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. 2019 Jan 5;19(1):2.
doi: 10.1186/s12880-018-0303-3.

Screening mammography for second breast cancers in women with history of early-stage breast cancer: factors and causes associated with non-detection

Yoo Kyung Yeom  1 , Eun Young Chae  2 , Hak Hee Kim  1 , Joo Hee Cha  1 , Hee Jung Shin  1 , Woo Jung Choi  1
Affiliations

Screening mammography for second breast cancers in women with history of early-stage breast cancer: factors and causes associated with non-detection

Yoo Kyung Yeom et al. BMC Med Imaging. .

Abstract

Background: The aim of our study was to identify the factors and causes associated with non-detection for second breast cancers on screening mammography in women with a personal history of early-stage breast cancer.

Methods: Between January 2000 and December 2008, 7976 women with early-stage breast cancer underwent breast surgery in our institution. The inclusion criteria of our study were patients who had: (a) subsequent in-breast recurrence, (b) surveillance mammography within 1 year before recurrence. Retrospective analysis of mammography was performed. Non-detection was defined as second breast cancers that were not visible on screening mammography. Imaging features, demographics, primary breast cancer (PBC) characteristics, and clinical features were evaluated to determine its association with non-detection. Univariate and multivariate logistic regression analyses were also performed to identify the factors related to non-detection.

Results: We identified 188 patients that met the criteria. Among them, 39% of patients showed non-detection (n = 74). Of the 74 patients with non-detection, 53 (72%) were classified as having no detectable mammographic abnormality (i.e., true negative) due to overlapping dense breast tissue (n = 32), obscured by postoperative scar (n = 12) or difficult anatomic location / poor positioning (n = 9). The remaining 21 patients were categorized as having subtle findings (n = 11) or missed cancer (n = 10). Non-detection for second breast cancers were significantly associated with mammographic breast density (p = 0.001, OR = 2.959) and detectability of PBC on mammography (p = 0.011, OR = 3.013).

Conclusion: Non-detection of second breast cancer in women with a personal history of early-stage breast cancer were associated with mammographic dense breast and lower detectability of PBC on mammography.

Keywords: Breast cancer; Mammography; Screening; Second breast cancer.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the institutional review board of Asan Medical Center (No. 2017–0440), and the need for informed consent was waived due to the retrospective design of the study.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of the study population
Fig. 2
Fig. 2
Two steps of mammographic evaluation
Fig. 3
Fig. 3
A 48-year-old woman with a PHBC in the left breast, classified as ‘true negative’. a Mediolateral oblique mammogram at primary breast cancer diagnosis showed extremely dense breast tissue and benign calcifications that were interpreted as negative. Primary breast cancer was a 22-mm microinvasive ductal carcinoma in the left breast. b Mediolateral oblique mammogram obtained 43 months after surgery also shows extremely dense breast tissue and no detectable abnormality except a postoperative change in the left breast. c Ultrasound image shows an 11-mm hypoechoic mass with partially not circumscribed margin (arrow) in the left breast subareolar area, which was pathologically proven to be a 12-mm microinvasive ductal carcinoma
Fig. 4
Fig. 4
A 39-year-old woman with a PHBC in the left breast, classified as interpretation error, ‘subtle finding’. a Mediolateral oblique mammogram shows an asymmetry (arrows) on the right upper breast. b Ultrasound image shows a 15-mm irregular hypoechoic mass (arrow) in the right breast, which was pathologically proven to be an invasive ductal carcinoma
See this image and copyright information in PMC

References

    1. Webb PM, Cummings MC, Bain CJ, Furnival CM. Changes in survival after breast cancer: improvements in diagnosis or treatment? Breast. 2004;13:7–14. doi: 10.1016/S0960-9776(03)00129-2. - DOI - PubMed
    1. Sant M, Allemani C, Capocaccia R, et al. Stage at diagnosis is a key explanation of differences in breast cancer survival across Europe. Int J Cancer. 2003;106:416–422. doi: 10.1002/ijc.11226. - DOI - PubMed
    1. Houssami N, Abraham LA, Miglioretti DL, et al. Accuracy and outcomes of screening mammography in women with a personal history of early-stage breast cancer. JAMA. 2011;305:790–799. doi: 10.1001/jama.2011.188. - DOI - PMC - PubMed
    1. Cho N, Han W, Han BK, et al. Breast cancer screening with mammography plus ultrasonography or magnetic resonance imaging in women 50 years or younger at diagnosis and treated with breast conservation therapy. JAMA Oncol. 2017;3:1495–1502. doi: 10.1001/jamaoncol.2017.1256. - DOI - PMC - PubMed
    1. van der Sangen MJ, Poortmans PM, Scheepers SW, et al. Prognosis following local recurrence after breast conserving treatment in young women with early breast cancer. Eur J Surg Oncol. 2013;39:892–898. doi: 10.1016/j.ejso.2013.05.004. - DOI - PubMed