title: Impact of screening on clinicopathological features and treatment for invasive breast cancer: results of two national surveys.
abstract: OBJECTIVE
  Several studies showed a breast cancer downstaging due to screening. A first national survey was conducted in France in 2001-2002 to evaluate in the current clinical practice the clinicopathological features and treatments of 1049 firstly operated breast cancers. In order to assess the impact of the national screening program implemented in all regions in France in 2004, a new survey was performed in 2007-2008.
  
  
  METHODS
  The new survey included 1433 firstly operated breast cancers prospectively collected. These new data were compared to the results of the first national survey.
  
  
  RESULTS
  According to TN classification, we found in the second survey T0: 27.6%, T1: 48.6%, T2: 21.3%, T3T4: 3.8% and Tx: 0.7%. Infiltrating ductal and lobular carcinomas represented 80% and 13% of tumours. Hormone receptors were positive in 85.3% and Her-2 overexpressed in 12.4% of tumours (83.9% and 20.6% in the first survey); 68.2% and 32% were pN0 and pN1-3. Lumpectomy and mastectomy were performed in 77% and 23% of the cases. Axillary dissection, sentinel node biopsy or both were performed in 42.6%, 41% and 16.4% of the cases, respectively. Radiotherapy, chemotherapy, hormonotherapy and trastuzumab were given to 93%, 51%, 83% and 9.3% of the patients. Compared with the results from the first survey, we found an increase of infraclinical lesions (T0 from 8.4 to 27.6%) and a wide decrease of pN+ rate (from 44% to 32%). The mastectomy rate was constant (23%), as well as radiotherapy use, whereas chemotherapy use decreased from 62.8 to 55.6%.
  
  
  CONCLUSIONS
  A complete national screening coverage clearly provides a favourable modification of breast cancer clinicopathological features. Both locoregional and adjuvant treatments were greatly downscaled.
authors.affiliation: Department of Oncology and Radiotherapy, institut du cancer Courlancy, 38, rue de Courlancy, 51100 Reims, France. Electronic address: bcutuli@iccreims.fr.
authors.forename: B
authors.initials: B
authors.lastname: Cutuli
authors.affiliation: Institut Claudius-Regaud, 33000 Toulouse, France.
authors.forename: F
authors.initials: F
authors.lastname: Dalenc
authors.affiliation: Institut Curie, 75005 Paris, France.
authors.forename: P-H
authors.initials: PH
authors.lastname: Cottu
authors.affiliation: Hôpital Tenon, 75020 Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Gligorov
authors.affiliation: Centre Léon-Bérard, 69008 Lyon, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Guastalla
authors.affiliation: Centre Paul-Strauss, 67000 Strasbourg, France.
authors.forename: T
authors.initials: T
authors.lastname: Petit
authors.affiliation: AstraZeneca, 92500 Rueil-Malmaison, France.
authors.forename: A
authors.initials: A
authors.lastname: Amrate
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology* / Q000628:therapy*; D018270:Carcinoma, Ductal, Breast / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D018275:Carcinoma, Lobular / Q000453:epidemiology / Q000378:metabolism / Q000473:pathology / Q000628:therapy; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006306:Health Surveys; D006801:Humans; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008403:Mass Screening; D008408:Mastectomy / Q000706:statistics & numerical data; D015412:Mastectomy, Segmental / Q000706:statistics & numerical data; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D018719:Erb-b2 Receptor Tyrosine Kinases / Q000378:metabolism; D011959:Receptors, Estradiol / Q000378:metabolism; D011980:Receptors, Progesterone / Q000378:metabolism; D021701:Sentinel Lymph Node Biopsy / Q000706:statistics & numerical data; D000068878:Trastuzumab; D055815:Young Adult
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000970:Antineoplastic Agents; D018719:Erb-b2 Receptor Tyrosine Kinases; D011959:Receptors, Estradiol; D011980:Receptors, Progesterone; D000068878:Trastuzumab; C508053:ERBB2 protein, human
keywords: Age; Axillary nodal involvement; Breast cancer; Cancer du sein; Chemotherapy; Chimiothérapie; Chirurgie; Dépistage; Envahissement ganglionnaire axillaire; Estrogen receptors; Radiotherapy; Radiothérapie; Récepteurs hormonaux; Screening; Surgery; Âge