title: Asymptomatic breast cancer in non-participants of the national screening programme in Norway: a confounding factor in evaluation?
abstract: OBJECTIVE
  To evaluate the extent and histopathological characteristics of asymptomatic breast cancer detected outside the Norwegian Breast Cancer Screening Program (NBCSP) in women targeted by the programme.
  
  
  METHODS
  Our study included 568 primary breast cancers (523 invasive and 45 ductal carcinoma in situ) diagnosed in 553 women aged 50-70, residing in Møre og Romsdal County, 2002-2008. The cancers were divided into screening-detected cancers in the NBCSP, interval cancers (ICs) and cancers detected in women not participating in the NBCSP (never participated and lapsed attendees), and further into asymptomatic and symptomatic cancers. Nottingham Prognostic Index (NPI) was used for comparisons across the groups and the distributions were compared using chi-square tests for statistical significance.
  
  
  RESULTS
  Twenty percent (19/97) of the ICs and 32% (69/213) of the breast cancers in non-participants were asymptomatic, with opportunistic screening as the most frequent detection method (42%, 8/19 for ICs and 54%, 37/69 for non-participants). There were no differences in distribution of NPI prognostic categories across subgroups of asymptomatic invasive cancers (screening-detected cancers in the NBCSP, asymptomatic ICs and asymptomatic cancers in non-participants) or between subgroups of symptomatic invasive cancers (symptomatic ICs and symptomatic cancers in non-participants). Asymptomatic cancers had a significantly more favourable distribution of NPI prognostic categories compared with symptomatic cancers (P < 0.001). The proportion of invasive cancers with excellent/good NPI was 53% (164/310) for all asymptomatic and 25% (52/211) for all symptomatic invasive cancers.
  
  
  CONCLUSIONS
  A considerable percentage of breast cancers detected outside the organized screening programme were asymptomatic, with a prognostic profile comparable with screening-detected breast cancers in the NBCSP. Individual data regarding the detection method for all breast cancers are needed for a complete evaluation of the organized screening programme in Norway.
authors.affiliation: Department of Radiology, Aalesund Hospital, Helse Møre og Romsdal HF, NO-6026 Aalesund, Norway. sorohoff@gmail.com
authors.forename: Solveig R
authors.initials: SR
authors.lastname: Hoff
authors.forename: Olbjørn
authors.initials: O
authors.lastname: Klepp
authors.forename: Solveig
authors.initials: S
authors.lastname: Hofvind
mesh_terms: D000368:Aged; D000465:Algorithms; D058070:Asymptomatic Diseases / Q000453:epidemiology*; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D002278:Carcinoma in Situ / Q000175:diagnosis* / Q000453:epidemiology*; D018270:Carcinoma, Ductal, Breast / Q000175:diagnosis / Q000453:epidemiology; D015986:Confounding Factors, Epidemiologic; D055088:Early Detection of Cancer; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data; D008875:Middle Aged; D009313:National Health Programs; D009664:Norway / Q000453:epidemiology; D010358:Patient Participation / Q000523:psychology / Q000706:statistics & numerical data*; D011379:Prognosis