Tumor Characteristics Associated With Mammographic Detection of Breast Cancer in the Ontario Breast Screening Program
Tumor Characteristics Associated With Mammographic Detection of Breast Cancer in the Ontario Breast Screening Program
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DOI：
10.1093/jnci/djr138
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发表时间：
2011-06-01
影响因子：
10.3
通讯作者：
Boyd, Norman F.
中科院分区：
文献类型：
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作者：
Kirsh, Victoria A.;Chiarelli, Anna M.;Boyd, Norman F.
背景很少有研究比较乳腺摄影筛查与筛查发现的乳腺癌之间的间隔期内诊断的乳腺癌类型的肿瘤特征的预后价值。（n = 431 480）在安大略乳腺筛查项目中，年龄在50岁及以上，在1994年1月1日至12月31日期间接受筛查，2002.间隔期癌症，定义为阴性筛查乳房X线检查后24个月内诊断的乳腺癌，如果在筛查时未发现但在回顾时发现，则被指定为真正的间隔期癌症（n = 288）或遗漏的间隔期癌症（n = 87）。选择筛查检测的乳腺癌（n = 450）以匹配间隔期癌症。肿瘤的阶段，等级，有丝分裂指数，组织学和激素受体的表达和比值比（OR）和95%的置信区间（CI）进行了评估，通过条件Logistic regulation.Results计算的真实和错过的间隔癌症的阶段和等级比匹配的屏幕检测到的乳腺癌。然而，真正的间隔癌有较高的有丝分裂指数（OR = 3.13，95% CI = 1.81至5.42），非导管组织学的百分比较高（OR = 1.94，95%CI = 1.05 ~ 3.59），且更可能为雌激素受体阴性孕激素受体阴性（OR = 2.49，95% CI = 1.68 ~ 3.70）。真正的间期癌更有可能有额外的雌激素和孕激素受体阴性和非导管形态的不良预后特征。研究结果表明，需要更敏感的筛查方式来检测真正的间隔期乳腺癌，以及早期检测快速生长肿瘤的不同方法。
Background Few studies have compared the prognostic value of tumor characteristics by type of breast cancer diagnosed in the interval between mammographic screenings with screen-detected breast cancers.Methods We conducted a case-case study within the cohort of women (n = 431 480) in the Ontario Breast Screening Program who were aged 50 years and older and were screened between January 1, 1994, and December 31, 2002. Interval cancers, defined as breast cancers diagnosed within 24 months after a negative screening mammogram, were designated as true interval cancers (n = 288) or missed interval cancers (n = 87) if they were not identified at the time of screening but were identified in retrospect. Screen-detected breast cancers (n = 450) were selected to match interval cancers. Tumors were evaluated for stage, grade, mitotic index, histology, and expression of hormone receptors and odds ratios (ORs) and 95% confidence intervals (CIs) were calculated by conditional logistic regression.Results Both true and missed interval cancers were of higher stage and grade than matched screen-detected breast cancers. However, true interval cancers had a higher mitotic index (OR = 3.13, 95% CI = 1.81 to 5.42), a higher percentage of nonductal histology (OR = 1.94, 95% CI = 1.05 to 3.59), and were more likely to be both estrogen receptor-negative (OR = 2.09, 95% CI = 1.32 to 3.30) and progesterone receptor-negative (OR = 2.49, 95% CI = 1.68 to 3.70) compared with matched screen-detected tumors.Conclusions In this study, interval cancers were of higher stage and grade compared with screen-detected cancers. True interval cancers were more likely to have additional adverse prognostic features of estrogen and progesterone receptor negativity and nonductal morphology. The findings suggest a need for more sensitive screening modalities to detect true interval breast cancers and different approaches for early detection of fast-growing tumors.