biennial screening (22/6,453, ICR 1.70/1000 (annualized), 95%CI: 0.70, 2.71)(p = 0.0605). Screening program policies of annual as compared with biennial screening in women with dense breasts had the greatest impact on reducing interval cancer rates. We review our results in the context of current dense breast notification in Canada.

scholarly journals Breast cancer in East Anglia: the impact of the breast screening programme on stage at diagnosis

1998 ◽  
Vol 5 (1) ◽  
pp. 42-48 ◽  
Author(s):  
J McCann ◽  
D Stockton ◽  
N Day
Keyword(s):  
Breast Cancer ◽  
Cancer Incidence ◽  
Breast Screening ◽  
Screening Programme ◽  
Early Stage ◽  
Age Group ◽  
Interval Cancers ◽  
East Anglia ◽  
Breast Screening Programme ◽  
The Impact

Objectives To assess the impact of the National Health Service breast screening programme on overall and stage-specific incidence of breast cancer in East Anglia; also, to predict the magnitude of the screening induced reduction in breast cancer mortality. Setting Women resident in East Anglia aged 50–69, diagnosed between 1976 and 1995. Methods Comparison of numbers and incidence of breast cancer by age, stage, and mode of detection; investigation of relative contributions of advanced (stages II, III, and IV) cancers to total incidence by detection mode; estimation of the reduction in advanced cancer incidence. Results There has been a large increase in early stage incidence in the age group 50–64 targeted by the screening programme. By 1995, the estimated decrease in advanced cancer incidence was between 7 and 19%. In 1995, of all breast cancers arising in the age group 50–69 years, 33% were screen detected, 27% were interval cancers, 15% were in non-attenders, 9% were in lapsed attenders, 7% occurred before invitation, and 4% arose in women outside the birth year range for invitation. Of the advanced cancers diagnosed in 1995, 31% were interval cancers, 20% were screen detected, 19% were in non-attenders, 12% were in lapsed attenders, 8% occurred before invitation, and 4% presented in women outside the birth year range for invitation. Conclusions Screening has brought about a large increase in detection of early stage cancers. This increase has not yet been fully matched by a corresponding deficit in advanced cancers, possibly because the full effect of screening has not yet been achieved. Reducing the proportion of interval cancers is necessary to increase the effect of screening on mortality.

scholarly journals Characteristics of Screen-Detected Breast Cancer of Turkish Bahcesehir (Istanbul) Screening Project

2018 ◽  
Vol 4 (Supplement 3) ◽  
pp. 9s-9s
Author(s):  
Neslihan Cabıoğlu ◽  
Sibel Ozkan-Gurdal ◽  
Arda Kayhan ◽  
Ayse Nilufer Ozaydın ◽  
Cennet Şahin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Research Funding ◽  
Conflicts Of Interest ◽  
Statistical Significance ◽  
Interval Cancer ◽  
Multivariable Logistic Regression Analysis ◽  
Breast Cancers ◽  
Interval Cancers ◽  
Ki 67 ◽  
Screening Programs

Purpose The Turkish Bahcesehir Breast Cancer Screening Project is a 10-year organized population-based screening program carried out in one of the largest counties of Istanbul, Turkey. The aim of the current study was to examine the biologic features of screen-detected and interval breast cancers for the first 9-year study period. Methods Between January 2009 and January 2018, 26,040 mammographies were performed with 2-year intervals for 8,408 women age 40 to 69 years. Clinicopathologic and biologic tumor characteristics—estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2-neu, and protein encoded by the MKI67 gene (Ki-67) —were analyzed for those patients who were diagnosed with breast cancer. Interval cancer was defined as symptomatic cancer diagnosed within 24 months of a negative screening. Ki-67 level > 20% was considered a high score. Results Median age was 52.5 years, and 37% were younger than age 50 years. Of 8,408 women, 113 breast cancers (1.3%) were detected. There were 14 ductal carcinoma in situ (12.4%) and 99 invasive cancers (87.6%). The majority of patients with invasive cancer had stage 1 (49.1%) or stage 2 (31.8%) disease. The majority of patients underwent breast-conserving therapy (83%) with sentinel lymph node biopsy alone (74.1%). Interval cancers (n = 11) were more likely to have multifocality or multicentricity ( P = .002) and high Ki-67 score ( P = .05). Furthermore, diagnosis with interval cancer was associated with more advanced disease, including stage II to IV disease and axillary positivity, and patients were more likely to have nonluminal cancers or tumors with lymphovascular invasion. However, these associations did not reach statistical significance. Multivariable logistic regression analysis identified multifocality or multicentricity as the only significant factor to be associated with interval cancers (odds ratio, 5.94; 95% CI, 1.4 to 25.4; P = .016). Conclusion Our findings suggest that the majority of screen-detected breast cancers exhibit either luminal A or B subtype with low Ki-67 scores and unifocal tumors. However, interval cancers were more likely to have aggressive biology and multicentricity that was less likely to be detected by mammographic screening programs and that required more aggressive surgical and systemic therapies. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Neslihan Cabioğlu Research Funding: Roche (Inst) Travel, Accommodations, Expenses: Genomic Health Sibel Ozkan-Gurdal Research Funding: Roche (Inst) Arda Kayhan Research Funding: Roche (Inst) Ayse Nilufer Ozaydin Research Funding: Roche (Inst) Cennet Şahin Research Funding: Roche (Inst) Beyza Ozcinar Research Funding: Roche (Inst) Erkin Aribal Employment: Nutricia – Danone and TRPharm (I) Leadership: Nutricia – Danone and TRPharm (I) Stock or Other Ownership: Roche (I) Honoraria: GE Healthcare, Fuji, Roche Travel, Accommodations, Expenses: Bayer Vahit Ozmen Honoraria: Pfizer, Roche Research Funding: Roche (Inst), Genekor, Roche Travel, Accommodations, Expenses: Pfizer

Improved survival rate for women with interval breast cancer – results from the breast cancer screening programme in Malmö, Sweden 1976–1999

2007 ◽  
Vol 14 (3) ◽  
pp. 138-143 ◽  
Author(s):  
Sophia Zackrisson ◽  
Lars Janzon ◽  
Jonas Manjer ◽  
Ingvar Andersson
Keyword(s):  
Breast Cancer ◽  
Case Fatality Rate ◽  
Screening Programme ◽  
Interval Cancer ◽  
Case Fatality ◽  
Mammographic Screening ◽  
Breast Cancers ◽  
Interval Cancers ◽  
Stage Distribution ◽  
Interval Breast Cancer

Objective: Breast cancers detected between screening examinations can influence the sensitivity of a screening programme. Studies of the prognosis of these so-called interval breast cancers show diverging results. We investigated the course of interval breast cancer over time in the Malmö Mammographic Screening Trial (MMST) 1976–86 and the Malmö Mammographic Service Screening Programme (MMSSP) 1990–99. Material and methods: Stage distribution and survival of interval cancers in MMSSP were compared with screen-detected and non-attender cancer cases in MMSSP, with interval cancers in MMST and with breast cancer cases in a non-screened population five years before the start of MMSSP (pre-screening cancer cases). Results: In MMSSP 1990–99, the interval cancers did not differ in stage distribution or survival compared with cancer cases in non-attenders, while screen-detected cancer cases had more favourable stage distribution and rate of survival than had the interval cancer cases. The MMST interval cancer cases, 1976–1986, had more favourable stage distribution but higher overall case fatality rate, relative risks (RR) 1.78 (1.00–3.20), and breast cancer case fatality rate, RR 2.05 (1.05–4.00), compared with the more recent MMSSP interval cancer cases. No significant difference in five-year survival was seen in the MMSSP interval cancer cases compared with pre-screening cancer cases not exposed to screening. Conclusion: In this urban population invited to mammographic screening, the survival rate for women with interval cancer has improved over a period of 20 years. Further studies are needed to assess what factors might explain changes in the course of interval breast cancer.

Breast cancer detection among Irish BRCA1 and BRCA2 mutation carriers.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e12038-e12038 ◽  
Author(s):  
Elaine Walsh ◽  
Michael P. Farrell ◽  
Fergal Gallagher ◽  
Roisin Clarke ◽  
Carmel Nolan ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Brca Mutation ◽  
Brca2 Mutation ◽  
Interval Cancer ◽  
Breast Cancers ◽  
Interval Cancers ◽  
Brca1 And Brca2 ◽  
Clinical Breast Exam ◽  
Mutation Carriers ◽  
Clinical Breast

e12038 Background: High-risk breast cancer screening for BRCA1/2 mutations carriers with clinical breast exam, mammography and MRI have sensitivities approaching 100%. Even with intensive screening BRCA mutation carriers can present with self-detected interval cancers. We investigate screening practices and presentation among a cohort of Irish BRCA1/2 mutation carriers. Methods: Females with breast cancer belonging to kindreds now known to harbour BRCA1/2 mutations were retrospectively identified. Records were reviewed for BRCA mutation, demographics, breast cancer diagnosis, stage, histology and screening. We assessed screening modalities and whether breast cancers were diagnosed at screening or as interval cancers. Results: 53 cases of breast cancer were diagnosed from 1968-2010 among 53 Irish hereditary breast ovarian cancer kindreds. BRCA mutation status was unknown at time of diagnosis but subsequently confirmed. Detection method was identified in 50% of patients: 84% by clinical breast exam (CBE), 4% mammography, 4% MRI and 8% by a combination of CBE and mammography. Fifteen women (28%) developed second breast cancer; 9(60%) were undergoing screening, 2 were not and 27% were unknown. 22% were detected by CBE alone; 34% mammography; 22% a combination of mammography and CBE and 22% by MRI. In 41%, histology changed between first and second diagnosis. Two women developed a third breast cancer. In one, her second was an interval cancer despite being in a screening programme. Her third was radiologically detected. Conclusions: In this cohort of Irish BRCA1/2 mutation carriers almost 25% of second breast cancers were not detected by screening. 4% of cases were phenocopies and in 41% histology changed between first and second diagnosis. [Table: see text]

scholarly journals Reduction in interval cancer rates following the introduction of two-view mammography in the UK breast screening programme

2013 ◽  
Vol 110 (3) ◽  
pp. 560-564 ◽  
Author(s):  
A Dibden ◽  
J Offman ◽  
D Parmar ◽  
J Jenkins ◽  
J Slater ◽  
...  
Keyword(s):  
Breast Screening ◽  
Screening Programme ◽  
Interval Cancer ◽  
Breast Screening Programme ◽  
Cancer Rates ◽  
The Uk

scholarly journals Effectiveness of a small breast screening programme: 25 year evaluation (25 year breast screening evaluation)

BJR|Open ◽  
2019 ◽  
Vol 1 (1) ◽  
pp. 20180018
Author(s):  
Andrew Patric Nisbet ◽  
Andrew Borthwick-Clarke ◽  
Nic Scott ◽  
Helen Goulding ◽  
Harwood Jane
Keyword(s):  
Breast Cancer ◽  
Quality Control ◽  
Cancer Mortality ◽  
Breast Screening ◽  
Screening Programme ◽  
Breast Cancer Mortality ◽  
Interval Cancers ◽  
Breast Screening Programme ◽  
Small Breast ◽  
The Impact

Objective: To evaluate mammography screening quality on the Island of Jersey over a 25-year period from Jan 1990 to end March 2015 from females invited between ages 50 to 75 using a 2 yearly screening interval. Jersey had a population of only around 67,000 at onset, rising to around 100,000 at the end of the 25 years. Methods: An analysis was performed of key routinely collected measures that are important to determining if a screening programme is on course to reduce breast cancer mortality such as uptake, recall rates, screen detected cancer and interval cancer rates. Further supporting indicators including grade, stage and comparative deaths from breast cancer in screen detected and not screen detected females were also assessed. Results: Over the 25-year period 19,768 females were invited to screening and 16,866 attended, giving an uptake of 85.2%. There were 501 screen detected cancers of which 400 were invasive, and 101 DCIS. 125 interval cancers presented outside screening over the 25 years. The annual recall rate over the last 20 years was <6% for prevalent round and 4% for incident round screening. Based on the standardized detection ratio (SDR) and uptake, the estimated reduction in mortality from breast cancer was calculated as 40.2%. Conclusions: Recommended population sizes for breast units range from a quarter to half a million people. For very small units like Jersey serving smaller populations, rigorous quality control is essential to maintain credibility. Despite the small size of the programme evidence shows a similar detection rate to the UK NHS Breast screening programme was achieved. In small programmes careful monitoring of rates of uptake, recall, cancer detection and interval rates are required over adequate time periods together with supporting information to show that small units can achieve national standards and detection rates necessary to reduce breast cancer mortality. Advances in knowledge: Running a small breast cancer screening programme is challenging for quality control. The impact on mortality can be predicted for small screening programmes despite their size. 10-year group survival in screen detected invasive breast cancer >90%. Interval cancers are more advanced than screen detected invasive cancers, so high suspicion is still required in breast symptoms after "normal" screen result. Mortality in lapsed/ceased attenders suggest that extending age range could be beneficial.

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