title: Breast cancer phenotype, nodal status and palpability may be useful in the detection of overdiagnosed screening-detected breast cancers.
abstract: BACKGROUND
  Breast cancer remains the leading cause of female cancer death despite improvements in treatment and screening. Screening is often criticized for leading to overdiagnosis and overtreatment. However, few have attempted to identify overdiagnosed cases.
  
  
  METHODS
  A large, consecutive series of patients treated for primary operable, screening-detected, breast cancer (n = 1610). Details from pathology and clinical reports, treatment and follow-up were available from our prospectively managed database. Univariate and multivariate Cox proportional models were used to study the prognostic variables in screening-detected breast cancers for distant metastatic and breast cancer-specific survival.
  
  
  RESULTS
  We included 1610 patients. The mean/median follow-up was 6.0/6.0 years. Univariate analysis: tumor size, palpability, breast cancer phenotype and nodal status were predictors of distant metastasis and breast cancer-specific death. Multivariate analysis: palpability, breast cancer phenotype and nodal status remained independent prognostic variables. Palpability differed by breast cancer phenotype.
  
  
  CONCLUSIONS
  Screening-detected breast cancer is associated with excellent outcome. Palpability, nodal status and breast cancer phenotype are independent prognostic variables that may select patients at increased risk for distant metastatic relapse and breast cancer-specific death. Overdiagnosed cases reside most likely in the nonpalpable node negative subgroup with a Luminal A phenotype.
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven. Electronic address: olivier.brouckaert@uzleuven.be.
authors.forename: O
authors.initials: O
authors.lastname: Brouckaert
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: A
authors.initials: A
authors.lastname: Schoneveld
authors.affiliation: Independent statistician, Lummen.
authors.forename: C
authors.initials: C
authors.lastname: Truyers
authors.affiliation: Centre for cancer prevention, University Hospital Leuven, Leuven, Belgium.
authors.forename: E
authors.initials: E
authors.lastname: Kellen
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: C
authors.initials: C
authors.lastname: Van Ongeval
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: I
authors.initials: I
authors.lastname: Vergote
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: P
authors.initials: P
authors.lastname: Moerman
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: G
authors.initials: G
authors.lastname: Floris
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: H
authors.initials: H
authors.lastname: Wildiers
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: M R
authors.initials: MR
authors.lastname: Christiaens
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: E
authors.initials: E
authors.lastname: Van Limbergen
authors.affiliation: Multidisciplinary Breast Center, University Hospital Leuven, Leuven.
authors.forename: P
authors.initials: P
authors.lastname: Neven
mesh_terms: D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D018270:Carcinoma, Ductal, Breast / Q000000981:diagnostic imaging* / Q000401:mortality / Q000556:secondary; D055088:Early Detection of Cancer; D005189:False Positive Reactions; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008327:Mammography; D008875:Middle Aged; D015999:Multivariate Analysis; D010173:Palpation; D010641:Phenotype; D011379:Prognosis; D016016:Proportional Hazards Models; D047368:Tumor Burden
keywords: breast cancer; palpability; prognosis; screening; subtypes