title: Mammographic and clinical characteristics of different phenotypes of screen-detected and interval breast cancers in a nationwide screening program.
abstract: In the context of a population-based screening program, we aimed to evaluate the major mammographic features and clinicopathological characteristics of breast tumors at diagnosis and the associations between them, focusing on tumors with the worst prognosis. We analyzed cancers diagnosed in a cohort of 645,764 women aged 45-69 years participating in seven population-based screening programs in Spain, between January 1, 2000 and December 31, 2006 and followed up until June 2009. We included all interval cancers and a sample of screen-detected cancers, whether invasive or in situ. We compared tumor-related information and breast density for different phenotypes (Triple-negative (TN), HER2+, Luminal B and Luminal A) in screen-detected and interval cancers. We used Chi-square or Fisher's exact test to compare major mammographic features of invasive versus in situ tumors, of screen-detected versus interval cancers, and of different types of interval cancers. We included 2582 tumors (1570 screen-detected and 1012 interval cancers). There were significant differences in the distribution of most clinicopathological variables between screen-detected and interval cancers. Invasive TN interval tumors were more common than other phenotypes in breasts with low mammographic density; three-quarters of these tumors presented as masses without associated calcifications. HER2+ tumors were more common in denser breasts and were associated with calcifications and multifocality. Architectural distortion was more common in Luminal A and Luminal B tumors. Certain radiologic findings are associated with pre-invasive lesions; these differ among invasive tumor phenotypes. We corroborate that TN and HER2+ cancers have distinctive appearances also in the context of population-based screening programs. This information can be useful for establishing protocols for diagnostic strategies in screening units.
authors.affiliation: Clinical Epidemiology and Cancer Screening, UDIAT-DC, Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain. mbare@tauli.cat.|Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Faculty of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Barcelona, Spain. mbare@tauli.cat.|Research Network on Health Services in Chronic Diseases (REDISSEC), Sabadell, Spain. mbare@tauli.cat.
authors.forename: Marisa
authors.initials: M
authors.lastname: Baré
authors.affiliation: Clinical Epidemiology and Cancer Screening, UDIAT-DC, Corporació Sanitària Parc Taulí, Sabadell, Catalonia, Spain.|Research Network on Health Services in Chronic Diseases (REDISSEC), Sabadell, Spain.
authors.forename: Núria
authors.initials: N
authors.lastname: Torà
authors.affiliation: General Directorate Public Health and Centre for Public Health Research (CSISP), FISABIO, Valencia, Spain.
authors.forename: Dolores
authors.initials: D
authors.lastname: Salas
authors.affiliation: Breast Imaging, Department of Radiology, UDIAT-DC, Parc Taulí Sabadell, Sabadell, Spain.
authors.forename: Melchor
authors.initials: M
authors.lastname: Sentís
authors.affiliation: Department of Radiology, Hospital de Santa Caterina, Salt, Girona, Spain.
authors.forename: Joana
authors.initials: J
authors.lastname: Ferrer
authors.affiliation: General Directorate Public Health and Centre for Public Health Research (CSISP), FISABIO, Valencia, Spain.
authors.forename: Josefa
authors.initials: J
authors.lastname: Ibáñez
authors.affiliation: Galician Breast Cancer Screening Programme, Directorate for Innovation and Management of Public Health, Santiago de Compostela, Spain.
authors.forename: Raquel
authors.initials: R
authors.lastname: Zubizarreta
authors.affiliation: Osakidetza Breast Cancer Screening Programme, Basque Country Health Service, Bilbao, Spain.
authors.forename: Garbiñe
authors.initials: G
authors.lastname: Sarriugarte
authors.affiliation: General Directorate of Health Care Programmes, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Barata
authors.affiliation: Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Laia
authors.initials: L
authors.lastname: Domingo
authors.affiliation: Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Faculty of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Barcelona, Spain.|Research Network on Health Services in Chronic Diseases (REDISSEC), Sabadell, Spain.|Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Castells
authors.affiliation: Department of Pediatrics, Obstetrics and Gynecology, and Preventive Medicine and Public Health, Faculty of Medicine, Autonomous University of Barcelona (UAB), Bellaterra, Barcelona, Spain.|Research Network on Health Services in Chronic Diseases (REDISSEC), Sabadell, Spain.|Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Sala
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor; D000071060:Breast Density; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D055088:Early Detection of Cancer; D005260:Female; D006801:Humans; D042361:Mammary Glands, Human / Q000002:abnormalities; D008327:Mammography / Q000379:methods; D008403:Mass Screening; D008875:Middle Aged; D060787:Neoplasm Grading; D009362:Neoplasm Metastasis; D009367:Neoplasm Staging; D010641:Phenotype; D011159:Population Surveillance; D013030:Spain / Q000453:epidemiology
chemical_list: D014408:Biomarkers, Tumor
keywords: Breast cancer; HER2+; Interval cancer; Mammographic features; Screening; Triple-negative