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

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

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Analysis of Low Estrogen Receptor (ER+) Breast Carcinomas in a Large Community Breast Cancer Center in Northern California

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.051 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S26-S27

Author(s):

G Bulusu ◽

K Duncan ◽

A Wheeler

Keyword(s):

Breast Cancer ◽

Estrogen Receptor ◽

Histological Grade ◽

Statistical Significance ◽

Cancer Center ◽

Pathology Report ◽

Breast Cancers ◽

Breast Carcinomas ◽

Ki 67 ◽

Er Positive

Abstract Introduction/Objective Estrogen Receptor (ER) expression in breast cancers is a crucial factor for endocrine therapy in patients with tumors expressing ER in ≥1% of tumor cells. The 2019 guidelines published by ASCO/CAP states that breast cancers that have a 1% to 10% of cells staining Estrogen Receptor (ER) positive should be reported as ER Low Positive cases. This study aims to address this subset of low-positive ER tumors and compare the clinical features to other known breast cancer subtypes. Methods/Case Report We conducted a retrospective review of a prospectively maintained breast cancer registry from 2013 to 2021 at Mills-Peninsula Medical Center, a Sutter Health Affiliate. The study reviewed patient charts with respect to the pathology report, operative report, chemotherapy regimen, and clinical outcomes. Statistical analyses were conducted using R Project for Statistical Coding, with The Student’s T-test used to compare continuous variables. Two-sided P values less than 0.05 indicate statistical significance. Results (if a Case Study enter NA) Our study identified 1316 cases of invasive breast carcinomas, of which 29 (2.16%) demonstrated ER Low-Positive expression. We aimed to evaluate the clinical and pathological features, such as histological grade, ER, PR, HER-2, Ki-67%, and patient age for these tumors. We found that ER Low-Positive tumors demonstrated higher mean histological grade morphology (2.5 out of 3, p<0.001) that was similar to that of Triple Negative Breast Cancers (TNBC) (3 of 3, p<0.001) than to High ER-Positive (1.6 of 3, p<0.001) cancers. Further observations, through examining proliferation rates by utilizing the Ki-67 index, indicate comparative trends between the ER Low-Positive cohort and the TNBC cohort. Conclusion The results suggest that the ER Low-Positive carcinomas, despite reported as ER-positive cases, present with similar clinicopathological features to those of ER-negative tumors. Through this study and future research, we would like to emphasize a stricter set of guidelines that can be adopted to reduce variability for reporting biomarkers. This standardization will allow oncologists to provide more appropriate treatment options and improve the quality of patient care.

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The Mode of Detection Is Not Associated with Quality of Life in Women with Breast Cancer

Breast Care ◽

10.1159/000504662 ◽

2019 ◽

Vol 15 (5) ◽

pp. 498-505

Author(s):

Bettina Braun ◽

Marc-André Kurosinski ◽

Laura Khil ◽

Joke Tio ◽

Barbara Krause-Bergmann ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Tumor Stage ◽

Screening Mammography ◽

Influential Factors ◽

Breast Cancers ◽

Interval Cancers ◽

Screening Programs ◽

Mode Of Detection

Introduction: Apart from saving lives, mammography screening programs (MSP) are expected to reduce negative side effects of treatment by detecting cancer earlier, when it is more responsive to less aggressive treatment. This study compared quality of life (QoL) among women with breast cancers that were detected either by screening mammography, as interval cancers, or clinically among women not participating in the MSP. Methods: Retrospective study of first-ever invasive breast cancers detected among MSP-eligible women aged 50–69 years between 2006 and 2012 in Münster, Germany. EORTC QLQ-C30 and -BR23 questionnaires were mailed to 1,399 cases still alive in 2015 (response rate 64.1%). Results: Women’s responses were obtained on average 6.1 years after diagnosis. Mean crude and age-adjusted scores for overall QoL, breast and body image (BBI), and five functional scales (FS) were comparable between groups of detection mode. Clearly lower adjusted means for most scores were observed in women with interval cancers, if time since diagnosis was less than 5 years. Cases younger than 60 years showed lower values for some FS, particularly among interval and screen-detected cases. Discussion/Conclusion: In summary, cases with breast cancer showed health-related score values that were similar to the general population of the same age. There was also no indication that mode of detection markedly influenced these scores. However, after adjusting for tumor stage and other influential factors, screening participants appeared more susceptible to score declines after a diagnosis of cancer than non-participants.

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Poor Biological Factors and Prognosis of Interval Breast Cancers: Long-Term Results of Bahçeşehir (Istanbul) Breast Cancer Screening Project in Turkey

JCO Global Oncology ◽

10.1200/go.20.00145 ◽

2020 ◽

pp. 1103-1113

Author(s):

Neslihan Cabioğlu ◽

Sibel Özkan Gürdal ◽

Arda Kayhan ◽

Nilüfer Özaydın ◽

Cennet Şahin ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Triple Negative ◽

Long Term Results ◽

Breast Cancers ◽

Interval Cancers ◽

Luminal A ◽

Ki 67 ◽

Luminal B

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

Journal of Medical Screening ◽

10.1258/096914107782066239 ◽

2007 ◽

Vol 14 (3) ◽

pp. 138-143 ◽

Cited By ~ 24

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.

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Breast cancer detection among Irish BRCA1 and BRCA2 mutation carriers.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e12038 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e12038-e12038 ◽

Cited By ~ 1

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]

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

Canadian Association of Radiologists Journal ◽

10.1177/08465371211027958 ◽

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.

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Left–right breast asymmetry and risk of screen-detected and interval cancers in a large population-based screening population

British Journal of Radiology ◽

10.1259/bjr.20200154 ◽

2020 ◽

Vol 93 (1112) ◽

pp. 20200154

Author(s):

Sue M Hudson ◽

Louise S Wilkinson ◽

Bianca L De Stavola ◽

Isabel dos-Santos-Silva

Keyword(s):

Breast Cancer ◽

Logistic Regression ◽

Cancer Diagnosis ◽

Linear Trend ◽

Conditional Logistic Regression ◽

Large Population ◽

Interval Cancer ◽

Population Based ◽

Breast Cancers ◽

Interval Cancers

Objectives: To assess the associations between automated volumetric estimates of mammographic asymmetry and breast cancers detected at the same (“contemporaneous”) screen, at subsequent screens, or in between (interval cancers). Methods: Automated measurements from mammographic images (N = 79,731) were used to estimate absolute asymmetry in breast volume (BV) and dense volume (DV) in a large ethnically diverse population of attendees of a UK breast screening programme. Logistic regression models were fitted to assess asymmetry associations with the odds of a breast cancer detected at contemporaneous screen (767 cases), adjusted for relevant confounders. Nested case–control investigations were designed to examine associations between asymmetry and the odds of: (a) interval cancer (numbers of cases/age-matched controls: 153/646) and (b) subsequent screen-detected cancer (345/1438), via conditional logistic regression. Results: DV, but not BV, asymmetry was positively associated with the odds of contemporaneous breast cancer (P-for-linear-trend (Pt) = 0.018). This association was stronger for first (prevalent) screens (Pt = 0.012). Both DV and BV asymmetry were positively associated with the odds of an interval cancer diagnosis (Pt = 0.060 and 0.030, respectively). Neither BV nor DV asymmetry were associated with the odds of having a subsequent screen-detected cancer. Conclusions: Increased DV asymmetry was associated with the risk of a breast cancer diagnosis at a contemporaneous screen or as an interval cancer. BV asymmetry was positively associated with the risk of an interval cancer diagnosis. Advances in knowledge: The findings suggest that DV and BV asymmetry may provide additional signals for detecting contemporaneous cancers and assessing the likelihood of interval cancers in population-based screening programmes.

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A blind review and an informed review of interval breast cancer cases in the Limburg screening programme, the Netherlands

Journal of Medical Screening ◽

10.1136/jms.7.1.19 ◽

2000 ◽

Vol 7 (1) ◽

pp. 19-23 ◽

Cited By ~ 21

Author(s):

J.M. de Rijke ◽

L.J. Schouten ◽

J.L. Schreutelkamp ◽

I. Jochem ◽

A.L.M. Verbeek

Keyword(s):

Breast Cancer ◽

The Netherlands ◽

Screening Programme ◽

Interval Cancer ◽

Breast Cancers ◽

Interval Cancers ◽

Blind Review ◽

Screening Practice ◽

Cancer Screening Programme ◽

Screening Mammograms

Objective To investigate the proportion of interval breast cancers that could have been detected at the previous screening examination, and to gain more insight into the characteristics of these tumours. Setting Breast cancer screening programme in mid- and southern Limburg, the Netherlands. Method Firstly, previous screening mammograms of 92 interval cancer cases were blindly reread by the radiologists from two different units as part of their daily screening workload. Secondly, a separate informed review was conducted, in which all of the cases (except for two) were subclassified into four categories: screening error; minimal signs; radiologically occult both at previous screening and at diagnosis; or radiologically occult at previous screening. Trends in recall rates and false and true positive rates were calculated to study potential changes during and after the blind review. Results In the blind review, 15% of the interval cancers were detected in both rereadings and 21% in one rereading. In the informed review, 25% were classified as a screening error and 24% as minimal signs present; 74% of the cases classified as a screening error had been recalled at least once in the blind review. Recall rates and false positive rates in daily screening practice increased significantly during and after the study period. Conclusions About one third of the interval cancers could have been detected in the previous screening round. In order to diminish the number of avoidable interval cancers, review and classification of interval cancers is an important tool for continuing the education of screening radiologists. Therefore, further development of review training procedures is necessary.

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Breast cancer detection among Irish BRCA1 and BRCA2 mutation carriers.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.27_suppl.59 ◽

2012 ◽

Vol 30 (27_suppl) ◽

pp. 59-59

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

59 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]

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

Journal of Medical Screening ◽

10.1177/096914139700400310 ◽

1997 ◽

Vol 4 (3) ◽

pp. 169-173 ◽

Cited By ~ 11

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.

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