Breast density as a determinant of interval cancer at mammographic screening
S Ciatto, C Visioli, E Paci, M Zappa, S Ciatto, C Visioli, E Paci, M Zappa
Abstract
The association of breast density (% of breast volume involved by fibro-glandular densities) with the risk of interval cancer (IC) was investigated by reviewing a consecutive series of 346 cancers detected at screening (SDC) during 1996-1999 and of 90 ICs, reported as negative in the same period and diagnosed in the following 2 years, and comparing them to a random sample of 360 healthy controls. The probability of IC was significantly associated with breast density, whatever grouping (0/1-25/26-74/>74%; 0-25/26-60/61-74/>74%; 0-25/26-74/>74%) was considered (chi(2)=30.67-34.08, P<0.<0.01): 27.8% of all ICs were classified in the >74% density class, as compared to 7% of SDC and 5% of healthy controls. No significant association to IC was observed for Wolfe pattern (P2/Dy vs N1/P1: chi(2)=0.30, P=0.960), number of used mammographic views (single oblique vs oblique+craniocaudal: chi(2)=0.02, P=0.90) or screening round (first vs repeat: chi(2)=1.41, P=0.23). Multivariate analysis confirmed the independent association of breast density to IC, the highest risk being observed for >74% density class (OR vs 0% class=13.4, 95% CI 2.7-65.6, OR vs all other density classes=5.1, 95% CI 2.6-10.0). Age showed an independent association too, older women having a lower risk of IC (OR=0.52 95% CI 0.3-09). Breast density (>74%) resulted as being a major determinant of IC. Special screening protocols (shorter rescreening interval, routine use of ultrasonography) might be suggested for these subjects in order to improve screening sensitivity and efficacy.
References
- Berkowitz JE, Gatewood OMB (1990) Hormonal replacement therapy: mammographic manifestations. Radiology 174: 199–201
- Bryan S, Brown J, Warren R (1995) Mammography screening: an incremental cost effectiveness analysis of two views versus one view procedures in London. J Epidemiol Commun Health 49: 70–78
- Ciatto S, Bonardi R, Zappa M (2001) Effects of hormone replacement therapy on the mammographic density of postmenopausal women undergoing screening mammography. Radiol Med 101: 39–43
- Ciatto S, Rosselli Del Turco M, Morrone D, Catarzi S, Ambrogetti D, Cariddi A, Zappa M (1995a) Independent double reading of screening mammograms. J Med Screen 2: 99–101
- Ciatto S, Rosselli Del Turco M, Zappa M (1995b) The detectability of breast cancer by screening mammography. Br J Cancer 71: 337–339
- Ciatto S, Zappa M (1993) A prospective study of the value of mammographic patterns as indicators of breast cancer risk in a screening experience. Eur J Radiol 17: 122–125
- Egan RL, Mosteller RC (1977) Breast cancer mammographic patterns. Cancer 40: 2087–2090
- Ma L, Fishell E, Wright B, Hanna W, Allan S, Boyd NF (1992) Case control study of factors associated with failure to detect breast cancer by mammography. J Natl Cancer Inst 84: 781–785
- Paci E, Ciatto S, Buiatti E, Cecchini S, Palli D, Rosselli Del Turco M (1990) Early indicators of efficacy of breast cancer screening programmes, results of the Florence District programme. Int J Cancer 46: 198–202
- Palli D, Rosselli Del Turco M, Buiatti E, Carli S, Ciatto S, Toscani L, Maltoni G (1986) A case control study of the efficacy of a non randomised breast cancer screening program in Florence (Italy). Int J Cancer 38: 501–504
- Peeters PHM, Verbeek AJM, Hendricks JHCL, Holland R, Mravunac M, Vooijs GP (1989) The occurrence of interval cancer in the Nijmegen screening programme. Br J Cancer 59: 929–932
- Perry N, Broeders M, de Wolf C, Tornberg S (eds) (2001) European Guidelines for Quality Assurance in Mammography Screening. Luxembourg: European Communities
- Sala E, Warren R, Mc Cann J, Duffy S, Day N, Luben R (1998) Mammographic parenchymal pattern and mode of detection. Implication for the breast screening programme. J Med Screen 5: 207–212
- Wald N, Chamberlain J, Hackshaw A (1993) Report of the European Society of Mastology: Breast Cancer Screening Evaluation Committee. Breast 2: 209–216
- Wolfe JN (1976) Breast patterns as an index of risk for developing breast cancer. AJR 126: 1130–1139
- Zappa M, Falini P, Bonardi R, Ambrogetti D, Giorgi D, Paci E, Ciatto S (2002) Monitoring interval cancers in mammographic screening: the Florence District programme experience. Breast 11: 301–305
Source: PubMed