title: Use of previous screening mammograms to identify features indicating cases that would have a possible gain in prognosis following earlier detection.
abstract: False-negative screening mammograms generally refer to breast cancers that were overlooked or misinterpreted at screening. An important question is whether earlier detection could have made a difference in the prognosis of the women concerned. We reviewed screening and diagnostic mammograms of 234 screen-detected and interval cancer cases (aged 44-84 years) diagnosed between 1991 and 1996 in the Nijmegen breast cancer screening programme. A lesion was visible on 117 (50%) of the screening mammograms prior to the diagnosis of breast cancer. Fifty-one out of the 117 cancers had poor prognostic characteristics at diagnosis (i.e. N+ and/or T2+) and could potentially have benefited from an earlier diagnosis ('possible gain'). The 'possible gain' cases were more often characterised by architectural distortion (29 vs. 10%; P=0.01) or a high-density mass (25 vs. 13%; P=0.06) on the mammogram prior to diagnosis than the 58 'no gain' cases. Our study shows that architectural distortion and non-spiculated high-density masses on the mammogram prior to diagnosis are associated with a possible gain in prognosis. Earlier detection of the carcinomas preceded by these signs may well have an impact on breast cancer mortality and thus warrant extra attention in radiological practice.
authors.affiliation: Department of Epidemiology and Biostatistics, University Medical Centre Nijmegen, Geert Grooteplein 21, 6525 EZ, Nijmegen, The Netherlands. m.broeders@epib.umcn.nl
authors.forename: M J M
authors.initials: MJ
authors.lastname: Broeders
authors.forename: N C
authors.initials: NC
authors.lastname: Onland-Moret
authors.forename: H J T M
authors.initials: HJ
authors.lastname: Rijken
authors.forename: J H C L
authors.initials: JH
authors.lastname: Hendriks
authors.forename: A L M
authors.initials: AL
authors.lastname: Verbeek
authors.forename: R
authors.initials: R
authors.lastname: Holland
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology*; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging / Q000473:pathology*; D018275:Carcinoma, Lobular / Q000000981:diagnostic imaging / Q000473:pathology*; D016009:Chi-Square Distribution; D005188:False Negative Reactions; D005260:Female; D006801:Humans; D008327:Mammography / Q000379:methods*; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012307:Risk Factors; D013997:Time Factors