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Cancers Between Mammograms

Posted 1/7/2013

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  Breast cancer is frightening in and of itself, and we all find specific things about our diagnoses to be especially scary. Whether it is the size of the tumor, the number of involved lymph nodes, the hormonal/ER status, LVI--there is always something. If you made a chart of all the things that go into a single breast cancer diagnosis (size, grade, etc) and had a "good" and a "not so good" column, we would all have at least one check in the "not so good" area. For my first breast cancer, it was the LVI (lymphatic vessel invasion) that sometimes kept me awake at night. For my second breast cancer, it was the fact that it was the second. How had that happened and what else lay ahead?

  For some women, the anxiety is focused on the fact that breast cancer was discovered between mammograms. Since breast cancer is a slow growing disease, almost all of the time, they worry about its not being seen on a mammogram and then diagnosed a few months later. Does this mean that it grew quickly and aggressively? Does it mean that the mammogram missed it? Is there a prognostic implication? This short article from Journal Watch speaks to these issues and is reassuring:

Breast Cancer Diagnosed Between Mammograms Isn't More Aggressive

Women with "interval" breast cancers had the same prognosis as women with breast

cancers who were never screened.

 

Are breast cancers diagnosed in women who have had previously normal screening mammograms more

aggressive than breast cancers diagnosed in women who haven't undergone screening mammograms?

To find out, Norwegian investigators carried out a population-based observational study.

In Norway, older women (age, 50–72) now are invited to receive screening mammography every 2 years.

Study participants were 1800 women with "interval breast cancer" (diagnosed within 26 months of their

last normal screening mammograms and before their next scheduled mammograms) and 5300 women

with breast cancer who had not undergone screening mammography. Compared with the nonscreened

group, women in the interval-cancer group exhibited slightly higher percentages of lobular cancers, large

tumors (>2 cm), negative lymph nodes, and stage II (vs. stage I) disease. However, breast cancer–related

mortality and overall mortality at 10 years were not significantly different between the groups. Notably, in

the interval-cancer group, tumor size, node status, grade, and hormone-receptor status were not

associated with time since last normal screening mammogram.

Comment: In this study, women with interval breast cancers had the same prognosis as women with breast cancer who had not been screened. The investigators did not compare the prognosis of women with interval breast cancers to the prognosis of women with screen-detected breast cancers, because screen-detected breast cancers are affected by length  bias sampling, lead time bias, and overdiagnosis bias. Thus, the comparisons in this study are valid.

In this study, women with interval breast cancers had the same prognosis as women with breast cancer who had not been screened. The investigators did not compare the prognosis of women with interval breast cancers to the prognosis of women with screen-detected breast cancers, because screen-detected breast cancers are affected by length  bias sampling, lead time bias, and overdiagnosis bias. Thus, the comparisons in this study are valid.

— Paul S. Mueller, MD, MPH, FACP

http://www.jwatch.org/?q=topic_breastcan

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