title: Prognostic role of detection method and its relationship with tumor biomarkers in breast cancer: the university of Texas M.D. Anderson Cancer Center experience.
abstract: OBJECTIVE
  To assess the effect of tumor detection method (screening versus symptom-based diagnosis) in predicting breast cancer survival and investigate how biological features of breast cancer are related to the tumor detection method.
  
  
  METHODS
  The study population consisted of 5,481 women diagnosed with primary invasive breast cancer between 1997 and 2005 and received their treatment at The University of Texas M. D. Anderson Cancer Center.
  
  
  RESULTS
  Patients with symptom-detected tumors had an increased risk of recurrence or death [relative risk (RR), 1.34; P = 0.006] and breast cancer-specific death (RR, 1.31; P = 0.117) than patients with screen-detected tumors after adjusting for tumor characteristics and treatments received. This relationship was especially evident among estrogen receptor (ER)-negative tumors (RR, 1.60 for breast cancer recurrence for ER-negative tumors; RR, 1.18 for ER-positive tumors). ER status and Ki-67 expression were statistically significantly associated with symptom detection rate after adjusting for patients' age, tumor stage, tumor size, and nuclear grade [odds ratio (OR) of ER negative versus ER positive, 1.35; P < 0.001; OR of Ki-67 10-30% versus <10%, 1.40; P = 0.005; OR of Ki-67 >30% versus <10%, 2.11; P < 0.001].
  
  
  CONCLUSIONS
  The method of detection was a statistically significant independent predictor of breast cancer recurrence. Information on the method of tumor detection should be collected to improve the prediction of prognosis of breast cancer patients.
authors.affiliation: Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
authors.forename: Wenli
authors.initials: W
authors.lastname: Dong
authors.forename: Donald A
authors.initials: DA
authors.lastname: Berry
authors.forename: Therese B
authors.initials: TB
authors.lastname: Bevers
authors.forename: Shu-Wan
authors.initials: SW
authors.lastname: Kau
authors.forename: Limin
authors.initials: L
authors.lastname: Hsu
authors.forename: Richard L
authors.initials: RL
authors.lastname: Theriault
authors.forename: Yu
authors.initials: Y
authors.lastname: Shen
mesh_terms: D000328:Adult; D014408:Biomarkers, Tumor / Q000032:analysis*; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D013781:Texas
chemical_list: D014408:Biomarkers, Tumor