Skip to main content
Log in

Breast Cancers Found by Screening: Earlier Detection, Lower Malignant Potential or Both?

  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

A population-based study was performed to compare the characteristics of clinically detected breast cancers and cancers detected by the Dutch screening program. To determine whether differences are most likely to be explained by earlier diagnosis or by the detection of biologically different cancers in the screening program, comparisons were stratified according to tumor size. Data were obtained from the population-based Eindhoven Cancer Registry. During the period 1996–1999, 568 screen-detected and 630 clinically detected invasive breast cancers were available for analysis. Compared with patients with clinically detected breast cancer, women with screen-detected breast cancer had smaller tumors (P < 0.0001), were more likely to have negative lymph nodes (P < 0.0001), tumors with a positive estrogen (P = 0.007) or progesterone (P = 0.019) receptor status and a lower mitotic activity index (P = 0.009). In the group with cancers ≤1.0 cm the screen-detected were more likely to have negative estrogen receptors (P = 0.027). The group with screen-detected tumors 1.1–2.0 cm across were more likely to have positive estrogen and progesterone receptors (P = 0.005 and P = 0.044, respectively) and tended to have a lower mitotic activity index (P = 0.078). No significant differences were found between screen-detected and clinically detected breast cancers of 2.1–3.0 cm across. After adjustments for tumor size, most of the differences between clinically detected and screen-detected breast cancers disappeared, suggesting that screen-detected breast cancers represent tumors in an earlier phase of their development, not a biologically different class.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cowan WK, Angus B, Henry J, Corbett IP, Reid WA, Horne CHW: Immunohistochemical and other features of breast carcinomas presenting clinically compared with those detected by cancer screening. Br J Cancer 64: 780–784, 1991

    Google Scholar 

  2. Cowan WK, Kelly P, Sawan A, Cunliffe WJ, Henry L, Higgs MJ, Lunt LG, Young JR, Horne CH, Angus B: The pathological and biological nature of screen-detected breast carcinomas: a morphological and immunohistochemical study. J Pathol 182: 29–35, 1997

    Google Scholar 

  3. Klemi PJ, Joensuu H, Toikkanen S, Tuominen J, Rasanen O, Tyrkko J, Parvinen I: Aggressiveness of breast cancers found with and without screening. Br Med J 304: 467–469, 1992

    Google Scholar 

  4. Klemi PJ, Toikkanen S, Rasanen O, Parvinen I, Joensuu H: Mammography screening interval and the frequency of interval cancers in a population-based screening. Br J Cancer 75: 762–766, 1997

    Google Scholar 

  5. Anderson TJ, Lamb J, Donnan P, Alexander FE, Huggins A, Muir BB, Kirkpatrick AE, Chetty U, Hepburn W, Smith A, Prescott RJ, Forrest P: Comparative pathology of breast cancer in a randomised trial of screening. Br J Cancer 64: 108–113, 1991

    Google Scholar 

  6. Crisp WJ, Higgs MJ, Cowan WK, Cunliffe WJ, Liston J, Lunt LG, Peakman DJ, Young JR: Screening for breast cancer detects tumours at an earlier biological stage. Br J Surg 80: 863–865, 1993

    Google Scholar 

  7. Kricker A, Farac K, Smith D, Sweeny A, McCredie M, Armstrong BK: Breast cancer in New South Wales in 1972– 1995: tumor size and the impact of mammographic screening. Int J Cancer 81: 877–880, 1999

    Google Scholar 

  8. Hakama M, Holli K, Isola J, Kallioniemi OP, Karkkainen A, Visakorpi T, Pukkala E, Saarenmaa I, Geiger U, Ikkala J, Nieminen T, Godenhjelm K, Koivula T: Aggressiveness of screen-detected breast cancers. Lancet 345: 221–224, 1995

    Google Scholar 

  9. Tabar L, Duffy SW, Vitak B, Chen HH, Prevost TC: The natural history of breast carcinoma: what have we learned from screening? Cancer 86: 449–462, 1999

    Google Scholar 

  10. Norden T, Thurfjell E, Hasselgren M, Lindgren A, Norgren A, Bergstrom R, Holmberg L: Mammographic screening for breast cancer. What cancers do we find? Eur J Cancer 33: 624–628, 1997

    Google Scholar 

  11. Holland PA, Walls J, Boggis CRM, Knox F, Baildam AD, Bundred NJ: A comparison of axillary node status between cancers detected at the prevalence and first incidence screening rounds. Br J Cancer 74: 1643–1646, 1996

    Google Scholar 

  12. Rajakariar R, Walker R: Pathological and biological features of mammographically detected invasive breast carcinomas. Br J Cancer 71: 150–154, 1995

    Google Scholar 

  13. Groenendijk RPR, Bult P, Tewarie L, Peer PGM, van der Sluis RF, Ruers TJM, Wobbes T: Screen-detected breast cancers have a lower mitotic activity index. Br J Cancer 82: 381–384, 2000

    Google Scholar 

  14. van Diest PJ, Baak JP, Matze-Cok P, Wisse-Brekelmans EC, van Galen CM, Kurver PH, Bellot SM, Fijnheer J, van Gorp LH, Kwee WS: Reproducibility of mitosis counting in 2469 breast cancer specimens: results from the Multicenter Morphometric Mammary Carcinoma Project. Hum Pathol 23: 603–607, 1992

    Google Scholar 

  15. Hermanek P, Sobin LH (eds): UICC TNM Classification of Malignant Tumours. Springer-Verlag, Berlin, 198, pp 94–99

  16. Tabar L, Fagerberg G, Day NE, Duffy SW, Kitchin RM: Breast cancer treatment and natural history: new insights from results of screening. Lancet 339: 412–414, 1992

    Google Scholar 

  17. Tabar L, Fagerberg G, Duffy SW, Day NE, Gad A, Grontoft O: Update of the Swedish two-county program of mammographic screening for breast cancer. Radiol Clin North Am 30: 187–210, 1992

    Google Scholar 

  18. Fracheboud J, de Koning HJ, Beemsterboer PM, Boer R, Hendriks JH, Verbeek AL, van Ineveld BM, de Bruyn AE, van der Maas PJ: Nation-wide breast cancer screening in The Netherlands: results of initial and subsequent screening 1990– 1995. National Evaluation Team for Breast Cancer Screening. Int J Cancer 75: 694–698, 1998

    Google Scholar 

  19. Fracheboud J, de Koning HJ, Beemsterboer PM, Boer R, Verbeek AL, Hendriks JH, van Ineveld BM, Broeders MJ, de Bruyn AE, van der Maas PJ: Interval cancers in the Dutch breast cancer screening programme. Br J Cancer 81: 912–917, 1999

    Google Scholar 

  20. Gilliland FD, Joste N, Stauber PM, Hunt WC, Rosenberg R, Redlich G, Key CR: Biologic characteristics of interval and screen-detected breast cancers. J Natl Cancer Inst 92: 743–749, 2000

    Google Scholar 

  21. Porter PL, El-Bastwissi AY, Mandelson MT, Lin MG, Khalid N, Watney EA, Cousens L, White D, Taplin S, White E: Breast tumor characteristics as predictors of mammographic detection: comparison of interval-and screen-detected cancers. J Natl Cancer Inst 91: 2020–2028, 1999

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ernst, M.F., Roukema, J.A., Coebergh, JW.W. et al. Breast Cancers Found by Screening: Earlier Detection, Lower Malignant Potential or Both?. Breast Cancer Res Treat 76, 19–25 (2002). https://doi.org/10.1023/A:1020213817562

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1020213817562

Navigation