title: Five-year risk of interval-invasive second breast cancer.
abstract: BACKGROUND
  Earlier detection of second breast cancers after primary breast cancer (PBC) treatment improves survival, yet mammography is less accurate in women with prior breast cancer. The purpose of this study was to examine women presenting clinically with second breast cancers after negative surveillance mammography (interval cancers), and to estimate the five-year risk of interval-invasive second cancers for women with varying risk profiles.
  
  
  METHODS
  We evaluated a prospective cohort of 15 114 women with 47 717 surveillance mammograms diagnosed with stage 0-II unilateral PBC from 1996 through 2008 at facilities in the Breast Cancer Surveillance Consortium. We used discrete time survival models to estimate the association between odds of an interval-invasive second breast cancer and candidate predictors, including demographic, PBC, and imaging characteristics. All statistical tests were two-sided.
  
  
  RESULTS
  The cumulative incidence of second breast cancers after five years was 54.4 per 1000 women, with 325 surveillance-detected and 138 interval-invasive second breast cancers. The five-year risk of interval-invasive second cancer for women with referent category characteristics was 0.60%. For women with the most and least favorable profiles, the five-year risk ranged from 0.07% to 6.11%. Multivariable modeling identified grade II PBC (odds ratio [OR] = 1.95, 95% confidence interval [CI] = 1.15 to 3.31), treatment with lumpectomy without radiation (OR = 3.27, 95% CI = 1.91 to 5.62), interval PBC presentation (OR = 2.01, 95% CI 1.28 to 3.16), and heterogeneously dense breasts on mammography (OR = 1.54, 95% CI = 1.01 to 2.36) as independent predictors of interval-invasive second breast cancers.
  
  
  CONCLUSIONS
  PBC diagnosis and treatment characteristics contribute to variation in subsequent-interval second breast cancer risk. Consideration of these factors may be useful in developing tailored post-treatment imaging surveillance plans.
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH). jmlee58@uw.edu.
authors.forename: Janie M
authors.initials: JM
authors.lastname: Lee
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH).
authors.forename: Diana S M
authors.initials: DS
authors.lastname: Buist
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH).
authors.forename: Nehmat
authors.initials: N
authors.lastname: Houssami
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH).
authors.forename: Emily C
authors.initials: EC
authors.lastname: Dowling
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH).
authors.forename: Elkan F
authors.initials: EF
authors.lastname: Halpern
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH).
authors.forename: G Scott
authors.initials: GS
authors.lastname: Gazelle
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH).
authors.forename: Constance D
authors.initials: CD
authors.lastname: Lehman
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH).
authors.forename: Louise M
authors.initials: LM
authors.lastname: Henderson
authors.affiliation: Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA (JML, CDL); Department of Radiology and Institute for Technology Assessment, Massachusetts General Hospital, Boston, MA (JML, ECD, EFH, GSG); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DSMB, RAH); Screening and Test Evaluation Program, School of Public Health, Sydney Medical School, University of Sydney, Sydney, Australia (NH); Department of Radiology, University of North Carolina, Chapel Hill, NC (LMH).
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
mesh_terms: D000328:Adult; D000368:Aged; D001940:Breast / Q000473:pathology*; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D002285:Carcinoma, Intraductal, Noninfiltrating / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D008327:Mammography; D008403:Mass Screening / Q000379:methods; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D016609:Neoplasms, Second Primary / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D009657:North Carolina / Q000453:epidemiology; D016017:Odds Ratio; D011159:Population Surveillance; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014861:Washington / Q000453:epidemiology