title: Detection methods predict differences in biology and survival in breast cancer patients.
abstract: BACKGROUND
  The aim of this study was to measure the biological characteristics involved in tumorigenesis and the progression of breast cancer in symptomatic and screen-detected carcinomas to identify possible differences.
  
  
  METHODS
  For this purpose, we evaluated clinical-pathological parameters and proliferative and apoptotic activities in a series of 130 symptomatic and 161 screen-detected tumors.
  
  
  RESULTS
  After adjustment for the smaller size of the screen-detected carcinomas compared with symptomatic cancers, those detected in the screening program presented longer disease-free survival (RR = 0.43, CI = 0.19-0.96) and had high estrogen and progesterone receptor concentrations more often than did symptomatic cancers (OR = 3.38, CI = 1.72-6.63 and OR = 3.44, CI = 1.94-6.10, respectively). Furthermore, the expression of bcl-2, a marker of good prognosis in breast cancer, was higher and HER2/neu expression was lower in screen-detected cancers than in symptomatic cancers (OR = 1.77, CI = 1.01-3.23 and OR = 0.64, CI = 0.40-0.98, respectively). However, when comparing prevalent vs incident screen-detected carcinomas, prevalent tumors were larger (OR = 2.84, CI = 1.05-7.69), were less likely to be HER2/neu positive (OR = 0.22, CI = 0.08-0.61) and presented lower Ki67 expression (OR = 0.36, CI = 0.17-0.77). In addition, incident tumors presented a shorter survival time than did prevalent ones (RR = 4.88, CI = 1.12-21.19).
  
  
  CONCLUSIONS
  Incident carcinomas include a variety of screen-detected carcinomas that exhibit differences in biology and prognosis relative to prevalent carcinomas. The detection method is important and should be taken into account when making therapy decisions.
authors.affiliation: Research Unit, Hospital Costa del Sol, University of Málaga, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carretera de Cádiz Km 187, 29600 MarbellaMálaga, Spain. mredondo@hcs.es
authors.forename: Maximino
authors.initials: M
authors.lastname: Redondo
authors.forename: Rafael
authors.initials: R
authors.lastname: Funez
authors.forename: Francisco
authors.initials: F
authors.lastname: Medina-Cano
authors.forename: Isabel
authors.initials: I
authors.lastname: Rodrigo
authors.forename: Mercedes
authors.initials: M
authors.lastname: Acebal
authors.forename: Teresa
authors.initials: T
authors.lastname: Tellez
authors.forename: M Jose
authors.initials: MJ
authors.lastname: Roldan
authors.forename: M Luisa
authors.initials: ML
authors.lastname: Hortas
authors.forename: Ana
authors.initials: A
authors.lastname: Bellinvia
authors.forename: Teresa
authors.initials: T
authors.lastname: Pereda
authors.forename: Laia
authors.initials: L
authors.lastname: Domingo
authors.forename: María
authors.initials: M
authors.lastname: Morales-Suarez Varela
authors.forename: Maria
authors.initials: M
authors.lastname: Sala
authors.forename: Antonio
authors.initials: A
authors.lastname: Rueda
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis* / Q000401:mortality*; D016022:Case-Control Studies; D018450:Disease Progression; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D053208:Kaplan-Meier Estimate; D008327:Mammography; D008875:Middle Aged; D011379:Prognosis; D016016:Proportional Hazards Models