Elsevier

Clinical Breast Cancer

Volume 14, Issue 4, August 2014, Pages 235-240
Clinical Breast Cancer

Original Study
Type of Breast Cancer Diagnosis, Screening, and Survival

https://doi.org/10.1016/j.clbc.2014.02.004Get rights and content

Abstract

Introduction

Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence of breast cancers detected through screening, before and after introduction of an organized screening, and we evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected breast cancer or those with palpable breast cancers.

Materials and Methods

We collected data about all women who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and recurrences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant.

Results

Among the 2070 cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A), 843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extrascreening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively, 99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference between the first 2 groups and the third (P < .05) and a trend between groups A and B (P = .081).

Conclusion

The diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the diagnosis, but a longer follow-up is necessary to confirm this data.

Introduction

Because of the detection of early-stage tumors, breast cancer screening reduced breast cancer mortality in Europe by 25%-31% in patients who were invited for screening and by 38%-48% in those who were actually screened during the last decade of the twentieth century and the first decade of the twenty-first.1 In our region of Italy, an organized breast cancer screening was firstly introduced in 2005, but despite the high compliance of invited women (which progressively increased after the screening introduction), a high prevalence still exists of women who have their breast cancer diagnosed by extrascreening objective examination or imaging.2, 3

In the present study, analyzed, among breast cancer patients treated in our department, the prevalence of breast cancers detected through the invitational screening, and the overall survival of these patients in comparison with that of women with an extrascreening imaging-detected breast cancer or those with palpable breast cancers.

Section snippets

Materials and Methods

We collected retrospective data for about 2811 women who underwent a breast operation following breast cancer diagnosis or suspicion in our clinic between January 2001 and April 2008, in order to have a follow-up of ≥ 5 years for every patient. Then, we excluded women with a diagnosis of benign lesion (471 patients), intralobular neoplasia (22 patients), or intraductal neoplasia (248 patients). Intraductal neoplasia represented the 17.6% of screen-detected and the 14.4% of extrascreening

Results

Among 2070 considered invasive breast cancers operated in our Clinic between January 2001 and April 2008, 247 were detected by the regional, organized, mammographic screening (group A), 1176 by extrascreening breast imaging (group B: 768 by mammography and 408 by ultrasound), and 1393 by extrascreening breast objective examination (group C). Interventions made in patients with breast cancer diagnosed through screening began in 2006. Before and after screening introduction the number of

Discussion

Breast cancer screening in our population succeeded in detecting early-stage tumors with favorable tumor characteristics, which have been consequently treated more frequently with breast and axillary conservative surgery, complementary breast irradiation and eventual hormonal therapy. Women with a screen-detected breast cancer had a significantly higher 5-years overall survival than women who had their breast cancer diagnosed by extrascreening objective examination or imaging, as well as a

Conclusion

In conclusion, breast cancer screening in our population resulted in a significant survival gain at 5 years from the diagnosis, but a longer follow up should be necessary to confirm this data, and further studies are required in order to evaluate interval cancers in order to better assess breast screening effectiveness in our population.

Disclosure

The authors have stated that they have no conflicts of interest.

References (30)

  • E. Paap et al.

    Breast cancer screening case-control study design: impact on breast cancer mortality

    Ann Oncol

    (2011)
  • K. Demissie et al.

    Empirical comparison of the results of randomized controlled trials and case-control studies in evaluating the effectiveness of screening mammography

    J Clin Epidemiol

    (1998)
  • M. Broeders et al.

    The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies

    J Med Screen

    (2012)
  • L. Driul et al.

    New surgical trends in breast cancer treatment: conservative interventions and oncoplastic breast surgery

    Minerva Ginecol

    (2013)
  • Busolin A, Clagnan E, Franzo A, Tillati S, Zanier L. I programmi di screening oncologici in Friuli Venezia Giulia dal...
  • A. Bleyer et al.

    Effect of three decades of screening mammography on breast-cancer incidence

    N Engl J Med

    (2012)
  • U.K. Independent

    Panel on Breast Cancer Screening. The benefits and harms of breast cancer screening: an independent review

    Lancet

    (2012)
  • P. Arnone et al.

    The TNM classification of breast cancer: need for change

    Updates Surg

    (2010)
  • I.D. Nagtegaal et al.

    Reduction in rate of node metastases with breast screening: consistency of association with tumor size

    Breast Cancer Res Treat

    (2013)
  • E. Paci et al.

    Quantification of the effect of mammographic screening on fatal breast cancers: The Florence Programme 1990-96

    Br J Cancer

    (2002)
  • E. Paci

    Summary of the evidence of breast cancer service screening outcomes in Europe and first estimate of the benefit and harm balance sheet

    J Med Screen

    (2012)
  • S.J. Otto et al.

    Mammography screening and risk of breast cancer death: a population-based case-control study

    Cancer Epidemiol Biomarkers Prev

    (2012)
  • E. Paap et al.

    A remarkable reduction of breast cancer deaths in screened versus unscreened women: a case-referent study

    Cancer Causes Control

    (2010)
  • D. Puliti et al.

    Effectiveness of service screening: a case-control study to assess breast cancer mortality reduction

    Br J Cancer

    (2008)
  • D. Roder et al.

    Population screening and intensity of screening are associated with reduced breast cancer mortality: evidence of efficacy of mammography screening in Australia

    Breast Cancer Res Treat

    (2008)
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