Why do large breast cancers still present in a population offered screening?

Kricker, Anne, Newman, Beth, Gertig, Dorota M., Goumas, Chris, Armes, Jane and Armstrong, Bruce K. (2008) Why do large breast cancers still present in a population offered screening?. International Journal of Cancer, 123 12: 2907-2914. doi:10.1002/ijc.23829

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Author Kricker, Anne
Newman, Beth
Gertig, Dorota M.
Goumas, Chris
Armes, Jane
Armstrong, Bruce K.
Title Why do large breast cancers still present in a population offered screening?
Journal name International Journal of Cancer   Check publisher's open access policy
ISSN 0020-7136
Publication date 2008-12-15
Sub-type Article (original research)
DOI 10.1002/ijc.23829
Open Access Status
Volume 123
Issue 12
Start page 2907
End page 2914
Total pages 8
Place of publication Hoboken, NJ, United States
Publisher John Wiley & Sons
Language eng
Subject 1306 Cancer Research
2730 Oncology
Abstract Rates of large breast cancers should decrease in a population that is offered mammography screening, but women continue to present with them. We sought an explanation in a population-based epidemiological study of 1,459 women diagnosed with invasive breast cancer in 2002-2003 in Australia; breast cancers were ≥2 cm in 766 women (53%) and 11-1.9 cm in a comparison group (693, 47%). We interviewed the women about their personal, mammogram and breast histories in the years before diagnosis and collected biological characteristics of tumors and mammogram dates from medical records. The strongest correlate of breast cancer size at diagnosis was the method of detection: the odds of a ≥2 cm breast cancer was substantially lower for detection by a screening mammogram (OR = 0.27, 95% CI 0.21-0.34; p < 0.001) than for detection after a breast symptom. Higher BMI (ORs ∼1.6 for >25 kg/m2), higher cancer grade (ORs of 1.6 for moderate, 2.89 for high grade) and lobular type (OR 2.09, 95% CI 1.45-3.0) were also independent correlates (p < 0.001) of a ≥2 cm breast cancer. HRT use strongly reduced the odds but only in cancers detected after a breast symptom (OR 5 0.49, 95% CI 0.33-0.74; p 5 0.002), not in those detected by a screening mammogram. As assessed from their proportional contribution to ≥2 cm breast cancers in our study population, lack of mammogram detection, BMI ≥25 kg/m2 and moderate or high grade of the cancer were the most important factors with population attributable fractions of 42%, 11% and 29% respectively; the first 2 are amenable to intervention.
Keyword Advanced breast cancer
Cancer grade
Mammogram detection
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collection: Mater Research Institute-UQ (MRI-UQ)
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Created: Tue, 06 Jan 2015, 15:09:54 EST by Ms Dulcie Stewart on behalf of Mater Research Institute-UQ