Receipt of adjuvant systemic therapy among patients with high-risk breast cancer detected by mammography screening.
BACKGROUND
Few studies have compared screen-detected (SD) breast cancer patients with symptomatic patients for the frequency and determinants of receipt of adjuvant systemic therapy according to accepted guidelines.


METHODS
Depending on the date of diagnosis, adjuvant therapy guidelines from the 5th, 6th, and 7th St. Gallen International Conferences were used as standards to audit the treatment of 598 node-negative high-risk patients (59% SD) and 430 node-positive patients (40% SD) aged 50-69 years from an Italian cancer registry (1997-2001). Odds ratios (OR) and 95% confidence intervals (CI) were calculated using backward stepwise logistic regression models.


RESULTS
Among node-negative high-risk patients, SD cancers were smaller (P = 0.000) and of lower grade (P = 0.003). Downgrading was generally from grade 3 to grade 2, with an increased proportion of patients placed in the high-risk category due to grade 2 alone. The total rates of adjuvant systemic therapy were similar (58 vs. 60%) whereas SD patients were less often treated according to the guidelines (34 vs. 45%; OR = 0.61; 95% CI, 0.44-0.86). After adjustment for tumour size and other weaker confounders, the OR was 0.99 (95% CI, 0.67-1.46). Among node-positive patients, the OR of receiving the standard adjuvant systemic therapy did not differ between SD and symptomatic cancers.


CONCLUSIONS
SD cancers amplified the prognostic heterogeneity of node-negative high-risk patients. Their lower likelihood of being treated according to the guidelines was largely explained by their lower risk profile. No evidence was found to suggest that physicians held a priori assumptions about the relative biological indolence of SD cancers.
Bucchi
Lauro
L
Romagna Cancer Registry, IRST, Luigi Pierantoni Hospital, Forli, Italy. l.bucchi@ausl.fo.it
Foca
Flavia
F
Ravaioli
Alessandra
A
Vattiato
Rosa
R
Balducci
Chiara
C
Fabbri
Carla
C
Cordaro
Carlo
C
Montanari
Emanuela
E
Ravegnani
Mila
M
Vitali
Benedetta
B
Sangiorgi
Diego
D
Leoni
Maurizio
M
Falcini
Fabio
F
D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000453:epidemiology* / Q000473:pathology; D017024:Chemotherapy, Adjuvant; D055088:Early Detection of Cancer; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012042:Registries; D016019:Survival Analysis
D000970:Antineoplastic Agents