Abstract
The aim was to evaluate how the inter-screening interval affected the performance of screening by mammographic appearances. This was a Swedish retrospective screening cohort study with information on screening history and mammography features in two periods (1977–1985 and 1996–2010). The pre-clinical incidence and the mean sojourn time (MST) for small breast cancer allowing for sensitivity by mammographic appearances were estimated. The percentage of interval cancer against background incidence (I/E ratio) was used to assess the performance of mammography screening by different inter-screening intervals. The sensitivity-adjusted MSTs (in years) were heterogeneous with mammographic features, being longer for powdery and crushed stone-like calcifications (4.26, (95% CI, 3.50–5.26)) and stellate masses (3.76, (95% CI, 3.15–4.53)) but shorter for circular masses (2.65, (95% CI, 2.06–3.55)) in 1996–2010. The similar trends, albeit longer MSTs, were also noted in 1977–1985. The I/E ratios for the stellate type were 23% and 32% for biennial and triennial screening, respectively. The corresponding figures were 32% and 43% for the circular type and 21% and 29% for powdery and crushed stone-like calcifications, respectively. Mammography-featured progressions of small invasive breast cancer provides a new insight into personalized quality assurance, surveillance, treatment and therapy of early-detected breast cancer.
Highlights
Unlike the results in 1977–1985, the incidence rate (I/E) ratios for the circular type were smaller than those for breast tumors of size 15 mm or larger. This is the first study to quantify the temporal natural history of small breast cancers (1–14 mm) by mammographic appearances using longitudinal follow-up data. These estimates of mean sojourn time (MST) grasped a better understanding of the heterogeneity of the biological properties of breast tumors and provided a new insight into precision screening policy and medical surveillance for breast tumors with different appearances on mammographs
Based on the estimates of MSTs, it reveals the heterogeneity of breast tumors by mammographic appearance in biological growth rate
Breast tumors featured as stellate masses and powdery and the crushed stone-like calcifications on the film of mammography have slow progressions compared to circular masses
Summary
Breast cancer can be detected in the pre-clinical detectable phase (PCDP) through an appropriate screening modality such as mammography so as to lead to mortality reduction from breast cancer by 13–33% [1,2,3,4].A number of previous studies have elucidated the temporal natural history of breast cancer, free of breast cancer, PCDP, clinical phase (CP) [5,6,7,8] and the extended process with the incorporation of tumor attributes such as node status [9,10,11] by modeling the average duration between PCDP and CP, named as the mean sojourn time (MST) [6,12,13]. Due to the widespread use of mammography screening for breast cancer, elucidating the natural history of breast cancer by mammographic features with emphasis on breast tumors less than 1–14 mm is of paramount importance [16,17,18]. The AAB type, including the stellate type, the circular type, the powdery type, and the crushed stone-like type, can be prevented by early detection through mammography, but the latter had poor prognosis and may not be amenable to early detection through screening [19,20]. Among AAB, the stellate type, the powdery type, and the crushed stone-like had better prognosis than the circular type [19]
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