Survival among women diagnosed with screen-detected or interval breast cancer classified as true, minimal signs, or missed through an informed radiological review

Kaitlyn M Tsuruda, Tone Hovda, Sameer Bhargava, Marit B Veierød, Solveig Hofvind, Kaitlyn M Tsuruda, Tone Hovda, Sameer Bhargava, Marit B Veierød, Solveig Hofvind

Abstract

Objectives: "True" breast cancers, defined as not being visible on prior screening mammograms, are expected to be more aggressive than "missed" cancers, which are visible in retrospect. However, the evidence to support this hypothesis is limited. We compared the risk of death from any cause for women with true, minimal signs, and missed invasive screen-detected (SDC) and interval breast cancers (IC).

Methods: This nation-wide study included 1022 SDC and 788 IC diagnosed through BreastScreen Norway during 2005-2016. Cancers were classified as true, minimal signs, or missed by five breast radiologists in a consensus-based informed review of prior screening and diagnostic images. We used multivariable Cox regression to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of death from any cause associated with true, minimal signs, and missed breast cancers, adjusting for age at diagnosis, histopathologic tumour diameter and grade, and subtype. Separate models were created for SDC and IC.

Results: Among SDC, 463 (44%) were classified as true and 242 (23%) as missed; among IC, 325 (39%) were classified as true and 235 (32%) missed. Missed SDC were associated with a similar risk of death as true SDC (HR = 1.20, 95% CI (0.49, 2.46)). Similar results were observed for missed versus true IC (HR = 1.31, 95% CI (0.77, 2.23)).

Conclusions: We did not observe a statistical difference in the risk of death for women diagnosed with true or missed SDC or IC; however, the number of cases reviewed and follow-up time limited the precision of our estimates.

Key points: • An informed radiological review classified screen-detected and interval cancers as true, minimal signs, or missed based on prior screening and diagnostic mammograms. • It has been hypothesised that true cancers, not visible on the prior screening examination, may be more aggressive than missed cancers. • We did not observe a statistical difference in the risk of death from any cause for women with missed versus true screen-detected or interval breast cancers.

Keywords: Breast neoplasms; Early detection of cancer; Mammography; Mass screening; Survival rate.

Conflict of interest statement

SH is the head of BreastScreen Norway. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Number of individuals included and excluded. Individuals were excluded sequentially using the exclusion criteria
Fig. 2
Fig. 2
Kaplan-Meier estimates of overall survival for true, minimal signs, and missed (a) screen-detected and (b) interval breast cancers
Fig. 3
Fig. 3
Nelson-Aalen cumulative hazard estimates of breast cancer death for true, minimal signs, and missed interval breast cancers

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