Advertisement

Persistent Untreated Screening-Detected Breast Cancer: An Argument Against Delaying Screening or Increasing the Interval Between Screenings

Published:April 27, 2017DOI:https://doi.org/10.1016/j.jacr.2017.01.038

      Abstract

      Purpose

      The aim of this study was to investigate the natural history of untreated screen-detected breast cancer.

      Methods

      A prospective cohort survey of Society of Breast Imaging fellows concerning the appearance on subsequent mammography of untreated breast cancer detected on screening mammography was conducted.

      Results

      A representative sample of the 108 actively practicing Society of Breast Imaging fellows (n = 42 [39%]) participated, each reporting outcomes data from his or her entire screening mammography practice. Among all practices, 25,281 screen-detected invasive breast cancers and 9,360 cases of screen-detected ductal carcinoma in situ were reported over the past 10 years. Among these cancers, there were 240 cases of untreated invasive breast cancer and 239 cases of untreated ductal carcinoma in situ, among which zero were reported to have spontaneously disappeared or regressed at next mammography.

      Conclusions

      Among 479 untreated breast cancers detected on screening mammography, none spontaneously disappeared or regressed. An unknown percentage of these cancers represent overdiagnosis, but because all untreated screen-detected cancers were visible and suspicious for malignancy at next mammographic examination, delaying the onset of screening or increasing the interval between screenings should not reduce the frequency of overdiagnosis.

      Key Words

      To read this article in full you will need to make a payment
      ACR Member Login
      ACR Members, access to JACR is a member benefit. Use your ACR credentials to access all JACR articles and features.
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. US National Library of Medicine. Health screening. Available at: https://medlineplus.gov/healthscreening.html. Accessed February 24, 2017.

        • Buseman S.
        • Mouchawar J.
        • Calonge N.
        • Byers T.
        Mammography screening matters for young women with breast carcinoma: evidence of downstaging among 42-49-year-old women with a history of previous mammography screening.
        Cancer. 2003; 97: 352-358
        • Saadatmand S.
        • Bretveld R.
        • Siesling S.
        • Tilanus-Linthorst M.M.
        Influence of tumour stage at breast cancer detection on survival in modern times: population based study in 173,797 patients.
        BMJ. 2015; 351: h4901
        • Oeffinger K.C.
        • Fontham E.T.
        • Etzioni R.
        • et al.
        Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society.
        JAMA. 2015; 314: 1599-1614
        • Howlander N.
        • Noone A.M.
        • Krapcho M.
        • et al.
        SEER cancer statistics review 1975-2013.
        National Cancer Institute, Bethesda, Maryland2016
        • Munoz D.
        • Near A.M.
        • van Ravesteyn N.T.
        • et al.
        Effects of screening and systemic adjuvant therapy on ER-specific US breast cancer mortality.
        J Natl Cancer Inst. 2014; 106: dju289
        • Berry D.A.
        • Cronin K.A.
        • Plevritis S.K.
        • et al.
        Effect of screening and adjuvant therapy on mortality from breast cancer.
        N Engl J Med. 2005; 353: 1784-1792
        • Swedish Organised Service Screening Evaluation Group
        Reduction in breast cancer mortality from organized service screening with mammography: 1. Further confirmation with extended data.
        Cancer Epidemiol Biomarkers Prev. 2006; 15: 45-51
        • Duffy S.W.
        • Tabar L.
        • Chen H.H.
        • et al.
        The impact of organized mammography service screening on breast carcinoma mortality in seven Swedish counties.
        Cancer. 2002; 95: 458-469
        • Hendrick R.E.
        • Smith R.A.
        • Rutledge III, J.H.
        • Smart C.R.
        Benefit of screening mammography in women aged 40-49: a new meta-analysis of randomized controlled trials.
        J Natl Cancer Inst Monogr. 1997; : 87-92
        • Tabar L.
        • Vitak B.
        • Chen H.H.
        • Yen M.F.
        • Duffy S.W.
        • Smith R.A.
        Beyond randomized controlled trials: organized mammographic screening substantially reduces breast carcinoma mortality.
        Cancer. 2001; 91: 1724-1731
        • Nelson H.D.
        • Pappas M.
        • Cantor A.
        • Griffin J.
        • Daeges M.
        • Humphrey L.
        Harms of breast cancer screening: systematic review to update the 2009 U.S. Preventive Services Task Force recommendation.
        Ann Intern Med. 2016; 164: 256-267
        • Siu A.L.
        Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2016; 164: 279-296
      2. US Preventive Services Task Force. Breast cancer: screening 2016. Available at: http://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/breast-cancer-screening1. Accessed February 24, 2017.

        • Welch H.G.
        • Prorok P.C.
        • O’Malley A.J.
        • Kramer B.S.
        Breast-cancer tumor size, overdiagnosis, and mammography screening effectiveness.
        N Engl J Med. 2016; 375: 1438-1447
      3. Society of Breast Imaging. Bylaws. Section 3. Requirements for active fellows. Available at: https://www.sbi-online.org/ABOUTSBI/Bylaws.aspx. Accessed February 24, 2017.

        • Welch H.G.
        • Black W.C.
        Overdiagnosis in cancer.
        J Natl Cancer Inst. 2010; 102: 605-613
        • Zahl P.H.
        • Maehlen J.
        • Welch H.G.
        The natural history of invasive breast cancers detected by screening mammography.
        Arch Intern Med. 2008; 168: 2311-2316
        • Gotzsche P.C.
        • Jorgensen K.J.
        • Zahl P.H.
        • Maehlen J.
        Why mammography screening has not lived up to expectations from the randomised trials.
        Cancer Causes Control. 2012; 23: 15-21

      Linked Article

      • Breast Cancer Screening Frequency and Overdiagnosis
        Journal of the American College of RadiologyVol. 14Issue 12
        • Preview
          In their interesting article, Arleo et al [1] observe that in a series of 479 untreated breast cancers (1.4% of screening-detected cases reported by 42 experienced imaging specialists), none spontaneously disappeared or regressed. On the basis of this finding, they argue that there is no point in delaying the initiation of screening until after 40 years of age or in providing less frequent (biennial) tests because potentially overdiagnosed cases left undetected (and consequently untreated) by a less-than-intensive screening protocol would still be detected later when the time of screening eventually comes.
        • Full-Text
        • PDF