Interim results from the Age Trial

S Moss,M Waller,H Cuckle,T Anderson

doi:10.1186/bcr848

Abstract

Since 1991, 160,884 women were randomised in the ratio 1:2 to intervention (annual mammography from age 40 to 41) and control arms. All breast cancers diagnosed in both arms were identified, and subjected to detailed histology review. Predicted deaths from breast cancer up to 10 years from entry were calculated using three different prognostic indices, based on 1287 cases diagnosed before 2000. There is currently an 8% excess of invasive breast cancers in the intervention arm, but nonsignificant decreases in the rates of cancers ≥20 mm and node-positive cancers. The ratio of predicted deaths in the intervention and control arms, adjusted for the excess diagnosis in the intervention arm, ranges from 0.89 to 0.90, and is borderline significant. This trial may result in a smaller breast cancer mortality reduction than other trials of women aged under 50, due to inclusion of all women from age 40 with possible lower sensitivity at younger ages. However, the present analysis, based on surrogate outcome measures, relies on several assumptions to overcome potential biases. Firm conclusions must await the analysis of observed mortality from breast cancer.

Highlights

Neoplastic tissue contains elevated levels of choline-containing metabolites [1,2]
We examined the extent to which the lower mammographic sensitivity found in hormone replacement therapy (HRT) users could be explained by any association of HRT use with higher density and more difficult to detect cancers
The results suggest that applying compression does not ensure breast thickness reduction and observing physical changes does not guarantee that breast thickness has been minimised

Summary

Introduction

Neoplastic tissue contains elevated levels of choline-containing metabolites (tCho) [1,2]. The presence of spiculation arising from a mass detected at mammography makes malignancy a probable diagnosis This is confirmed by this review of the first 8 years of screening in East Sussex where only 3.6% of masses with spiculation were benign at excision (24 out of 668), compared with 33.3% of masses without spiculation (102 out of 306). When breast core biopsy reveals lobular neoplasia (lobular carcinoma in situ [LCIS] or atypical lobular hyperplasia [ALH]) a management dilemma follows, as uncertainty regarding the significance of LCIS/ALH exists. Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Is this an indicator of increased risk of breast cancer or should it be considered a marker for more serious local pathology? Should surgical excision be undertaken in these cases?

Methods

Results

Discussion

Conclusion