• About Us
    • Contact Us
    • Login
    • ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
About Us Contact Us Login ObGFirst
  • COVID-19
  • Alerts
  • OB
  • 2T US Atlas
  • The Genome
  • GYN
    • 0 CME Hours
    • GYN
    • Sexual Health
  • Primary Care
  • Your Practice
  • #GrandRounds
  • My Bookshelf
  • Now@ObG
  • Media
#Grand Rounds

More from the WHI: Are Breast Cancers That Develop Between Mammograms Associated with Worse Survival Outcomes?

image_pdfFavoriteLoadingFavorite

BACKGROUND AND PURPOSE:

  • Interval breast cancers (IBCs) are defined as cancers that develop after a negative mammogram but before the patient’s next screening
    • IBCs appear to have a worse prognosis
  • Irvin et al. (JAMA Network Open, 2020) sought to compare the prognostic features and mortality rate of associated with IBCs vs  breast cancers detected by screening

METHODS:

  • Cohort study
  • Data source
    • Women’s Health Initiative (WHI) study
    • The Women’s Health Initiative study recruited participants from 1993 to 1998 and followed up for a median of 19 years | The present study includes data collected through March 31, 2018
  • Population included in this study
    • Age 50 to 79 years
    • Compliant with breast cancer screening
    • Developed breast cancer
  • Study design
    • Collected data: Mammography data | Tumor characteristics | Demographic data
    • Breast cancers detected by screening and IBCs were defined based on
      • Mammogram history
      • Date of last mammogram
      • Type of visit
      • Results of examination
    • Interval breast cancers were subdivided into those occurring
      • Within 1 year following negative mammogram
      • Between 1 and 2.5 years following negative mammogram
  • Primary outcome
    • Breast cancer–specific mortality for
      • Breast cancer detected by screening
      • IBCs
  • Secondary outcomes
    • Prognostic and tumor characteristics for each group

RESULTS:

  • 3019 women were compliant with screening developed breast cancer
    • Mean (SD) age at enrollment: 63.1 (6.8) years
    • Mean (SD) age at diagnosis: 68.5 (7.1) years
  • Breast cancer diagnoses
    • Interval breast cancers: 1050 cases
      • 30.9% were diagnosed between 1 and 2.5 years after negative mammogram
    • Breast cancer detected by screening: 1969 cases
  • Comparing IBCs within 1 year vs screening detection group
    • More lobular histologic characteristics
      • IBCs: 13.0%
      • Screening detected cancers: 8.1%
    • Larger tumor size
      • IBCs: 1.97 cm
      • Screening detected cancers: 1.43 cm
    • Higher clinical stage
      • Regional
        • IBCs: 28.4%
        • Screening detected cancers: 17.3%
      • Distant
        • IBCs: 3.7%
        • Screening detected cancers: 0.6%
    • More lymph node involvement
      • IBCs: 27.1%
      • Screening detected cancers: 17.0%
  • IBCs diagnosed within 1 year were associated with increased breast cancer–specific mortality when compared to cancers identified by screening
    • Unadjusted hazard ratio (HR) 1.92 (95% CI, 1.39 to 2.65)
  • Breast cancer–specific mortality risk was increased for IBCs diagnosed within 1 year after adjusting for trial group, molecular subtype, waist to hip ratio and histologic characteristics and either
    • Tumor size: HR 1.46 (95% CI, 1.03 to 2.08) or
    • Lymph node involvement: HR 1.44 (95% CI, 1.03 to 2.01)
  • However, when adjusted for both tumor size and lymph node involvement, results, breast cancer-specific mortality association was no longer statistically significant
    • HR 1.34 (95% CI, 0.96 to 1.88)
  • IBCs diagnosed between 1 and 2.5 years from a mammogram were not different from breast cancers detected by screening for prognostic factors or mortality

CONCLUSION:

  • Interval breast cancers within 1 year of negative mammogram overall were associated with worse survival compared to breast cancers detected at time of scheduled screening
  • However, the authors state

The poor prognosis for women with IBCs diagnosed within 1 year after negative mammogram results might not be due to delayed diagnosis but rather to distinct biological characteristics associated with the cancer

For instance, increased lymph node involvement is often seen in IBCs and cannot be accounted for entirely by delayed diagnosis but rather may be due to a unique biology.

Learn More – Primary Sources:

Comparison of Mortality Among Participants of Women’s Health Initiative Trials With Screening-Detected Breast Cancers vs Interval Breast Cancers

Now You Can Get ObG Clinical Research Summaries Direct to Your Phone, with ObGFirst

ObGFirst® – Try It Free! »

image_pdfFavoriteLoadingFavorite
< Previous
All #Grand Rounds Posts
Next >

Related ObG Topics:

A Breast Cancer Diagnosis in the Interval Between Mammograms: Who is at Risk?
For Women with A Personal History of Breast Cancer: Mammography or Breast MRI?
Can Ultrasonography in Addition to Mammography Improve Breast Cancer Screening Effectiveness?

Sections

  • COVID-19
  • Alerts
  • OB
  • GYN
    • GYN
    • Sexual Health
  • 2T US Atlas
  • The Genome
  • Primary Care
  • Your Practice
  • #Grand Rounds
  • My Bookshelf
  • Now@ObG
  • Media

ObG Library

  • Hysteroscopy
  • Fertility
  • Site Map/
  • © ObG Project/
  • Terms and Conditions/
  • Privacy/
  • Contact Us/
© ObG Project
SSL Certificate


  • Already an ObGFirst Member?
    Welcome back

    Log In

    Want to sign up?
    Get guideline notifications
    CME Included

    Sign Up

Get Guideline Alerts Direct to Your Phone
Try ObGFirst Free!

Sign In

Lost your password?

Sign Up for ObGFirst and Stay Ahead

  • - Professional guideline notifications
  • - Daily summary of a clinically relevant
    research paper
  • - Includes 1 hour of CME every month

ObGFirst Free Trial

Log In to ObG First

Please log in to access OBGFirst and the 2T Ultrasound Atlas

Password Trouble?

Sign Up for ObGFirst

  • - Access 2T US Atlas
  • - Guideline notifications
  • - Daily research paper summaries
  • - And lots more!

ObG First Free Trial

Media - Internet

Computer System Requirements

OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.

Disclosure of Unlabeled Use

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.

The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer

Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
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.

Jointly provided by

NOT ENOUGH CME HOURS

It appears you don't have enough CME Hours to take this Post-Test. Feel free to buy additional CME hours or upgrade your current CME subscription plan

Subscribe

JOIN OBGFIRST AND GET CME/CE CREDITS

One of the benefits of an ObGFirst subscription is the ability to earn CME/CE credits from the ObG entries you read. Tap the button to learn more about ObGFirst

Learn More
Leaving ObG Website

You are now leaving the ObG website and on your way to PRIORITY at UCSF, an independent website. Therefore, we are not responsible for the content or availability of this site