Highlights
- •In an organized mammography screening programme interval cancers have a worse prognostic tumour profile than screen-detected cancers.
- •Analysis of molecular subtype distributions versus breast density reveals a higher percentage of the triple-negative phenotype in low-density breasts.
- •The observations support arguments against the prolongation of screening intervals in low-density breasts.
Abstract
Objective
The objective is to investigate tumour prognostic factors versus breast density in
screen-detected cancers and interval cancers. The results may highlight the need for
more personalised screening protocols based on breast density in organized screening
programmes.
Study design
A retrospective study was performed of tumour characteristics of screen-detected cancers
(n=468) and interval cancers (n=515) of 983 women who participated in the Flemish
Breast Cancer Screening Programme in 2009-2010. Breast density was obtained from the
screening programme data. Information on nodal invasion and histological grading was
taken from the Belgian Cancer Registry. Tumour size and proliferation and receptor
expression status were retrieved from pathology reports. The differences in tumour
characteristics between screen-detected and interval cancers as well as the variation
in these variables with breast density in both groups were studied by logistic regression.
Results
A comparison of tumour characteristics between screen-detected cancers and interval
cancers systematically showed features of more aggressive tumours in interval cancers:
larger tumour size, nodal invasion, grade 3 tumours, and hormone receptor negative
phenotype (p<0.05). The analysis of tumour characteristics versus breast density in
screen-detected cancers showed higher numbers of aggressive grade 3 tumours in low-density
breasts and of the luminal A subtype with good prognosis in high-density breasts (p<0.05).
This analysis for interval cancers highlights a high proportion of the difficult-to-treat
triple-negative subtype in low-density breasts compared with high-density breasts.
In conclusion, the study data support arguments against changes in breast cancer screening
programmes with prolongation of screening intervals in low-density breasts.
Keywords
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Available from: https://www.europeancancerleagues.org/our-projects-mypebs/.
Article info
Publication history
Published online: December 16, 2021
Accepted:
December 12,
2021
Received in revised form:
July 29,
2021
Received:
April 5,
2021
Identification
Copyright
© 2021 Elsevier B.V. All rights reserved.
