Risk factors and tumor characteristics of interval cancers by mammographic density.

PURPOSE To compare tumor characteristics and risk factors of interval breast cancers and screen-detected breast cancers, taking mammographic density into account. PATIENTS AND METHODS Women diagnosed with invasive breast cancer from 2001 to 2008 in Stockholm, Sweden, with data on tumor characteristics (n = 4,091), risk factors, and mammographic density (n = 1,957) were included. Logistic regression was used to compare interval breast cancers with screen-detected breast cancers, overall and by highest and lowest quartiles of percent mammographic density. RESULTS Compared with screen-detected breast cancers, interval breast cancers in nondense breasts (≤ 20% mammographic density) were significantly more likely to exhibit lymph node involvement (odds ratio [OR], 3.55; 95% CI, 1.74 to 7.13) and to be estrogen receptor negative (OR, 4.05; 95% CI, 2.24 to 7.25), human epidermal growth factor receptor 2 positive (OR, 5.17; 95% CI, 1.64 to 17.01), progesterone receptor negative (OR, 2.63; 95% CI, 1.58 to 4.38), and triple negative (OR, 5.33; 95% CI, 1.21 to 22.46). In contrast, interval breast cancers in dense breasts (> 40.9% mammographic density) were less aggressive than interval breast cancers in nondense breasts (overall difference, P = .008) and were phenotypically more similar to screen-detected breast cancers. Risk factors differentially associated with interval breast cancer relative to screen-detected breast cancer after adjusting for age and mammographic density were family history of breast cancer (OR, 1.32; 95% CI, 1.02 to 1.70), current use of hormone replacement therapy (HRT; OR, 1.84; 95% CI, 1.38 to 2.44), and body mass index more than 25 kg/m(2) (OR, 0.49; 95% CI, 0.29 to 0.82). CONCLUSION Interval breast cancers in women with low mammographic density have the most aggressive phenotype. The effect of HRT on interval breast cancer risk is not fully explained by mammographic density. Family history is associated with interval breast cancers, possibly indicating disparate genetic background of screen-detected breast cancers and interval breast cancers.

[1]  X. Castells,et al.  Tumor phenotype and breast density in distinct categories of interval cancer: results of population-based mammography screening in Spain , 2014, Breast Cancer Research.

[2]  L. Eriksson,et al.  Mammographic density and survival in interval breast cancers , 2013, Breast Cancer Research.

[3]  E. Paci,et al.  Biological characteristics of interval cancers: a role for biomarkers in the breast cancer screening , 2013, Journal of Cancer Research and Clinical Oncology.

[4]  P. Porter,et al.  Body mass index, tumor characteristics, and prognosis following diagnosis of early-stage breast cancer in a mammographically screened population , 2013, Cancer Causes & Control.

[5]  Jingmei Li,et al.  High-throughput mammographic-density measurement: a tool for risk prediction of breast cancer , 2012, Breast Cancer Research.

[6]  A. Musolino,et al.  Human epidermal growth factor receptor 2 status and interval breast cancer in a population-based cancer registry study. , 2012, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[7]  Sarah A. Edwards,et al.  Tumor characteristics associated with mammographic detection of breast cancer in the Ontario breast screening program. , 2011, Journal of the National Cancer Institute.

[8]  J. Hokanson,et al.  Differential expression of prognostic biomarkers between interval and screen-detected breast cancers: does age or family history matter? , 2011, Breast Cancer Research and Treatment.

[9]  Harry J de Koning,et al.  BRCA1-associated breast cancers present differently from BRCA2-associated and familial cases: long-term follow-up of the Dutch MRISC Screening Study. , 2010, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[10]  G. Svane,et al.  Breast Cancer Screening Program in Stockholm County, Sweden – Aspects of Organization and Quality Assurance , 2010, Breast Care.

[11]  Maria Sala,et al.  Phenotypic characterization and risk factors for interval breast cancers in a population-based breast cancer screening program in Barcelona, Spain , 2010, Cancer Causes & Control.

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

[13]  Anna Chiarelli,et al.  Body Size, Mammographic Density, and Breast Cancer Risk , 2006, Cancer Epidemiology Biomarkers & Prevention.

[14]  B. Møller,et al.  Use of hormone therapy and risk of breast cancer detected at screening and between mammographic screens , 2006, International journal of cancer.

[15]  M. El-Tamer,et al.  The development of interval breast malignancies in patients with BRCA mutations , 2004, Cancer.

[16]  B. Viták,et al.  Interval cancers in the Norwegian breast cancer screening program: Frequency, characteristics and use of HRT , 2001, International journal of cancer.

[17]  J. Klijn,et al.  Effectiveness of breast cancer surveillance in BRCA1/2 gene mutation carriers and women with high familial risk. , 2001, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[18]  P. Porter,et al.  Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. , 2000, Journal of the National Cancer Institute.

[19]  C R Key,et al.  Biologic characteristics of interval and screen-detected breast cancers. , 2000, Journal of the National Cancer Institute.

[20]  P. Porter,et al.  Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. , 1999, Journal of the National Cancer Institute.

[21]  D. Scott,et al.  Differences in Ki67 and c-erbB2 expression between screen-detected and true interval breast cancers. , 1999, Clinical cancer research : an official journal of the American Association for Cancer Research.

[22]  G. Svane,et al.  Two models for radiological reviewing of interval cancers , 1999, Journal of medical screening.

[23]  N. Boyd,et al.  The quantitative analysis of mammographic densities. , 1994, Physics in medicine and biology.

[24]  J. Hokanson,et al.  Complementary approaches to assessing risk factors for interval breast cancer , 2010, Cancer Causes & Control.

[25]  P. Peeters,et al.  The epidemiological profile of women with an interval cancer in the DOM screening programme , 2004, Breast Cancer Research and Treatment.