Interval Breast Cancers Research Articles

A study of interval breast cancer within the NHS breast screening programme

Aim—To define the biological nature and malignant potential of interval cancers presenting to a breast unit within the NHS breast screening programme. Methods—112 interval cancers were compared with matched, screen...

The visibility of cancer on earlier mammograms in a population-based screening programme

The aim of this study was to examine how frequently the later-round screen-detected and interval breast cancers were visible in earlier screening mammograms by retrospective review and to compare their radiological and clinicopathological features with those diagnosed by primary screening. In a population-based mammography screening programme 63 731 women aged 50–59 years were invited and 56 158 examinations were carried out in the period 1987–1992 in the Tampere area in Finland. A total of 276 breast cancers were detected, of which 131 were diagnosed on later screening rounds or were interval cancers. A retrospective review of previous screening mammograms was carried out in 130 cases by the radiologist who diagnosed the breast cancer and thus knew the exact location of the tumour, no blinded review was carried out. 43 (33%) cancers were visible, 84 (65%) were not visible and 3 (2%) not included on the mammogram in a retrospective review. Later round screen-detected cancers were statistically significantly more often visible in earlier screening mammograms (43%) than interval cancers (19%) ( P=0.002). Tumours missed by screening mammography but which were visible on retrospective review were often histologically well-differentiated and were more often diagnosed in the subsequent screening round than by clinical diagnosis as interval cancers. If all retrospectively visible interval cancers had been diagnosed by screening 19% (10/54) of the interval cancers could have been avoided. If all retrospectively visible cancers had been diagnosed at the time of false-negative screening or assessment 65% (84/130) of all patients would have benefitted from an earlier diagnosis compared with the actual figure of 31% (41/130).

The effect of hormone replacement therapy on the sensitivity of screening mammograms

AIM: The use of hormone replacement therapy (HRT) can lead to various changes on the mammogram including increasing density. The object of this study was to assess the effect of HRT on the sensitivity of mammographic screening by comparing HRT usage in women with screen detected breast cancers with HRT usage at the time of screening in women presenting with interval cancers. METHODS: The West of Scotland Breast Screening Programme serves a population of 180,000 women aged 50–64 years old. Between May 1988 and December 1995, 1461 breast cancers were detected by the screening programme in 1441 women over the age of 50 and 372 interval breast cancers presented in 371 women screened between these dates. HRT usage at the time of screening was noted with details of age, postcode and the time between screening and diagnosis in the case of the women with interval cancers. RESULTS: Among women under 65 years old, screened between 1988–1993, 12.3% of women with screen detected cancers and 22.2% of women with interval cancers were using HRT ( P<0.001). Further analysis demonstrates that interval cancer rate is related to age as well as HRT use. After adjusting for age at time of screening, deprivation category and year of screening, the relative risk of a woman using HRT having an interval cancer compared with that of a woman not using HRT is 1.79. The relative risk of an interval cancer arising in the first year after screening for a woman on HRT is 2.27. CONCLUSION: The use of HRT and being of an age below 60 years are both risk factors for presenting with an interval cancer after mammographic breast screening. Our results indicate that the use of HRT leads to a decrease in the sensitivity of mammographic screening.

‘Blind’ review of interval breast cancers

‘Blind’ review of interval breast cancers

Östergötland mammographic screening programme: Compliance, referral rate, and risk of interval breast cancer after a negative screen

Östergötland mammographic screening programme: Compliance, referral rate, and risk of interval breast cancer after a negative screen

Interval breast cancers in the NHS Breast Screening Programme: does the current definition exclude too many?

To examine the impact of the definition of interval breast cancers on interval cancer rates arising from the prevalent (first) screening round. Interval breast cancers arising from the prevalent (first) screening round at the Warwickshire, Solihull and Coventry Breast Screening Unit (17 April 1989 to 31 March 1992) were identified by comparison of data held at the unit with records at the West Midlands Cancer Intelligence Unit. Exclusion criteria used in National statistics were applied to this sample to quantify their impact on achieved interval cancer rates. The round lengths experienced by individual women at the unit were determined from the prevalent and incident invitation dates for 155 women with incident (re-screen) breast cancers detected in the second round. Warwickshire, Solihull and Coventry Breast Screening Unit. 59,017 women screened between 17 April 1989 and 31 March 1992 with a negative screening result and 155 women with incident screen detected cancers. A total of 278 interval cancers were identified, giving an overall rate from the prevalent screening round of 47.1/10,000 women screened. Of these, 213 met the criteria used in the definition of interval cancers for National statistics and were termed "core" interval cancers. The overall "core" interval rate was 36.1/ 10,000 women screened, similar to interval cancer rates found in the north west of United Kingdom. Thus applying commonly used exclusion criteria produced a 23.4% reduction in the apparent interval cancer rate, with the largest decrease resulting from the exclusion of cancers arising at 36 months or more from the last screen. The exclusion criteria used in the definition of interval cancers have a significant impact on observed interval cancer rates. Of particular concern is the exclusion in the current National definitions of cancers arising at 36 months or more from the last screen, which may mask a problem with significant implications for the success of the NHSBSP.

Histopathology and growth rate of interval breast carcinoma. Characterization of different subgroups.

Interval breast cancers are defined as carcinomas occurring within 2 years after a negative screening Distinction has to made between cancers existent at the time of screening but missed for some reason, and fast-growing incident cancers. This is important because the natural history and the implications for the treatment of the patient might differ. Radiologic and histopathologic characteristics were assembled for 104 interval cancers diagnosed within the DOM project, the Utrecht program for the early detection of breast cancer. At a mammographic review for 27 cases, signs of malignant or benign tumor were found (missed cases). For 77 cases no radiologic signs were present on review. Twenty of these cases had a mitotic rate of > 3 and a high tumor growth rate (mean doubling time: 51 days). This combination seemed implausible, therefore, it was thought hypothesized that these tumors were most likely present, although radiologically invisible (masked), at the time of screening. The remaining cases (n = 57) were classified as true interval cancers and further divided into 14 fast-growing cases (mitotic rate > or = 3/high-power field [HPF]) and 43 cases with an intermediate growth rate (mitotic rate < 3/HPF). Factors associated with the masking of tumors were the histologic tumor type, absence of microscopic calcifications, and presence of dense breast tissue. Fast-growing tumors were characterized by a young patient age, absence of microscopic calcifications, and a high percentage of regional lymph node positive tumors. The 5-year survival probability was 100% for missed cases, 70% for masked cases, 80% for cases with an intermediate growth rate, and 54% for fast-growing cases. It is possible to separate interval breast cancers in true interval cases and cases (most likely) existent at the time of screening. Part of this last group is invisible by mammography (masked).

Screening interval breast cancers: mammographic features and prognosis factors.

To review the mammographic features of screening interval breast cancers and to compare the tumor size, histologic grade, and lymph node involvement with those in screening-detected and unscreened symptomatic cancers. Screening mammography was performed in 72,773 women aged 50-64 years. Ninety interval cancers were identified in 89 women. The mammographic and histopathologic features of these cancers were analyzed. At review of the screening mammograms, interval cancers were classified into four groups: 51 true-positive, 20 false-negative, seven mammographically occult, and 12 unclassified. The most common missed abnormality in the false-negative cases was architectural distortion. Interval cancers were larger, of higher grade, and more likely to have lymph node involvement than screening-detected tumors and were of similar size, histologic grade, and stage of lymph node involvement as symptomatic tumors. Prognosis in interval cancers is similar to that in symptomatic, unscreened tumors and statistically significantly worse than that in screening-detected cancers.

中間期乳癌 当科手術例よりみた中間期乳癌症例の検討

中間期乳癌 当科手術例よりみた中間期乳癌症例の検討

中間期乳癌 中間期乳癌の特徴

検診後2年間の間に, 検診以外の手段により発見された中間期乳癌の発生要因として考えられることは, 最終検診時に所見を見逃した場合と検診後の短期間に乳癌が臨床的に顕性化した場合である。前者が主な理由であれば, 中間期乳癌には臨床診断の困難であったものが多く含まれることになり, 後者であれば中間期乳癌には増殖性の高い腫瘍細胞からなるものが多いこととなる。今回, われわれは以上の2つの推論を踏まえて, 中間期乳癌26例を中間期乳癌以外の544例と対比・検討し, 中間期乳癌の特徴を明らかにした。その結果, 中間期乳癌は集検発見乳癌, 外来発見乳癌と比べて, (1) 60歳以上の症例が少ない。 (2) 腫瘍細胞の核分裂像頻度が高いものが多い。 (3) c-erbB-2蛋白発現陽性例の割合が多い。そして, (4) 中間期乳癌のn因子は二峰性を示した。以上から, 中間期乳癌には見逃し例の混在も考えられるが, 主として, 増殖性の高い乳癌が多いと思われた。

Screening mammography behavior in women with screening and interval breast cancers

Screening mammography behavior in women with screening and interval breast cancers

Classifying interval cancers

No definitive way of classifying interval breast cancers (cancers presenting between screening rounds) has been determined, yet their number and classification forms one of the quality assurance (QA) standards for the National Health Service Breast Screening Programme (NHSBSP). This study was undertaken to identify how different screening centres undertake this process, and to compare the classifications obtained when a test set of mammograms was reviewed using three different methods. A questionnaire was sent to the 17 Regional UK breast screening QA centres. Twelve (80%) of the 15 centres completing the questionnaire had a formal method for reviewing interval cancers. Five of these (33%) attempted to simulate screening by mixing the interval cancers with other screening films. In 11 (73%) centres, a group (size range 3-14) of radiologists was involved. In a simulated film viewing exercise we assessed whether different methods of classification would alter the number of interval cancers classified as false negative (where an abnormality suspicious of malignancy can be identified on review of the original screening films). Six radiologists reviewed a set of 50 interval cancers by three different methods: independent reading of the interval cancers mixed with screening mammograms; independent reading of the interval cancers on their own; and finally a consensus opinion of the interval cancers alone using the films taken at diagnosis. No discussion or review of these cases had taken place prior to the study. The number of interval cancers classified as false negative increased by 10% when they were reviewed in isolation compared to review among 'normal' screening films. The false negative rate varied widely (4% to 56% P < 0.01) depending on the criteria required to fulfil a false negative interval cancer classification--whether only one, a majority, or all of the radiologists were required to see the abnormality on the original screening films. In order for inter-unit and regional comparisons to be useful, a standard review method of mixing the interval cancer films with normal screening films and using a consensus opinion by a minimum of three external reviewers is suggested.

Survival in interval breast cancer in the DOM screening programme.

The study describes breast cancer survival of 75 interval cancer cases (cancer occurring within 2 years of a negative screen) detected in women who participated in the DOM screening programme. After mammographic revision, this group was divided into 17 so-called 'missed' cases and 58 'true' interval cases. Ten year survival of these 58 'true' interval cases was 58%, which was not significantly different from that of 219 cancers detected in a non-screened, control group of women, diagnosed with breast cancer before the start of screening (63%; log rank chi 2 test, P = 0.98). Results remained essentially the same after correction for age at diagnosis, tumour size, axillary status and year of diagnosis. Ten year survival of 'true' interval cancers (58%) was slightly worse than that of 'missed' cases (67%; log rank chi 2 test: P = 0.38). This difference could largely be explained by differences in tumour size and axillary status. We conclude that there was no important difference in survival between 'true' interval cancers and non-screened historical controls. This could mean that either this subgroup of interval cancers does not constitute an excess of rapidly growing tumours, or if it does, that a fast growth rate is not associated with an exceptionally poor prognosis.

Re: Interval breast cancers in the screening mammography program of British Columbia: analysis and classification.

Re: Interval breast cancers in the screening mammography program of British Columbia: analysis and classification.

Informed consent may increase non-attendance rate

EDITOR,—The Health of the nation aims at reducing deaths from breast cancer in women invited for screening by a quarter by 2000. This target is unlikely to be met as there are only five years to go; judging by the current rates of interval breast cancer, we are probably only half way to that target.1 If there is any reduction in mortality from breast cancer by 2000 it is just as likely to be attributable to the improvements in treatment since the …

What should be done about interval breast cancers?

The paper by Woodman and colleagues in this week's journal contains the first published data from the NHS breast screening programme on cancers diagnosed in the three years after a negative screen (“interval cancers”) (p 224).1 It reports 15.8 interval cancers per 10000 women screened in the North West region in the 24 months after screening, which is higher than the target that was set for Britain. Preliminary data from 46 screening centres, collected by the National Breast Screening Radiology Quality Assurance Committee, are very similar, suggesting that the North West region is representative of the United Kingdom as a whole. Comparing rates of interval cancer with those reported in the literature is difficult because different groups have reported the data using different methods and the populations studied have different age compositions. The rates reported today, however, are higher than the rate of 9.4/10000 in the Swedish two county trial2 and are very similar to the rates reported from the Nijmegen (15.7/10000)3 and Stockholm (19.2/10000) trials.4 In Nijmegen in the eight successive screening rounds …

Determination of mammographic screening intervals with surrogate measures for women aged 40-49 years.

HomeRadiologyVol. 193, No. 2 PreviousNext Determination of mammographic screening intervals with surrogate measures for women aged 40-49 years.S A FeigS A FeigS A FeigPublished Online:Nov 1 1994https://doi.org/10.1148/radiology.193.2.7972732MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked In Article HistoryPublished in print: 1994 FiguresReferencesRelatedDetailsCited ByEvidence to Support Screening Women in Their 40sKimberly M.Ray, Elissa R.Price, Bonnie N.Joe2017 | Radiologic Clinics of North America, Vol. 55, No. 3Personalized Screening for Breast Cancer: A Wolf in Sheep's Clothing?Stephen A.Feig2015 | American Journal of Roentgenology, Vol. 205, No. 6Screening Mammography Benefit ControversiesStephen A.Feig2014 | Radiologic Clinics of North America, Vol. 52, No. 3Breast ImagingStephen A.Feig, Stephen W.Duffy20114–9 Breast cancer mortality after screening mammography in British Columbia womenS.A.Feig2008 | Breast Diseases: A Year Book Quarterly, Vol. 18, No. 4Auditing and Benchmarks in Screening and Diagnostic MammographyStephen A.Feig2007 | Radiologic Clinics of North America, Vol. 45, No. 5Factors Contributing to Mammography Failure in Women Aged 40–49 YearsStephen A.Feig2006 | Breast Diseases: A Year Book Quarterly, Vol. 16, No. 44–8 A Basal Epithelial Phenotype Is More Frequent in Interval Breast Cancers Compared With Screen Detected TumorsS.A.Feig2006 | Breast Diseases: A Year Book Quarterly, Vol. 16, No. 4Screening Mammography Controversies: Resolved, Partly Resolved, and UnresolvedStephen A.Feig2005 | The Breast Journal, Vol. 11, No. s1Current status of breast ultrasoundGeorgian-SmithDianne M2004 | Applied RadiologyRecent Results in Cancer ResearchStephen A.Feig2003 | , Vol. 163Screening strategy for breast cancerStephen A.Feig2003 | Seminars in Breast Disease, Vol. 6, No. 4Breast Cancer Screening for High-Risk Women: Too Little, Too Late?KatrinaArmstrong, Barbara L.Weber2001 | Journal of Clinical Oncology, Vol. 19, No. 4Medical RadiologyS. M.Ascher2000Medical RadiologyI.Schreer, H.-J.Frischbier2000Medical RadiologyL. J. WarrenBurhenne2000Role and evaluation of mammography and other imaging methods for breast cancer detection, diagnosis, and stagingStephen A.Feig1999 | Seminars in Nuclear Medicine, Vol. 29, No. 1BREAST CANCER SCREENINGBrenda E.Sirovich, Harold C.Sox1999 | Surgical Clinics of North America, Vol. 79, No. 5Prognosis, treatment, and recurrence of breast cancer for women attending or not attending the Screening Mammography Program of British ColumbiaIvo A.Olivotto, DonnaMates, LisaKan, JonathanFung, RajivSamant, Linda J. WarrenBurhenne1999 | Breast Cancer Research and Treatment, Vol. 54, No. 1The benefits of mammography are not limited to women of ages older than 50 yearsRuthHeimann, JeffreyBradley, SamuelHellman1998 | Cancer, Vol. 82, No. 11American College of Radiology guidelines for breast cancer screening.S AFeig, C JD'Orsi, R EHendrick, V PJackson, D BKopans, BMonsees, E ASickles, C BStelling, MZinninger, PWilcox-Buchalla1998 | American Journal of Roentgenology, Vol. 171, No. 1Survival of women ages 40-49 years with breast carcinoma according to method of detectionCarol P.McPherson, Karen K.Swenson, GailJolitz, Charles L.Murray1997 | Cancer, Vol. 79, No. 10Increased benefit from shorter screening mammography intervals for women ages 40-49 yearsStephen A.Feig1997 | Cancer, Vol. 80, No. 11National Institutes of Health Consensus Development Conference Statement: Breast Cancer Screening for Women Ages 40-49, January 21-23, 19971997 | JNCI Journal of the National Cancer Institute, Vol. 89, No. 14Mammography Outcomes in a Practice Setting by Age: Prognostic Factors, Sensitivity, and Positive Biopsy RateMichael N.Linver, Stuart B.Paster1997 | JNCI Monographs, Vol. 1997, No. 22Breast Cancer Screening Outcomes in Women Ages 40-49: Clinical Experience With Service Screening Using Modern MammographyEdward A.Sickles1997 | JNCI Monographs, Vol. 1997, No. 22Assessment of radiation risk from screening mammographyStephen A.Feig1996 | Cancer, Vol. 77, No. 5Screening Mammography in Women Under Fifty Years of AgeStephen A.Feig1996 | The Breast Journal, Vol. 2, No. 3Estimation of currently attainable benefit from mammographic screening of women aged 40-49 yearsStephen A.Feig1995 | Cancer, Vol. 75, No. 10Mammographic screening of women aged 40–49 years. Benefit, risk, and cost considerationsStephen A.Feig1995 | Cancer, Vol. 76, No. S10The Canadian national breast screening study. Why? what next? and so what?Cornelia J.Bathes1995 | Cancer, Vol. 76, No. S10MAMMOGRAPHY SCREENING OF WOMEN AGED 40 TO 49 YEARSStephen A.Feig1994 | Obstetrics and Gynecology Clinics of North America, Vol. 21, No. 4Recommended Articles RSNA Education Exhibits RSNA Case Collection Vol. 193, No. 2 Metrics Altmetric Score PDF download

Interval breast cancers in the Screening Mammography Program of British Columbia: analysis and classification.

Interval cancers in an annual mammography screening program are defined as cancers detected within 12 months after a mammographic screening in which findings are considered normal. Our objective was to analyze interval cancers for histologic type, tumor size, staging, and histologic grade. A classification for interval cancers is presented. Detection of interval cancers is an integral part of quality control and is required for the establishment of sensitivity rates for screening mammography, a necessary part of implementing the recommendations for breast cancer screening. A total of 47,583 mammographic screening examinations of 38,219 women were available for review for the period of July 1988 to March 1991. Linkage with the provincial population-based cancer registry provided identification of all interval cancers of the breast. Histologic analysis of breast cancers was provided by an internationally recognized breast cancer pathologist who interpreted the specimens twice. A total of 207 breast cancers were detected at mammographic screening (true-positive cancers) during the first 33 months of the program, and 37 interval cancers were identified during the 33 months of screening plus a 12-month interval. Blinded review by three radiologists experienced in screening mammography resulted in classification of 21 of 37 cases as true interval cancers and 16 cases as misses. No interval cancers were missed because of poor mammographic technique. The sensitivity of screening mammography was 85%, 63% for patients less than 50 years old and 89% for patients more than 50 years old. The specificity was 93% for all patients (both younger and older than 50 years). The availability of a population-based cancer registry in the province of British Columbia makes an accurate determination of interval cancers and sensitivity rates possible. These data are essential for quality analysis, program planning, and education of radiologists in screening mammography. There were more true interval cancers than misses, and histologic analysis demonstrated that the majority of interval cancers were in stages I and II.

Interval breast cancers are not biologically distinct—Just more difficult to diagnose

Breast cancer diagnosed within 1 year of a negative annual screening examination is called interval breast cancer (IBC) and is considered to be a more virulent subtype of disease. We reviewed clinical data on 24 women who were diagnosed as having IBC while participating in the Breast Cancer Detection Demonstration Project at Ellis Fischel Cancer Hospital and the Women's Cancer Control Program screening project in Columbia, Missouri, between 1974 and 1992. We reinterpreted mammograms from the visit prior to the diagnosis of IBC for possible misdiagnosis, changes suggestive of malignancy, and Wolfe's patterns. Archival paraffin blocks from 19 patients were used to determine qualitative expression of tumor markers. Observed 5-, 8-, and 10-year survival rates were identical to published data for patients with non-IBC. Seventy-four percent of the mammograms evidenced dysplastic Wolfe's patterns (P2 and DY), and one patient was found retrospectively to have shown evidence of cancer which was missed. Compared to breast cancers in general, fewer IBC tumors expressed tumor markers associated with poor prognosis. Survival rates and tumor marker expressions in this retrospective cohort suggest that IBC tumors are not more biologically aggressive than noninterval tumors. They are more difficult to diagnose both by physical examination and mammography.

The epidemiological profile of women with an interval cancer in the DOM screening programme

Risk factors for breast cancer were compared in 107 women with interval breast cancer (cancers occurring within 2 years after a negative screen) and 258 women with breast cancer detected at 1st screening. All women (aged 40-67) were screened in the DOM project (the Utrecht programme for the early detection of breast cancer). Women with an interval cancer reported more often a history of benign breast disease (OR 4.66, 95% C.I. 2.08-10.41) and an artificial menopause (OR 4.07; 95% C.I. 1.74-9.55) than women with a screen detected cancer. Women with an interval cancer were taller than women with a screen detected cancer; this was seen most clearly in women with an artificial menopause (chi 2 for trend = 5.88; p = 0.02) and to a lesser extent in premenopausal women (chi 2 for trend = 1.70; p = 0.19). Premenopausal women with an interval cancer were heavier than women with a screen detected cancer (chi 2 for trend = 4.66; p = 0.03); whereas natural postmenopausal women with an interval cancer were leaner than women with a screen detected cancer (chi 2 for trend = 1.57; p = 0.21). All analyses were done while correcting for age and selected other risk factors for breast cancer. These results suggest that the epidemiological profile of pre- and post-menopausal women with an interval cancer differs from that of women with a screen detected cancer, which might imply a different natural history of these two types of breast tumours.