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Aggressive tumor characteristics seen in screen-interval breast cancers

Issue: June 25, 2012

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HER-2–positive tumor status may account for a large proportion of the breast cancers diagnosed between mammographic screening intervals, according to the results of a population-based study.

About 10% to 20% of breast cancers are diagnosed in the intervals between screening visits, according to background information in the study.

With this study, the researchers hoped to determine if HER-2 status and other biologic characteristics were responsible for these intervals cancers.

They evaluated all invasive breast cancers collected by the Parma Province Cancer Registry in women aged 50 to 69 years between 2004 and 2007. During this time, 292 screen-detected breast cancers occurred and 48 interval breast cancers occurred. Seventy-nine percent of patients had HER-2–negative disease, 15% had HER-2–positive disease and 6% were missing HER-2 status.

Interval cancers occurred more frequently in younger women and were diagnosed at a later stage and larger tumor size (P<.001). Tumors that were more likely to be identified during screening intervals had high histologic grade (OR=1.8; 95% CI, 1.2-3.8), high proliferate rate (OR=2.4; 95% CI, 1.2-4.5), negative ER status (OR=1.6; 95% CI, 1.1-3.1) or HER-2–positive status (OR=3.4; 95% CI, 1.7-7.1).

An age-stratified analysis revealed that women aged younger than 60 years were four times as likely to develop interval-detected cancer than screen-detected cancer if their tumors were HER-2–positive (OR=4.4; 95% CI, 1.2-9.4). In comparison, women aged 60 years or older had only a twofold increased risk (OR=2.2; 95% CI, 0.9-5.3).

“The observation that HER-2–positive status and other tumor molecular markers are more common in interval cancer suggests that some subset of cancers that are not detected by mammography are increasing,” the researchers wrote. “This finding could lead to intervention studies that aim to optimize imaging technologies and screening intervals to improve the early detection of aggressive, fast-growing breast cancer phenotypes.”

References:

• Musolino A. J Clin Oncol.2012;doi:10.1200/JCO.2011.37.6434.