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Differences in subtype distribution between screen-detected and symptomatic invasive breast cancer and their impact on survival

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Abstract

Purpose

Stage shift is considered a major reason for more favorable outcomes in patients with screen-detected breast cancer. However, even after adjusting for clinical stage, unresolved issues concerning the reasons for a survival benefit associated with screening programs remain. This study aims to evaluate differences in subtype distribution and outcomes among patients with screen-detected and symptomatic invasive breast cancer and assess whether variations in subtype distribution could explain differences in prognosis.

Methods

Survival analysis was performed to estimate the likelihood of distant recurrence and death in 1132 patients. Subtypes were defined as luminal A [estrogen receptor (ER)+ and/or progesterone receptor (PR)+, human epidermal growth factor receptor 2 (HER2)−, and Ki67 low], luminal B (HER2−) (ER+ and/or PR+, HER2−, and Ki67 high), luminal B (HER2+) (ER+ and/or PR+ and HER2+), HER2 overexpressing (ER−, PR−, and HER2+), and triple negative (ER−, PR−, and HER2−).

Results

Screen-detected cancers had favorable clinicopathological characteristics, such as smaller tumor size and a lower frequency of lymph node involvement. Women with screen-detected cancers had a survival advantage. Subtype distribution differed significantly among women with screen-detected and symptomatic cancer. Screen-detected cancers were more likely to be luminal A and less likely to be HER2 overexpressing or triple negative cancer compared with symptomatic cancers (luminal A 61.3 vs. 44.2%, HER2 overexpressing 4.0 vs. 8.0%, triple negative 8.0 vs. 15.9%). Node status, mode of detection, and subtype were independent prognostic factors in the multivariate analysis.

Conclusions

Differences in subtype distribution between screen-detected and symptomatic cancer could partially explain differences in outcomes.

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Authors and Affiliations

  1. Department of Breast Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan

    N. Kobayashi, M. Hikichi, K. Ushimado & T. Utsumi

  2. Department of Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan

    A. Sugioka

  3. Department of Diagnostic Pathology, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan

    Y. Kiriyama & M. Kuroda

Authors
  1. N. Kobayashi
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  2. M. Hikichi
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  3. K. Ushimado
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  4. A. Sugioka
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  5. Y. Kiriyama
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  6. M. Kuroda
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  7. T. Utsumi
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Correspondence to T. Utsumi.

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Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants

This study has been approved by the appropriate institutional research ethics committee and has been performed in accordance with the ethical standards outlined in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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For this type of study, formal consent was not required.

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Kobayashi, N., Hikichi, M., Ushimado, K. et al. Differences in subtype distribution between screen-detected and symptomatic invasive breast cancer and their impact on survival. Clin Transl Oncol 19, 1232–1240 (2017). https://doi.org/10.1007/s12094-017-1660-z

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  • DOI: https://doi.org/10.1007/s12094-017-1660-z

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