Locally advanced breast cancers are more likely to present as Interval Cancers: results from the I-SPY 1 TRIAL (CALGB 150007/150012, ACRIN 6657, InterSPORE Trial)
Interval cancers (ICs), defined as cancers detected between regular screening mammograms, have been shown to be of higher grade, larger size, and associated with lower survival, compared with screen-detected cancers (SDCs) and comprise 17% of cancers from population-based screening programs. We sought to determine the frequency of ICs in a study of locally advanced breast cancers, the I-SPY 1 TRIAL. Screening was defined as having a mammogram with 2 years, and the proportion of ICs at 1 and 2 years was calculated for screened patients. Differences in clinical characteristics for ICs versus SDCs and screened versus non-screened cancers were assessed. For the 219 evaluable women, mean tumor size was 6.8 cm. Overall, 80% of women were over 40 and eligible for screening; however, only 31% were getting screened. Among women screened, 85% were ICs, with 68% diagnosed within 1 year of a previously normal mammogram. ICs were of higher grade (49% vs. 10%) than SDCs. Among non-screened women, 28% (43/152) were younger than the recommended screening age of 40. Of the entire cohort, 12% of cancers were mammographically occult (MO); the frequency of MO cancers did not differ between screened (11%) and non-screened (15%). ICs were common in the I-SPY 1 TRIAL suggesting the potential need for new approaches beyond traditional screening to reduce mortality in women who present with larger palpable cancers.
KeywordsScreening Neoadjuvant Interval cancer
National Cancer Institute Specialized Program of Research Excellence in Breast Cancer, American College of Radiology Imaging Network, Cancer and Leukemia Group B, National Cancer Institute Center for Bioinformatics, The Breast Cancer Research Foundation, and Bruce and Martha Atwater are acknowledged. Grant numbers: NCI SPORE: CA58207, ACRIN: U01 CA079778 & CA080098, CALGB: CA31964 & CA33601.
- 10.Porter PL, El-Bastawissi AY, Mandelson MT, Lin MG, Khalid N, Watney EA, Cousens L, White D, Taplin S, White E (1999) Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst 91(23):2020–2028PubMedCrossRefGoogle Scholar
- 18.Esserman L et al (2009) Poster session: Breast cancer molecular profiles and tumor response of neoadjuvant doxorubicin and paclitaxel: the I-SPY TRIAL (CALGB 150007/150012, ACRIN 6657). ASCO Annual Meeting, Orlando, FL, May 29–31Google Scholar
- 19.Buxton ELMB (2005) The challenge of integrating information and improving care for breast cancer: The I SPY Trial informatics effort. In: Perry MC (ed) American society of clinical oncology. Lisa Greaves, OrlandoGoogle Scholar
- 27.I-SPY 2 TRIAL [www.ispy2.org]
- 29.Warner E, Plewes DB, Hill KA, Causer PA, Zubovits JT, Jong RA, Cutrara MR, DeBoer G, Yaffe MJ, Messner SJ et al (2004) Surveillance of BRCA1 and BRCA2 mutation carriers with magnetic resonance imaging, ultrasound, mammography, and clinical breast examination. JAMA 292(11):1317–1325PubMedCrossRefGoogle Scholar