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Comparative Study
. 2008 Jun 3;98(11):1741-4.
doi: 10.1038/sj.bjc.6604368. Epub 2008 May 27.

Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone?

G C Wishart  1 , D C Greenberg, P D Britton, P Chou, C H Brown, A D Purushotham, S W Duffy
Affiliations
Comparative Study

Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone?

G C Wishart et al. Br J Cancer. .

Abstract

This paper examines whether screen-detected breast cancer confers additional prognostic benefit to the patient, over and above that expected by any shift in stage at presentation. In all, 5604 women (aged 50-70 years) diagnosed with invasive breast cancer between 1998 and 2003 were identified by the Eastern Cancer Registration and Information Centre (ECRIC) and mammographic screening status was determined. Using proportional hazards regression, we estimated the effect of screen detection compared with symptomatic diagnosis on 5-year survival unadjusted, then adjusted for age and Nottingham Prognostic Index (NPI). A total of 72% of the survival benefit associated with screen-detected breast cancer can be accounted for by age and shift in NPI. Survival analysis by continuous NPI showed a small but systematic survival benefit for screen-detected cancers at each NPI value. These data show that although most of the screen-detected survival advantage is due to a shift in NPI, the mode of detection does impact on survival in patients with equivalent NPI scores. This residual survival benefit is small but significant, and is likely to be due to differences in tumour biology. Current prognostication tools may, therefore, overestimate the benefit of systemic treatments in screen-detected cancers and lead to overtreatment of these patients.

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Figures

Figure 1
Figure 1
Survival by detection mode.
Figure 2
Figure 2
Fitted 5-year survival by continuous NPI (P=0.01).
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References

    1. Callagy GM, Pharoah PD, Pinder SE, Hsu FD, Nielsen TO, Ragaz J, Ellis IO, Huntsman D, Caldas C (2006) BCL-2 is a prognostic marker independently of the Nottingham Prognostic Index. Clin Cancer Res 12(8): 2468–2475 - PubMed
    1. Cox DR (1972) Regression models and life-tables. J Roy Stat Soc 34: 187–220
    1. Duffy SW, Tabar L, Fagerberg G, Gad A, Grontoft O, South MC, Day NE (1991) Breast screening, prognostic factors and survival-results from the Swedish two-county study. Br J Cancer 64: 1133–1138 - PMC - PubMed
    1. Freedman LS, Graubard BI, Schatzkin A (1992) Statistical validation of intermediate endpoints for chronic diseases. Stat Med 11: 167–187 - PubMed
    1. Joensuu H, Lehtimaki T, Holli K, Elomaa L, Turpeenniemi-Hujanen T, Kataja V, Anttila A, Lundin M, Isola J, Lundin J (2004) Risk for distant recurrence of breast cancer detected by mammography screening or other methods. JAMA 292: 1064–1073 - PubMed

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