Abstract
BackgroundLead time, the interval between screen detection and when a disease would have become clinically evident, has been cited to explain longer survival times in mammography detected breast cancer cases (BC).MethodsAn institutional retrospective cohort study of BC outcomes related to detection method (mammography (MamD) vs. patient (PtD)). Cases were first primary invasive stage I-III BC, age 40–74 years (n = 6603), 1999–2016. Survival time was divided into 1) distant disease-free interval (DDFI) and 2) distant disease-specific survival (DDSS) as two separate time interval outcomes. We measured statistical association between detection method and diagnostic, treatment and outcome variables using bivariate comparisons, Cox proportional hazards analyses and mean comparisons. Outcomes were distant recurrence (n = 422), DDFI and DDSS.Results39% of cases were PtD (n = 2566) and 61% were MamD (n = 4037). MamD cases had a higher percentage of Stage I tumors [MamD 69% stage I vs. PtD 31%, p < .001]. Rate of distant recurrence was 11% among PtD BC cases (n = 289) vs. 3% of MamD (n = 133) (p < .001). Order of factor entry into the distant recurrence time interval (DDFI) model was 1) TNM stage (p < .001), 2) HR/HER2 status (p < .001), 3) histologic grade (p = .005) and 4) detection method (p < .001). Unadjusted PtD DDFI mean time was 4.34 years and MamD 5.52 years (p < .001), however when stratified by stage, the most significant factor relative to distant recurrence, there was no significant difference between PtD and MamD BC. Distant disease specific survival time did not differ by detection method.ConclusionWe observed breast cancer distant disease-free interval to be primarily associated with stage at diagnosis and tumor characteristics with less contribution of detection method to the full model. Patient and mammography detected breast cancer mean lead time to distant recurrence differed significantly by detection method for all stages but not significantly within stage with no difference in time from distant recurrence to death. Lead time difference related to detection method appears to be present but may be less influential than other factors in distant disease-free and disease specific survival.
Highlights
Lead time, the interval between screen detection and when a disease would have become clinically evident, has been cited to explain longer survival times in mammography detected breast cancer cases (BC)
The incidence of recurrent metastatic breast cancer and breast cancer mortality have decreased in recent years coincident with improvement in breast cancer survival due to both reduced incidence of higher stage disease related to mammography screening and improved adjuvant systemic therapy for invasive stage I-III disease [1,2,3,4]
Tumor characteristics differed with mammography detected (MamD) BC cases more likely Hormone receptor (HR)+/Human epidermal growth factor receptor 2 (HER2)- [64% vs. 36% patient detected (PtD) BC] and the reverse for triple negative breast cancer (TNBC) [39% MamD BC vs 61% PtD BC) (p < .001)]
Summary
The interval between screen detection and when a disease would have become clinically evident, has been cited to explain longer survival times in mammography detected breast cancer cases (BC). Mammography screening has shifted breast cancer detected to more early stage (stage 0 (DCIS) and stage I-II) and less late stage breast cancer (stage III and IV) over time in screened populations [10,11,12,13,14,15,16]. Lead time is not a measure used to evaluate breast cancer survival improvement associated with screening mammography which is measured by differential breast cancer mortality over time between screened and unscreened populations
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