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Organized screening detects breast cancer at earlier stage regardless of molecular phenotype

  • Original Article – Clinical Oncology
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

Abstract

Purpose

Mortality reduction attributable to organized breast screening is modest. Screening may be less effective at detecting more aggressive cancers at an earlier stage. This study was conducted to determine the relative efficacy of screening mammography to detect cancers at an earlier stage by molecular phenotype.

Methods

We identified 2882 women with primary invasive breast cancer diagnosed between January 1, 2008 and December 31, 2012 and who had a mammogram through the Ontario Breast Screening Program in the 28 months before diagnosis. Five tumor phenotypes were defined by expression of estrogen (ER) and progesterone (PR) receptors and HER2/neu oncogene. We conducted univariable and multivariable analyses to describe the predictors of detection as an interval cancer. Additional analyses identified predictors of detection at stages II, III, or IV compared with stage I, by phenotype. Analyses were adjusted for the effects of age, grade, and breast density.

Results

ER negative and HER2 positive tumors were over-represented among interval cancers, and triple negative cancers were more likely than ER +/HER2 − cancers to be detected as interval cancers OR 2.5 (95% CI 2.0–3.2, p < 0.0001). Method of detection (interval vs. screen) and molecular phenotype were independently associated with stage at diagnosis (p < 0.0001), but there was no interaction between method of detection and phenotype (p = 0.44).

Conclusion

In a screened population, triple negative and HER2 + breast cancers are diagnosed at a higher stage but this appears to be due to higher growth rates of these tumors rather than a relative inability of screening to detect them.

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Acknowledgements

The opinions, results, and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by the Institute for Clinical Evaluative Sciences or the Ontario Ministry of Health and Long-Term Care is intended or should be inferred. Parts of this material are based on data and information provided by Cancer Care Ontario (CCO). The opinions, results, views, and conclusions reported in this paper are those of the authors and do not necessarily reflect those of CCO. No endorsement by CCO is intended or should be inferred.

Funding

This study is supported by the Institute for Clinical Evaluative Sciences, which is funded by an annual Grant from the Ontario Ministry of Health and Long-Term Care.

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Authors and Affiliations

  1. Department of Surgery, University of Toronto, Toronto, ON, Canada

    Claire M. B. Holloway

  2. Critical Care Services Ontario, University Health Network, Toronto, Canada

    Li Jiang

  3. Institute for Clinical Evaluative Sciences, Queen’s University, Kingston, ON, Canada

    Marlo Whitehead

  4. Division of Breast, Endocrine, Metabolic and Gastrointestinal Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA

    Jennifer M. Racz

  5. Institute for Clinical Evaluative Sciences and Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University, Kingston, ON, Canada

    Patti A. Groome

  6. Sunnybrook Health Sciences Centre, T2-109 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Claire M. B. Holloway

Authors
  1. Claire M. B. Holloway
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  2. Li Jiang
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  3. Marlo Whitehead
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  4. Jennifer M. Racz
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Corresponding author

Correspondence to Claire M. B. Holloway.

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Conflict of interest

The authors have no conflicts of interest to disclose. The study was conducted in accordance with Ontario and Canadian law.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

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Holloway, C.M.B., Jiang, L., Whitehead, M. et al. Organized screening detects breast cancer at earlier stage regardless of molecular phenotype. J Cancer Res Clin Oncol 144, 1769–1775 (2018). https://doi.org/10.1007/s00432-018-2687-4

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  • DOI: https://doi.org/10.1007/s00432-018-2687-4

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