Samantha Puvanesarajah1, Susan M Gapstur2, Alpa V Patel2, Mark E Sherman3, W Dana Flanders2,4, Ted Gansler2, Melissa A Troester5, Mia M Gaudet2. 1. Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA. samantha.puvanesarajah@cancer.org. 2. Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA. 3. Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA. 4. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA. 5. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Abstract
PURPOSE: In a screened population, breast cancer-specific mortality is lower for screen-detected versus symptom-detected breast cancers; however, it is unclear whether this association varies by follow-up time and/or tumor characteristics. To further understand the prognostic utility of mode of detection, we examined its association with breast cancer-specific mortality, overall and by follow-up time, estrogen receptor status, tumor size, and grade. METHODS: In the Cancer Prevention Study-II Nutrition Cohort, 3975 routinely screened women were diagnosed with invasive breast cancer (1992-2015). Among 2686 screen-detected and 1289 symptom-detected breast cancers, 206 and 209 breast cancer deaths, respectively, occurred up to 24 years post diagnosis. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from Cox proportional hazard regression models. RESULTS: Controlling for prognostic factors, symptom detection was associated with higher risk of breast cancer-specific death up to 5 years after diagnosis (HR≤5years = 1.88, 95% CI 1.21-2.91) this association was attenuated in subsequent follow-up (HR>5years = 1.26, 95% CI 0.98-1.63). Within tumor characteristic strata, there was a 1.3-2.7-fold higher risk of breast cancer death associated with symptom-detected cancers ≤ 5 years of follow-up, although associations were only significant for women with tumors < 2 cm (HR≤5years = 2.42, 95% CI 1.19-4.93) and for women with grade 1 or 2 tumors (HR≤5years = 2.72, 95% CI 1.33-5.57). In subsequent follow-up, associations were closer to the null. CONCLUSIONS: Screen detection is a powerful prognostic factor for short-term survival. Among women who survived at least 5 years after breast cancer diagnosis, other clinical factors may be more predictive of breast cancer survival.
PURPOSE: In a screened population, breast cancer-specific mortality is lower for screen-detected versus symptom-detected breast cancers; however, it is unclear whether this association varies by follow-up time and/or tumor characteristics. To further understand the prognostic utility of mode of detection, we examined its association with breast cancer-specific mortality, overall and by follow-up time, estrogen receptor status, tumor size, and grade. METHODS: In the Cancer Prevention Study-II Nutrition Cohort, 3975 routinely screened women were diagnosed with invasive breast cancer (1992-2015). Among 2686 screen-detected and 1289 symptom-detected breast cancers, 206 and 209 breast cancer deaths, respectively, occurred up to 24 years post diagnosis. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from Cox proportional hazard regression models. RESULTS: Controlling for prognostic factors, symptom detection was associated with higher risk of breast cancer-specific death up to 5 years after diagnosis (HR≤5years = 1.88, 95% CI 1.21-2.91) this association was attenuated in subsequent follow-up (HR>5years = 1.26, 95% CI 0.98-1.63). Within tumor characteristic strata, there was a 1.3-2.7-fold higher risk of breast cancer death associated with symptom-detected cancers ≤ 5 years of follow-up, although associations were only significant for women with tumors < 2 cm (HR≤5years = 2.42, 95% CI 1.19-4.93) and for women with grade 1 or 2 tumors (HR≤5years = 2.72, 95% CI 1.33-5.57). In subsequent follow-up, associations were closer to the null. CONCLUSIONS: Screen detection is a powerful prognostic factor for short-term survival. Among women who survived at least 5 years after breast cancer diagnosis, other clinical factors may be more predictive of breast cancer survival.
Entities:
Keywords:
Breast; Breast neoplasms/mortality; Epidemiology; Mammography; Survival analysis
Authors: Mia M Gaudet; Emily Deubler; W Ryan Diver; Samantha Puvanesarajah; Alpa V Patel; Ted Gansler; Mark E Sherman; Susan M Gapstur Journal: Breast Cancer Res Treat Date: 2021-01-04 Impact factor: 4.872
Authors: Marilina García; Maximino Redondo; Irene Zarcos; Javier Louro; Francisco Rivas-Ruiz; Teresa Téllez; Diego Pérez; Francisco Medina Cano; Kenza Machan; Laia Domingo; Maria Del Mar Vernet; Maria Padilla-Ruiz; Xavier Castells; Maria Sala Journal: Eur J Breast Health Date: 2022-04-01
Authors: Elisabeth K Trapp; Peter A Fasching; Tanja Fehm; Andreas Schneeweiss; Volkmar Mueller; Nadia Harbeck; Ralf Lorenz; Claudia Schumacher; Georg Heinrich; Fabienne Schochter; Amelie de Gregorio; Marie Tzschaschel; Brigitte Rack; Wolfgang Janni; Thomas W P Friedl Journal: Cancers (Basel) Date: 2022-08-16 Impact factor: 6.575