© 1999 by Oxford University Press
Journal of the National Cancer Institute, Vol. 91, No. 23, 2020-2028,
December 1, 1999
© 1999 Oxford University Press
REPORTS |
Breast Tumor Characteristics as Predictors of Mammographic Detection: Comparison of Interval- and Screen-Detected Cancers
Affiliations of authors: P. L. Porter, Program in Cancer Biology, Division of Human Biology, Fred Hutchinson Cancer Research Center, Seattle, WA, and Department of Pathology, University of Washington, Seattle; A. Y. El-Bastawissi, N. Khalid (Cancer Prevention Research Program, Division of Public Health Sciences), M. G. Lin, E. A. Watney, L. Cousens (Program in Cancer Biology), Division of Human Biology, Fred Hutchinson Cancer Research Center; M. T. Mandelson, Department of Epidemiology, University of Washington, and Center for Health Studies, Group Health Cooperative, Seattle; D. White, Department of Radiology, Group Health Cooperative; S. Taplin, Department of Family Medicine, University of Washington, and Center for Health Studies, Group Health Cooperative, Seattle; E. White, Cancer Prevention Research Program, Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, and Department of Epidemiology, University of Washington.
Correspondence to: Peggy L. Porter, M.D., Fred Hutchinson Cancer Research Center, Cancer Biology, C1-015, 1100 Fairview Ave., N., Seattle, WA 98109 (e-mail: pporter{at}fhcrc.org).
BACKGROUND: Although mammographic screening is useful for detecting early breast cancer, some tumors are detected in the interval between screening examinations. This study attempted to characterize fully the tumors detected in the two different manners. METHODS: Our study utilized a case-control design and involved a cohort of women undergoing mammographic screening within the defined population of a health maintenance organization (the Group Health Cooperative of Puget Sound). Women were classified as having "interval" or "interval-detected" cancers (n = 150) if their diagnosis was made within 24 months after a negative-screening mammogram or one that indicated a benign condition. Cancers were classified as "screen detected" (n = 279) if the diagnosis occurred after a positive assessment by screening mammography. Tumors from women in each group were evaluated for clinical presentation, histology, proliferative characteristics, and expression of hormone receptors, p53 tumor suppressor protein, and c-erbB-2 protein. RESULTS: Interval-detected cancers occurred more in younger women and were of larger tumor size than screen-detected cancers. In unconditional logistic regression models adjusted for age and tumor size, tumors with lobular (odds ratio [OR] = 1.9; 95% confidence interval [CI] = 0.9-4.2) or mucinous (OR = 5.5; 95% CI = 1.5-19.4) histology, high proliferation (by either mitotic count [OR = 2.9; 95% CI = 1.5-5.7] or Ki-67 antigen expression [OR = 2.3; 95% CI = 1.3-4.1]), high histologic grade (OR = 2.1; 95% CI = 1.2-4.0), high nuclear grade (OR = 2.0; 95% CI = 1.0-3.7), or negative estrogen receptor status (OR = 1.8; 95% CI = 1.0-3.1) were more likely to surface in the interval between screening examinations. Tumors with tubular histology (OR = 0.2; 95% CI = 0.0-0.8) or with a high percentage of in situ components (50%) (OR = 0.5; 95% CI = 0.2-1.2) were associated with an increased likelihood of screen detection. CONCLUSIONS: Our data from a large group of women in a defined population indicate that screening mammography may miss tumors of lobular or mucinous histology and some rapidly proliferating, high-grade tumors.
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