Characteristics and prognosis of interval cancers after biennial screen-film or full-field digital screening mammography.

Abstract

We determined the characteristics and prognosis of interval breast cancers (IC) at screen-film (SFM) and full-field digital (FFDM) screening mammography. The study population consisted of 417,746 consecutive screening mammograms (302,699 SFM screens and 115,047 FFDM screens), obtained between 2000 and 2011. During 2-year follow-up, we collected breast imaging reports, surgical reports, and pathology results. A total of 800 ICs had been diagnosed in the screened population, of which 288 detected in the first year (early ICs) and 512 in the second year (late ICs) after a negative screen. 31.3% of early IC's and 19.1% of late IC's, respectively, were visible in retrospect on the latest previous screens, but had been missed during screening (P<0.001). Missed invasive ICs were larger (28.5mm vs. 23.9mm, P=0.003) and showed a higher fraction of T3+cancers (16.9 vs. 8.5%, P=0.02) than true ICs (i.e., not visible at the latest screen). A higher portion of missed than true ICs underwent mastectomy (44.7 vs. 30.8%, P=0.002). We found no differences in mammographic and tumor characteristics for early ICs, detected either after SFM or FFDM. Late ICs following FFDM were more often true ICs than missed ICs (69.0 vs. 57.6%, P=0.03) and more often receptor triple negative (P=0.02), compared to late ICs at SFM. Interval cancer subgroups showed comparable overall survival. Interval cancer subgroups show distinctive mammographic and tumor characteristics but a comparable overall survival.