Breast cancer phenotype, nodal status and palpability may be useful in the detection of overdiagnosed screening-detected breast cancers
Menée à partir de données de registres médicaux portant sur 1 610 patientes atteintes d'un cancer primitif du sein opérable (durée médiane de suivi : 6 ans), cette étude montre que le phénotype de la tumeur, la palpabilité de cette dernière et le statut des ganglions lymphatiques sont des facteurs pronostiques indépendants pouvant permettre de réduire le surdiagnostic et de sélectionner les patientes présentant un risque élevé de métastases distantes et de décès par cancer du sein
Background : Breast cancer remains the leading cause of female cancer death despite improvements in treatment and screening. Screening is often criticized for leading to overdiagnosis and overtreatment. However, few have attempted to identify overdiagnosed cases.
Patients and methods : A large, consecutive series of patients treated for primary operable, screening-detected, breast cancer (n = 1610). Details from pathology and clinical reports, treatment and follow-up were available from our prospectively managed database. Univariate and multivariate Cox proportional models were used to study the prognostic variables in screening-detected breast cancers for distant metastatic and breast cancer-specific survival.
Results : We included 1 610 patients. The mean/median follow-up was 6.0/6.0 years. Univariate analysis : tumor size, palpability, breast cancer phenotype and nodal status were predictors of distant metastasis and breast cancer-specific death. Multivariate analysis : palpability, breast cancer phenotype and nodal status remained independent prognostic variables. Palpability differed by breast cancer phenotype.
Conclusion : Screening-detected breast cancer is associated with excellent outcome. Palpability, nodal status and breast cancer phenotype are independent prognostic variables that may select patients at increased risk for distant metastatic relapse and breast cancer-specific death. Overdiagnosed cases reside most likely in the nonpalpable node negative subgroup with a Luminal A phenotype.
Annals of Oncology , résumé, 2013