Five-Year Overall Survival of Interval Breast Cancers is Better than Non- Interval Cancers from Korean Breast Cancer Registry.

Jung Sun Lee,Minkyung Oh,Han-Byoel Lee,Onvox Yi,Joon Jeong,Se-Heon Cho,Min Ho Park,Heung Kyu Park,Hyun-Ah Kim

doi:10.31557/apjcp.2019.20.6.1717

Abstract

Objective:Interval breast cancer (IC) is a limitation of breast cancer screening. We investigated data from a large scaled breast cancer dataset of patients with breast cancer who underwent breast cancer screening in order to recapitulate the overall survival (OS) of patients with ICs compared to those with non-ICs. Methods:A total of 27,141 patients in the Korean breast cancer registry with breast cancer who had ever participated in biannual national breast cancer screening programs between 2009 and 2013 were enrolled. We compared the social, pregnancy-associated, and pathologic characteristics between the IC and non-IC groups and identified the significant prognostic factors for OS. Results:The proportion of ICs was 1.3% (370/27,141) in this study population. ICs were correlated with age 45-55 years at diagnosis, higher levels of education, early menopause (<50 years), hormone replacement therapy, specific provinces (Kangwon, Kyungnam, Jeju, and Dae-jeon), and family history of breast cancer. Low-to-intermediate nuclear grade, early stage (stage 0-I), and low Ki-67 level were also correlated with IC proportion. Non-ICs were associated with an increased risk of five-year mortality (hazard ratio [HR] 7.4; 95% confidence interval [CI]:1.85-29.66; p = 0.005) compared to ICs. Lymph node metastasis, residence (Kyung-nam province), low education status, high histologic grade, and asymptomatic cancers increased the HR of five-year OS. Conclusion:ICs occurred unequally in specific province and relatively high-educated women in Korea. They were also diagnosed with early-stage breast cancer with a favorable recurrence risk, and their outcome was better than those of patients with other breast cancers in breast cancer screening.

Highlights

When a mammography screening program is fully implemented, interval cancers comprise a substantial proportion of incident breast cancers
Non-Interval breast cancer (IC) were associated with an increased risk of five-year mortality compared to ICs
About the incidence of ICs in Korea, it has been reported that it increased from 5.2 persons in 2009 to 7.8 persons per 10,000 negative mammography findings in 2014 (Lee et al, 2016), similar to those reported in other countries (Kemp Jacobsen et al, 2015)

Summary

Introduction

When a mammography screening program is fully implemented, interval cancers comprise a substantial proportion of incident breast cancers. Several studies (Collett et al.,2005; Bellio et al, 2005; Sihto et al, 2008) have reported that the prognosis of ICs considered is poorer than that of screening-detected breast cancers because IC tumors are, on average, larger than those of more advanced cancers, and tried to identify women at risk of ICs. Previous randomized trials on mammography screening found that ICs were associated with similar (Holmberg et al, 1986; Delacour-Billon et al, 2017), better (Frisell et al, 1992) or poorer (Andersson et al, 1998; Musolino et al, 2018) survival compared to that of non-screened breast cancers. Kalager et al, (2012) reported in an observational cohort study that the prognosis of women with ICs was the same as that of women with breast cancer diagnosed without mammography screening

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Conclusion