Breast Cancer Screening Interval: Effect on Rate of Late-Stage Disease at Diagnosis and Overall Survival.

Autor:	Zuley ML; Department of Radiology, Division of Breast Imaging, School of Medicine & University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA., Bandos AI; Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA., Duffy SW; Wolfson Institute of Population Health, Queen Mary University of London, London, England., Logue D; Imaging Research, Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA., Bhargava R; Department of Pathology and Pathology at Magee-Womens Hospital of the University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA., McAuliffe PF; Department of Surgery and Breast Surgical Oncology at Magee-Womens Hospital of the University of Pittsburgh Medical Center, School of Medicine, University of Pittsburgh, Pittsburgh, PA., Brufsky AM; Division of Hematology/Oncology, School of Medicine & University of Pittsburgh Medical Center, University of Pittsburgh, Pittsburgh, PA., Nishikawa RM; Imaging Research, Department of Radiology, School of Medicine, University of Pittsburgh, Pittsburgh, PA.
Jazyk:	angličtina
Zdroj:	Journal of clinical oncology : official journal of the American Society of Clinical Oncology [J Clin Oncol] 2024 Nov 10; Vol. 42 (32), pp. 3837-3846. Date of Electronic Publication: 2024 Aug 21.
DOI:	10.1200/JCO.24.00285
Abstrakt:	Purpose: Controversy continues regarding the effect of screening mammography on breast cancer outcomes. We evaluated late-stage cancer rate and overall survival (OS) for different screening intervals using a real-world institutional research data mart. Methods: Patients having both a cancer registry record of new breast cancer diagnosis and prediagnosis screening history between 2004 and 2019 were identified from our institutional research breast data mart. Time interval between the two screening mammograms immediately preceding diagnosis and the time to cancer diagnosis were determined. Screening interval was deemed annual if ≤15 months, biennial if >15 and ≤27 months, intermittent if >27 months, and baseline if only one prediagnosis screen was known. The primary end point was late-stage cancer (TNM stage IIB or worse), and the secondary end point was OS. The association of screening interval and late-stage cancer was analyzed using multivariable logistic regression adjusting for prediagnosis characteristics. Proportional hazards regression was used for survival analysis. Potential lead time was analyzed using survival from a uniform fixed time point. Results: In total, 8,145 patients with breast cancer had prediagnosis screening mammography in the timeframe. The percentage of late-stage cancers diagnosed increased significantly with screening interval with 9%, 14%, and 19% late stages for annual, biennial, and intermittent groups ( P < .001), respectively. The trend persisted regardless of age, race, and menopausal status. Biennial and intermittent groups had substantially worse OS than the annual screened group, with relative hazards of 1.42 (95% CI, 1.11 to 1.82) and 2.69 (95% CI, 2.11 to 3.43), respectively, and 1.39 (95% CI, 1.08 to 1.78) and 2.01 (95% CI, 1.58 to 2.55) after adjustment for potential lead time. Conclusion: Annual mammographic screening was associated with lower risk of late-stage cancer and better OS across clinical and demographic subgroups. Our study suggests benefit of annual screening for women 40 years and older.
Databáze:	MEDLINE
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