Abstract
Objective
To evaluate how breast cancers come to clinical attention (mode of detection [MOD])
in a population-based cohort, determine the relative frequency of different MODs,
and characterize patient and tumor characteristics associated with MOD.
Patients and Methods
We used the Rochester Epidemiology Project to identify women ages 40 to 75 years with
a first-time diagnosis of breast cancer from May 9, 2017, to May 9, 2019 (n=500) in
a 9-county region in Minnesota. We conducted a retrospective medical record review
to ascertain the relative frequency of MODs, evaluating differences between screening
mammography vs all other MODs by breast density and cancer characteristics. Multiple
logistic regression was conducted to examine the likelihood of MOD for breast density
and stage of disease.
Results
In our population-based cohort, 162 of 500 breast cancers (32.4%) were detected by
MODs other than screening mammography, including 124 (24.8%) self-detected cancers.
Compared with women with mammography-detected cancers, those with MODs other than
screening mammography were more frequently younger than 50 years of age (P=.004) and had higher-grade tumors (P=.007), higher number of positive lymph nodes (P<.001), and larger tumor size (P<.001). Relative to women with mammography-detected cancers, those with MODs other
than screening mammography were more likely to have dense breasts (odds ratio, 1.87;
95% CI, 1.20 to 2.92; P=.006) and advanced cancer at diagnosis (odds ratio, 3.58; 95% CI, 2.29 to 5.58; P<.001).
Conclusion
One-third of all breast cancers in this population were detected by MODs other than
screening mammography. Increased likelihood of nonmammographic MODs was observed among
women with dense breasts and advanced cancer.
Abbreviations and Acronyms:
DCIS (ductal carcinoma in situ), MOD (mode of detection), OR (odds ratio), REP (Rochester Epidemiology Project), SBE (self breast examination)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Mode of detection: an independent prognostic factor for women with breast cancer.J Med Screen. 2016; 23: 89-97
- Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II.Breast Cancer Res Treat. 2019; 177: 679-689
- Breast density and breast cancer-specific survival by detection mode.BMC Cancer. 2018; 18: 386
- Incidence, characteristics, and outcomes of interval breast cancers compared with screening-detected breast cancers.JAMA Netw Open. 2020; 3e2018179
- Comparison of mortality among participants of Women’s Health Initiative trials with screening-detected breast cancers vs interval breast cancers.JAMA Netw Open. 2020; 3e207227
- Molecular characteristics of screen-detected vs symptomatic breast cancers and their impact on survival.Br J Cancer. 2009; 101: 1338-1344
- Molecular profiles of screen detected vs. symptomatic breast cancer and their impact on survival: results from a clinical series.BMC Cancer. 2013; 13: 15
Breast Cancer Surveillance Consortium. BCSC Standard Definitions, Version 2. Updated November 26, 2018. Accessed March 10, 2021. https://www.bcsc-research.org/application/files/3915/6141/0474/BCSC_data_definitions_v2.0_11_26_2018.pdf
- The National Mammography Database: preliminary data.AJR Am J Roentgenol. 2016; 206: 883-890
- Self-examination does not reduce breast cancer mortality.J Fam Pract. 2003; 52: 104-106
- Practice Bulletin Number 179: Breast cancer risk assessment and screening in average-risk women.Obstet Gynecol. 2017; 130: e1-e16
- American Cancer Society. Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society [published correction appears in JAMA. 2016;315(13):1406].JAMA. 2015; 314: 1599-1614
- Breast density legislation and clinical evidence.Radiol Clin North Am. 2017; 55: 513-526
- Current status of supplemental screening in dense breasts.J Clin Oncol. 2016; 34: 1840-1843
- Supplemental screening for breast cancer in women with dense breasts: a systematic review for the U.S. Preventive Services Task Force.Ann Intern Med. 2016; 164: 268-278
- Factors related to breast cancer detection mode and time to diagnosis in Alberta, Canada: a population-based retrospective cohort study.BMC Health Serv Res. 2016; 16: 65
- Mammographic density and risk of breast cancer by mode of detection and tumor size: a case-control study.Breast Cancer Res. 2016; 18: 63
- Impact of risk factors on different interval cancer subtypes in a population-based breast cancer screening programme.PLoS One. 2014; 9e110207
- Self-detection remains a key method of breast cancer detection for U.S. women.J Womens Health (Larchmt). 2011; 20: 1135-1139
- Data resource profile: Expansion of the Rochester Epidemiology Project medical records-linkage system (E-REP).Int J Epidemiol. 2018; 47 (368j): 368
- Data resource profile: the Rochester Epidemiology Project (REP) medical records-linkage system.Int J Epidemiol. 2012; 41: 1614-1624
- History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population.Mayo Clin Proc. 2012; 87: 1202-1213
- Use of a medical records linkage system to enumerate a dynamic population over time: the Rochester Epidemiology Project.Am J Epidemiol. 2011; 173: 1059-1068
- ACR BI-RADS Atlas: Breast Imaging Reporting and Data System.5th ed. American College of Radiology, 2013
- Breast.in: Amin M.B. Edge S. Greene F. American Joint Committee on Cancer. AJCC Cancer Staging Manual. 8th ed. Springer, 2017: 589-636
TMIST/EA1151 Study: Tomosynthesis Mammographic Imaging Screening Trial. American College of Radiology website. Accessed March 10, 2021. https://www.acr.org/-/media/ACR/Files/Research/TMIST-Site-Process-Summary.pdf?la=en
- Breast cancer: screening. US Preventive Services Task Force website.(Published January 11 2016. Accessed March 10, 2021.)
- Physician breast cancer screening recommendations following guideline changes: results of a national survey.JAMA Intern Med. 2017; 177: 877-878
- Breast cancer screening: conflicting guidelines and medicolegal risk.JAMA. 2013; 309: 2555-2556
- Breast cancer risk factors by mode of detection among screened women in the Cancer Prevention Study-II.Breast Cancer Res Treat. 2021; 186: 791-805
- Mammographic features and histopathological findings of interval breast cancers.Acta Radiol. 2008; 49: 975-981
- Long-term prognosis of breast cancer detected by mammography screening or other methods.Breast Cancer Res. 2011; 13: R134
- Interval cancers in breast cancer screening: comparison of stage and biological characteristics with screen-detected cancers or incident cancers in the absence of screening.Tumori. 2010; 96: 198-201
- Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project.Mayo Clin Proc. 2012; 87: 151-160
Article info
Footnotes
Grant Support: This work was supported in part by GRANT12599809 award F30CA235848 from the National Cancer Institute at the National Institutes of Health (S.N.B.), the Rochester Epidemiology Project (grant R01-AG034676; Principal Investigators: Walter A. Rocca, MD, MPH, and Jennifer L. St Sauver, PhD), and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery.
Identification
Copyright
© 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
