Abstract
BackgroundA limited number of studies have explored the association between self-reported symptoms and the risk of breast cancer among participants of population based screening programs. MethodsWe performed descriptive statistics on recall, screen-detected and interval cancer, positive predictive value and histopathological tumour characteristics by symptom group (asymptomatic, lump, and skin or nipple changes) as reported from 785,642 women aged 50–69 when they attended BreastScreen Norway 1996–2016. Uni- and multivariable mixed effects logistic regression models were used to analyze the association between symptom group and screen-detected or interval cancer. Results were presented as odds ratios and 95% confidence intervals (CI). ResultsA lump or skin/nipple change was reported in 6.2% of the 3,307,697 examinations. The rate of screen-detected cancers per 1000 examinations was 45.2 among women with a self-reported lump and 5.1 among asymptomatic women. Adjusted odds ratio of screen-detected cancer was 10.1 (95% CI: 9.3–11.1) and 2.0 (95% CI: 1.6–2.5) for interval cancer among women with a self-reported lump versus asymptomatic women. Tumour diameter, histologic grade and lymph node involvement of screen-detected and interval cancer were less prognostically favourable for women with a self-reported lump versus asymptomatic women. ConclusionDespite targeting asymptomatic women, 6.2% of the screening examinations in BreastScreen Norway was performed among women who reported a lump or skin/nipple change when they attended screening. The odds ratio of screen-detected cancer was higher for women with versus without symptoms. Standardized follow-up guidelines might be beneficial for screening programs in order to take care of women reporting signs or symptoms of breast cancer when they attend screening.
Highlights
A lump in the breast is the most common symptom of breast cancer, and is often emphasized by breast cancer awareness campaigns [1]
Breast cancer screening programs are aimed at asymptomatic, average-risk women, while women with lumps or other breast symptoms are recommended to seek medical advice [2]
We found substantial variation in the distribution of symptom groups between the breast centers in BreastScreen Norway (Tables Se1)
Summary
A lump in the breast is the most common symptom of breast cancer, and is often emphasized by breast cancer awareness campaigns [1]. A high proportion of symptomatic women might reduce the efficacy of a screening program, as women with symptomatic breast cancers are expected to have less prognostically favourable histopathological tumour characteristics compared to women with screen-detected cancer, and should have sought medical advice earlier [5,6]. Methods: We performed descriptive statistics on recall, screen-detected and interval cancer, positive predictive value and histopathological tumour characteristics by symptom group (asymptomatic, lump, and skin or nipple changes) as reported from 785,642 women aged 50e69 when they attended BreastScreen Norway 1996e2016. Adjusted odds ratio of screen-detected cancer was 10.1 (95% CI: 9.3 e11.1) and 2.0 (95% CI: 1.6e2.5) for interval cancer among women with a self-reported lump versus asymptomatic women. Conclusion: Despite targeting asymptomatic women, 6.2% of the screening examinations in BreastScreen Norway was performed among women who reported a lump or skin/nipple change when they attended screening.
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