Influence of mammographic parenchymal pattern in screening-detected and interval invasive breast cancers on pathologic features, mammographic features, and patient survival.

OBJECTIVE The aim of our study was to assess the effect of mammographic parenchymal pattern on patient survival, mammographic features, and pathologic features of breast cancer in a screened population. MATERIALS AND METHODS We classified the parenchymal pattern (according to BI-RADS) of 759 screened women who presented with a screening-detected (n = 455) or interval (n = 304) invasive breast cancer. Pathologic details (tumor size, histologic grade, lymph node stage, vascular invasion, and histologic type) and mammographic appearances were recorded. Breast cancer-specific survival was ascertained, with a median follow-up of 9.0 years. RESULTS An excess of interval cancers was seen in women with dense breasts (p < 0.0001). Screening-detected (but not interval) tumors were significantly smaller in fatty breasts (p = 0.014). Tumor grade, lymph node stage, vascular invasion, and histologic type did not vary significantly with mammographic parenchymal pattern in screening-detected or interval cancers. Screening-detected cancers in fatty breasts were more likely to appear as indistinct (p = 0.003) or spiculated (p = 0.002) masses in contrast to cancers in dense breasts, which more commonly appeared as architectural distortions (p < 0.0001). No significant breast cancer-specific survival difference was seen by mammographic parenchymal pattern for screening-detected cancers (p = 0.75), interval cancers (p = 0.82), or both groups combined (p = 0.12). CONCLUSION The prognosis of screened women presenting with breast cancer is unrelated to dense mammographic parenchymal pattern despite an excess of interval cancers and larger screening-detected tumors in this group. These data support the mammographic screening of women with dense parenchymal patterns.

[1]  I. Ellis,et al.  The detection of ductal carcinoma in situ at mammographic screening enables the diagnosis of small, grade 3 invasive tumours. , 1997, British Journal of Cancer.

[2]  P. Langenberg,et al.  Breast Imaging Reporting and Data System: inter- and intraobserver variability in feature analysis and final assessment. , 2000, AJR. American journal of roentgenology.

[3]  J. Wolfe.  Breast patterns as an index of risk for developing breast cancer. , 1976, AJR. American journal of roentgenology.

[4]  C. Wells,et al.  Correlation between ultrasound characteristics, mammographic findings and histological grade in patients with invasive ductal carcinoma of the breast. , 2000, Clinical radiology.

[5]  L. Liberman,et al.  Breast imaging reporting and data system (BI-RADS). , 2002, Radiologic clinics of North America.

[6]  S. Duffy,et al.  Mammographic parenchymal patterns and mode of detection: implications for the breast screening programme , 1998, Journal of medical screening.

[7]  I Andersson,et al.  Reduced breast cancer mortality in women under age 50: updated results from the Malmö Mammographic Screening Program. , 1997, Journal of the National Cancer Institute. Monographs.

[8]  L. Tabár,et al.  Mammography service screening and mortality in breast cancer patients: 20-year follow-up before and after introduction of screening , 2003, The Lancet.

[9]  I. Ellis,et al.  Screening-detected and symptomatic ductal carcinoma in situ: mammographic features with pathologic correlation. , 1994, Radiology.

[10]  E B Larson,et al.  Effect of postmenopausal hormonal replacement therapy on mammographic density and parenchymal pattern. , 1995, Radiology.

[11]  T. Sellers,et al.  Association of mammographically defined percent breast density with epidemiologic risk factors for breast cancer (United States) , 2000, Cancer Causes & Control.

[12]  I. Ellis,et al.  Pathological prognostic factors in breast cancer. , 1999, Critical reviews in oncology/hematology.

[13]  Mark A Helvie,et al.  Invasive cancers detected after breast cancer screening yielded a negative result: relationship of mammographic density to tumor prognostic factors. , 2004, Radiology.

[14]  S. Duffy,et al.  Mammographic parenchymal patterns and breast cancer natural history--a case-control study. , 2001, Acta oncologica.

[15]  K. Ormándi,et al.  Tumor Characteristics in Screen-Detected and Symptomatic Breast Cancers , 2008, Pathology and Oncology Research.

[16]  Emily White,et al.  Association between Mammographic Breast Density and Breast Cancer Tumor Characteristics , 2005, Cancer Epidemiology Biomarkers & Prevention.

[17]  Zhimin Huo,et al.  Computerized analysis of digitized mammograms of BRCA1 and BRCA2 gene mutation carriers. , 2002, Radiology.

[18]  T. Nagayasu,et al.  Clinical significance of categorisation of mammographic density for breast cancer prognosis. , 2005, International journal of oncology.

[19]  Jennifer A Harvey,et al.  Quantitative assessment of mammographic breast density: relationship with breast cancer risk. , 2004, Radiology.

[20]  J. Hendriks,et al.  Initiation of population-based mammography screening in Dutch municipalities and effect on breast-cancer mortality: a systematic review , 2003, The Lancet.

[21]  A. Langer,et al.  Exploration des seins denses en mammographie : techniques et limites , 2008 .

[22]  D. Thompson,et al.  Reproducibility and consistency in classification of breast parenchymal patterns. , 1983, AJR. American journal of roentgenology.

[23]  Shinzaburo Noguchi,et al.  Quantitative assessment of mammographic density and breast cancer risk for Japanese women. , 2008, Breast.

[24]  I. Ellis,et al.  Correlations between the mammographic features of screen detected invasive breast cancer and pathological prognostic factors , 1997 .

[25]  S. Duffy,et al.  Size, node status and grade of breast tumours: association with mammographic parenchymal patterns , 2000, European Radiology.

[26]  S Ciatto,et al.  A prospective study of the value of mammographic patterns as indicators of breast cancer risk in a screening experience. , 1993, European journal of radiology.

[27]  Ingvar Andersson,et al.  Long-term effects of mammography screening: updated overview of the Swedish randomised trials , 2002, The Lancet.

[28]  R. Blamey,et al.  Pathological prognostic factors in breast cancer. II. Histological type. Relationship with survival in a large study with long‐term follow‐up , 1992, Histopathology.

[29]  R. Blamey.  4. The design and clinical use of the nottingham prognostic index in breast cancer , 1996 .

[30]  I Persson,et al.  Effect of estrogen and estrogen-progestin replacement regimens on mammographic breast parenchymal density. , 1997, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[31]  C A Kelsey,et al.  Effects of age, breast density, ethnicity, and estrogen replacement therapy on screening mammographic sensitivity and cancer stage at diagnosis: review of 183,134 screening mammograms in Albuquerque, New Mexico. , 1998, Radiology.

[32]  I. Ellis,et al.  Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer: experience from a large study with long-term follow-up. , 2002, Histopathology.

[33]  J. Wolfe.  Breast parenchymal patterns and their changes with age. , 1976, Radiology.

[34]  M. H. Dilhuydy,et al.  Seins denses et dépistage organisé : place de l’échographie , 2008 .