Using tumor phenotype, histological tumor distribution, and mammographic appearance to explain the survival differences between screen-detected and clinically detected breast cancers
- PMID: 25046200
- DOI: 10.1111/apm.12294
Using tumor phenotype, histological tumor distribution, and mammographic appearance to explain the survival differences between screen-detected and clinically detected breast cancers
Abstract
In the era of mass screening for breast cancer with mammography, it has been noted that conventional tumor attributes and mammographic appearance are insufficient to account for the better prognosis of screen-detected tumors. Such prognostication may require additional updated pathological information regarding tumor phenotype (e.g., basal status) and histological tumor distribution (focality). We investigated this hypothesis using a Bayesian approach to analyze breast cancer data from Dalarna County, Sweden. We used data for tumors diagnosed in the Swedish Two-County Trial and early service screening period, 1977-1995, and from the mature service screening period, 1996-1998. In the early period of mammographic screening (1977-1995), the crude hazard ratio (HR) of breast cancer death for screen-detected cases compared with symptomatic ones was 0.22 (95% CI: 0.17-0.29) compared with 0.53 (95% CI: 0.34-0.76) when adjusted for conventional tumor attributes only. Using the data from the mature service screening period, 1996-1998, the HR was 0.23 (95% CI: 0.08-0.44) unadjusted and 0.71 (95% CI: 0.26-1.47) after adjustment for tumor phenotype, mammographic appearance, histological tumor distribution, and conventional tumor attributes. The area under the ROC curve (AUC) for the prediction of breast cancer deaths using these variables without the detection mode was 0.82, only slightly less than that observed when additionally including the detection mode (AUC=0.83). Using Freedman statistics, conventional tumor attributes and mammographic appearances explained 58% (95% CI: 57.5-58.6%) of the difference of breast cancer survival between the screen-detected and the clinically detected breast cancers, whereas the corresponding figure was increased to 77% (95% CI: 75.6-77.6%) when adding the two information on tumor phenotype and histological tumor distribution. The results indicated that conventional tumor attributes and mammographic appearance are not sufficient to be interim markers for explaining the survival difference between screen-detected and clinically detected cancers in the era marked by the widespread use of mammography. Additional information on tumor phenotype and histological distribution may be added as effective interim markers for explaining the benefit of the early detection of breast cancer with mammography.
Keywords: Bayesian approach; Mammography; breast cancer; histological tumor distribution; survival; tumor phenotype.
© 2014 APMIS. Published by John Wiley & Sons Ltd.
Similar articles
-
Novel mammographic image features differentiate between interval and screen-detected breast cancer: a case-case study.Breast Cancer Res. 2016 Oct 5;18(1):100. doi: 10.1186/s13058-016-0761-x. Breast Cancer Res. 2016. PMID: 27716311 Free PMC article.
-
Mammographic tumour appearance and triple-negative breast cancer associated with long-term prognosis of breast cancer death: a Swedish Cohort Study.Cancer Epidemiol. 2015 Apr;39(2):200-8. doi: 10.1016/j.canep.2015.01.013. Epub 2015 Feb 26. Cancer Epidemiol. 2015. PMID: 25731718
-
Favourable prognostic factors of subsequent screen-detected breast cancers among women aged 50-69.Eur J Cancer Prev. 2012 Nov;21(6):499-506. doi: 10.1097/CEJ.0b013e328350b0f4. Eur J Cancer Prev. 2012. PMID: 22273849 Review.
-
Mammography in symptomatic and asymptomatic patients.Hematol Oncol Clin North Am. 1989 Dec;3(4):611-40. Hematol Oncol Clin North Am. 1989. PMID: 2691492 Review.
-
Update of the Swedish two-county program of mammographic screening for breast cancer.Radiol Clin North Am. 1992 Jan;30(1):187-210. Radiol Clin North Am. 1992. PMID: 1732926 Clinical Trial.
Cited by
-
Mode of presentation and skin thickening on ultrasound may predict nodal burden in breast cancer patients with a positive axillary core biopsy.Br J Radiol. 2020 Apr;93(1108):20190711. doi: 10.1259/bjr.20190711. Epub 2020 Jan 28. Br J Radiol. 2020. PMID: 31971817 Free PMC article.
-
Clinicopathologic characteristics of HER2-positive pure mucinous breast carcinoma: a systematic investigation into an unusual tumor.Int J Clin Exp Pathol. 2019 May 1;12(5):1666-1677. eCollection 2019. Int J Clin Exp Pathol. 2019. PMID: 31933985 Free PMC article.
-
Pre-operative stromal stiffness measured by shear wave elastography is independently associated with breast cancer-specific survival.Breast Cancer Res Treat. 2018 Sep;171(2):383-389. doi: 10.1007/s10549-018-4836-5. Epub 2018 Jun 1. Breast Cancer Res Treat. 2018. PMID: 29858751 Free PMC article.
-
PAM50 and Risk of Recurrence Scores for Interval Breast Cancers.Cancer Prev Res (Phila). 2018 Jun;11(6):327-336. doi: 10.1158/1940-6207.CAPR-17-0368. Epub 2018 Apr 5. Cancer Prev Res (Phila). 2018. PMID: 29622545 Free PMC article.
-
Differences in subtype distribution between screen-detected and symptomatic invasive breast cancer and their impact on survival.Clin Transl Oncol. 2017 Oct;19(10):1232-1240. doi: 10.1007/s12094-017-1660-z. Epub 2017 Apr 13. Clin Transl Oncol. 2017. PMID: 28409323
Publication types
MeSH terms
Substances
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical