Abstract
BackgroundStage shift is widely considered a major determinant of the survival benefit conferred by breast cancer screening. However, factors and mechanisms underlying such a prognostic advantage need further clarification. We sought to compare the molecular characteristics of screen detected vs. symptomatic breast cancers and assess whether differences in tumour biology might translate into survival benefit.MethodsIn a clinical series of 448 women with operable breast cancer, the Kaplan-Meier method and the log-rank test were used to estimate the likelihood of cancer recurrence and death. The Cox proportional hazard model was used for the multivariate analyses including mode of detection, age at diagnosis, tumour size, and lymph node status. These same models were applied to subgroups defined by molecular subtypes.ResultsScreen detected breast cancers tended to show more favourable clinicopathological features and survival outcomes compared to symptomatic cancers. The luminal A subtype was more common in women with mammography detected tumours than in symptomatic patients (68.5 vs. 59.0%, p=0.04). Data analysis across categories of molecular subtypes revealed significantly longer disease free and overall survival for screen detected cancers with a luminal A subtype only (p=0.01 and 0.02, respectively). For women with a luminal A subtype, the independent prognostic role of mode of detection on recurrence was confirmed in Cox proportional hazard models (p=0.03). An independent role of modality of detection on survival was also suggested (p=0.05).ConclusionsMolecular subtypes did not substantially explain the differences in survival outcomes between screened and symptomatic patients. However, our results suggest that molecular profiles might play a role in interpreting such differences at least partially.Further studies are warranted to reinterpret the efficacy of screening programmes in the light of tumour biology.
Highlights
Stage shift is widely considered a major determinant of the survival benefit conferred by breast cancer screening
Women who were symptomatic at diagnosis were more commonly younger, with the proportion of patients aged ≤ 49 years being significantly higher compared to women in the mammography group (37.5% vs. 27.2%, p
In conclusions, breast cancer patients with mammography detected tumours tended to show more favourable clinicopathological features and survival outcomes compared to women who were symptomatic at cancer diagnosis
Summary
Stage shift is widely considered a major determinant of the survival benefit conferred by breast cancer screening. Consistent evidence from randomized controlled trials of mammography in breast cancer screening demonstrates a 20-35% reduction in mortality from the disease [1,2,3]. On this basis, the Council of Europe recommends population-based organized mammographic screenings for women aged 50–69 years and claims that screening programmes fulfil the European guidelines [1,2]. Asymptomatic women in the aforementioned age range are individually identified and invited to attend mammography screenings Key issues such as eligibility criteria, quality assurance, follow up of positive results and programme evaluation are centrally regulated and comply with national and international guidelines [1,2]. The decentralized nature and lack of systematic reports on activities and outcomes represent further distinctive features [3,4]
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