A Breast Cancer Diagnosis in the Interval Between Mammograms: Who is at Risk?
BACKGROUND AND PURPOSE:
Interval cancers are those that are diagnosed after receiving a ‘negative screen’ mammography report, but before the next recommended screening examination
15% of breast cancers are ‘interval cancers’ and include
Cancers that were missed on the initial ‘negative screen’
Rapid growing cancers that were not present on the initial screen and present due to symptoms (e.g. detecting a lump) which tend to be poorer prognosis
McCarthy et al. (JAMA Oncology, 2018) sought to identify women who were at higher risk for a poor prognosis (latter group) with interval cancer
Mammogram data was collected from the Population-Based Research Optimizing Screening Through Personalized Regimens (PROSPR) consortium
Participants: Women ≥40 years with no earlier diagnosis of breast cancer who received screening mammography and negative screening results (BI-RADS 1 or 2)
Cancer diagnoses within 1 year after screening mammography were obtained from state cancer registries
Poor prognosis breast cancers were defined as
Distant metastases | Cancer-positive regional lymph nodes | Estrogen receptor–positive and/or progesterone receptor–positive and HER2-negative invasive cancer 2 cm or more in diameter | Eestrogen receptor–negative, progesterone receptor–negative, HER2-negative (triple-negative) invasive cancer 1 cm or more in diameter | HER2-positive invasive cancer 1 cm or more in diameter
Association of age, breast density, and family history with cancer diagnosis was assessed using logistic regression analysis
306,028 women were included in the study
272,881 women had a negative screening result
Only 160 women (5.9 per 10,000) had a cancer within 1 year of negative screening mammography
Interval cases were more likely to have poor prognosis compared to positive mammography cases (43.8% v. 26.9% )
Among all women with negative mammography results
Women with dense breasts were twice as likely to receive a cancer diagnosis vs nondense breasts (odds ratio [OR] of 2.07; 95% CI,1.48-2.89 (P = .02)
Age and family history were not associated with greater likelihood of cancer diagnosis
Among those with interval breast cancer, younger women (40-49 years) were more likely to receive poor prognosis than older women (70-89 years)
OR of 3.52; 95% CI, 1.15-10.72; (P= .048; P for trend = .005)
Breast density and family history were not associated with poor prognosis interval cancers
In cases with positive mammogram results, positive predictive value for subsequent cancer diagnosis depended on older patient age and positive family history but not breast density
40-49 years vs those 70-89 years: OR, 0.22; 95% CI, 0.18-0.26 (P < .001)
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This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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