Breast Cancer Screening Study
Breast cancer is a significant health concern among women globally, impacting mortality rates. This study evaluates the effectiveness of screening in reducing morbidity levels in comparison to clinically diagnosed cases. The research encompasses patient characteristics, tumor profiles, treatment strategies, and analyses to determine the impact of diagnostic methods on treatment outcomes.
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Clinique du sein Centre ISALA CHU Saint-Pierre Bula-Ibula Diane, 11/2022
INTRODUCTION Breast cancer: the most frequent cancer in women worldwide mortality: - Treatment improvement - Screening Screening Oeffinger KC, Fontham ETH, Etzioni R, Herzig A, Michaelson JS, Shih Y-CT, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 20 oct 2015;314(15):1599-614 Autier P, Boniol M. Mammography screening: A major issue in medicine. Eur J Cancer Oxf Engl 1990. 19 d c 2017;90:34-62
INTRODUCTION Screening Benefit 20% reduction in BC mortality in some studies Harm 30-50% BC overdiagnosis from screening in other studies All breast cancers physical and psychological morbidity
AIM To assess the contribution of screening to morbidity reduction by comparing: Women screened Clinically diagnosed women
MATERIALS AND METHODS Design : retrospective study Recruitment: - 666 with BC from 2010 to 2013 in CHU Saint-Pierre
MATERIALS AND METHODS 1stanalysis: 666 patients in 2 groups: Screened: Clinically diagnosed: - Mammography and/or - - - - - Mass Axillar adenopathy Mammary discharge Pain sonography
MATERIALS AND METHODS 2ndanalysis:
MATERIALS AND METHODS 3rdanalysis Multivariate analysis to examine the effect of diagnostic mode on benefiting: - mastectomy or lumpectomy - axillary dissection or removal of the sentinel lymph node - whether or not to receive chemotherapy
RESULTS 1) Characteristics of patients, tumors and received treatments (Global analysis of screened versus diagnosed patients) Clinically diagnosed tumors (n = 387) Screened tumors (n = 279) Characteristics p Women s characteristics - - Mean age (years-old) [SD] % with personal and/or familial BC histoy 57 [11] 34.6 59 [15] 37.7 0.196 0.436
RESULTS Screened tumors (n = 279) Clinically diagnosed tumors (n = 387) Characteristics P 1) Characteristics of patients,tumors and received treatments (Global analysis of screened versus diagnosed patients) Tumors characteristics - - Mean size (mm) [SD] Grade (%) : 1 2 3 16,46 [15,40] 22,62 [19,27] <0.001 25.4 45.9 19.7 16.0 45.7 29.7 0.001 // // - - % invasive carcinoma % carcinomes in situ 74.2 18.3 87.4 7.2 <0.001 // - - % ductal carcinoma % lobular carcinoma 79.9 18,3 83.5 15,0 0.480 // - - - - - - % node positive % ER positive % PR positive Ki 67 >15% HER2 gene amplification (%) Metastasis (%) 5.7 79.9 74.2 13.6 4.7 2.9 19.7 71.8 66.9 28.7 12.1 14.0 <0.001 0.017 0.043 <0.001 0.005 <0.001
RESULTS 1) Characteristics of patients, tumors and received treatments (Global analysis of screened versus diagnosed patients) Clinically diagnosed tumors (n = 387) Screened tumors (n = 279) Characteristics P Treatments characteristics - Lumpectomies (%) - Mastectomies (%) - Removal sentinel node(%) - Axillary LND (%) - Chemotherapy (%) - Hormonotherapy (%) - Radiotherapy (%) 82.8 15.8 75.6 15.1 20.8 77.1 83.5 59.7 29.5 44.7 35.4 48.3 62.5 74.9 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 0.008
RESULTS 2) Characteristics of screened and diagnosed tumors in patients without familial or personal BC history, stratifed by age and by mode of presentation 40-49 years old 50-69 years old 70-75 years old Clinically diagnosed tumors (n=38) Clinically diagnosed tumors (n=98) Clinically diagnosed tumors (n=27) Screened tumors (n=37) Screened tumors (n=104) Screened tumors (n=15) Characteristics p p p Stade T (%) : - Tis - T1a-T1b - T1c - T2 - T3 - T4 23.3 33.3 28.3 8.3 1.7 0 7.2 14.5 30.4 37.7 4.3 4.3 18.9 33.7 29.6 7.1 0.6 0.6 5.6 16.8 31.8 24.0 7.3 6.1 0.0 63.0 22.2 7.4 0.0 3.7 10.6 12.8 29.8 31.9 6.4 6.4 <0.001 <0.001 0.001 Stade N (%) : - N0 - N1 - N2 - N3 83.3 1.7 0.0 0.0 72.5 15.9 0.0 1.4 76.3 6.5 0.0 0.0 68.7 16.2 0.6 0.6 81.5 7.4 0.0 0.0 68.1 19.1 0.0 0.0 0.029 0.036 0.359 Stade M (%) : - M1 0.0 10.1 0.040 0.0 3.9 0.027 3.7 12.8 0.436
RESULTS 40-49 years old 50-69 years old 70-75 years old Clinically diagnosed tumors (n=38) Clinically diagnosed tumors (n=98) Clinically diagnosed tumors (n=27) Characteristics Screened tumors (n=37) Screened tumors (n=104) Screened tumors (n=15) p p p Other tumors characteristics: Mean size (mm) [SD] % ductal tumors % lobular tumors % ER positive % PR positive % with Ki 67 >15% HER2 gene amplific (%) Grade (%) : 1 2 3 Metastasis (%) 18.34 [15.29] 91.7 8.3 80.0 73.3 15.0 3.3 18.05 [14.22] 81.6 15.8 72.5 65.2 30.4 14.5 0.703 16.27 [16.13] 77.9 20.2 79.3 75.7 13.6 4.1 22.76 [18.21] 83.7 14.3 72.6 67.0 26.8 11.7 0.001 9,87 [5,64] 73.3 26.7 85.2 74.1 7.4 11.1 25,42 [17,75] 77.8 22.2 66.0 63.8 29.8 2.1 0,002 0,205 0,327 0.158 0.209 0.012 0.003 0,298 0,268 0.146 0.073 0.022 <0.001 0,746 0,746 0.073 0.365 0.020 0.078 32.4 40.5 21.6 1.7 21.1 36.8 34.2 14.5 26.9 45.2 14.4 3.0 15.3 51.0 25.5 12.3 26.7 60.0 6.7 0.0 25.9 37.0 22.2 17.0 0.363 0.038 0.302 0.009 0.003 0.023
RESULTS 40-49 years old 50-69 years old 70-75 years old Characteristics Clinically diagnosed tumors (n=38) Clinically diagnosed tumors (n=98) Clinically diagnosed tumors (n=27) Screened tumors (n=37) Screened tumors (n=104) Screened tumors (n=15) p p p Treatments characteristics: - Lumpectomies (%) - Mastectomies (%) - Removal SNL node (%) - Axillary LND (%) - Chemotherapy (%) - Hormonotherapy (%) 85.0 13.3 75.0 13.3 31.6 76.7 72.5 23.2 47.8 42.0 65.2 53.6 0.085 0.151 0.002 <0.001 <0.001 0.016 81.7 17.8 75.1 16.0 18.3 79.3 63.1 32.4 48.3 38.8 49.7 65.9 <0.001 0.002 <0.001 <0.001 <0.001 0.005 92.6 7.4 81.5 11.1 18.5 77.8 57.4 25.5 52.2 17.4 27.7 57.4 0.001 0.055 0.012 0.469 0.378 0.078
RESULTS 3) Multivariate analysis Lumpectomy vs mastectomy Age groups According to the mode of BC detection (screened or clinically diagnosed) p OR (IC 95%) All <0.001 2.61 (1.72-3.95) 40-49 y-o 0.454 50-69 y-o 0.002 2.63 (1.53-4.54) 70-75 y-o 0.132
RESULTS 3) Multivariate analysis SNL node removal vs Axillary LND Age groups According to the mode of BC detection (screened or clinically diagnosed) p OR (IC 95%) All <0.001 4.46 (2.88-6.91) 40-49 y-o 0.004 4.18 (1.56-11.17) 50-69 y-o <0.001 4.64 (2.62-8.21) 70-75 y-o 0.085
RESULTS 3) Multivariate analysis Chemotherapy vs no chemotherapy Age groups According to the mode of BC detection (screened or clinically diagnosed) p OR (IC 95%) All <0.001 4.79 (3.19-7.18) 40-49 y-o <0.001 4.47 (1.97-10.15) 50-69 y-o <0.001 5.27 (3.07-9.04) 70-75 y-o 0.148
DISCUSSION Several studies have shown that screened tumors: - smaller - Earlier stages - lower grade + of our study: takes into account the history of breast cancer 1 in 3 + patients had a family and/or personal history of breast cancer Barth RJ, Gibson GR, Carney PA, Mott LA, Becher RD, Poplack SP. Detection of breast cancer on screening mammography allows patients to be treated with less-toxic therapy. AJR Am J Roentgenol. janv 2005;184(1):324-9. Cowan WK, Kelly P, Sawan A, Cunliffe WJ, Henry L, Higgs MJ, et al. The pathological and biological nature of screen-detected breast carcinomas: a morphological and immunohistochemical study. J Pathol. mai 1997;182(1):29-35. Spillane AJ, Kennedy CW, Gillett DJ, Carmalt HL, Janu NC, Rickard MT, et al. Screen-detected breast cancer compared to symptomatic presentation: an analysis of surgical treatment and end-points of effective mammographic screening. ANZ J Surg. juill 2001;71(7):398-402.
DISCUSSION Women 40-49 years old No fewer mastectomies for screened tumours than for diagnosed tumours 4x times more likely not to receive chemotherapy 4x times more likely not to have an axillary dissection
DISCUSSION Women 50-69 years old -Tumors screened: 81.7% lumpectomies -Clinically diagnosed tumors: 63.1% lumpectomies -5x more likely to be treated with chemotherapy if clinically diagnosed (OR: 5.27). - => ES: neurotoxicity, cardiomyopathy, increased thromboembolic risk, etc. Azim HA, de Azambuja E, Colozza M, Bines J, Piccart MJ. Long-term toxic effects of adjuvant chemotherapy in breast cancer. Ann Oncol. 1 sept 2011;22(9):1939-47. Cameron AC, Touyz RM, Lang NN. Vascular Complications of Cancer Chemotherapy. Can J Cardiol. juill 2016;32(7):852-62.
DISCUSSION Women 70-75 years old -No difference in treatment between screened women and clinically diagnosed women
DISCUSSION Informed choice Advantages and benefits sometimes not enough Inform about the extent of these effects
DISCUSSION Limitations of the study - No separation between opportunistic and systematic screening - Cancers of undifferentiated intervals from other cancers diagnosed - No information on other factors such as HRT intake, BMI, breast density.
CONCLUSION o Overdiagnosed BC: No marker to date to identify them and the rest of the tumors are evolving o Screening: smaller, less agressive tumors Less mutilating treatments Lower morbidity Inform patients about overdiagnosis, its uncertainty but also about the benefits on morbidity conferred on them by screening
FOR THE FUTURE Taking action: - Before screening By selecting the women to be screened on the basis of factors other than age - After screening By detecting tumors at risk of being overdiagnosed Our Projects: MyPeBS Association of European Cancer Leagues ECL [Internet]. [cit 13 mai 2018]. Disponible sur: https://www.europeancancerleagues.org/our-projects- mypebs/ Groen EJ, Elshof LE, Visser LL, Rutgers EJT, Winter-Warnars HAO, Lips EH, et al. Finding the balance between over- and under-treatment of ductal carcinoma in situ (DCIS). Breast Edinb Scotl. f vr 2017;31:274-83.
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