CLINICOPATHOLOGICAL CHARACTERISTICS OF BREAST CANCERS DIAGNOSED IN PARTICIPANTS, NON-PARTICIPANTS AND NOT INVITED TO THE BREAST CANCER SCREENING PROGRAMME IN NORTHERN PORTUGAL (2003-2008): PART ONE EVALUATION
Abstract
The aim of this study was to evaluate the clinical and pathological characteristics of the invasive breast cancers diagnosed in women participant in the beginning of breast cancer screening programme, compared to cancers detected in non-participants and in not invited women. Data was retrieved from the population-based North Region Cancer Registry and from the organized population-based Breast Cancer Screening Programme (BCSP) of the north region of Portugal, and records were matched to select the three groups for comparison. In 125 screening participants, 75.8% of invasive breast cancers were ≤ 20 mm, 67.7% had no axillary lymph nodes metastasis and 58.1% were stage I. These characteristics were significantly more favourable than those found in breast cancers detected in non-participants (57 women) or not invited (314 women). After multivariable analysis, size remained the only distinguishing characteristic of breast cancers detected within the screening programme compared to the other two studied groups. Breast cancers detected in screening participants were significantly smaller, which is consistent with findings by other authors. The more favourable prognostic characteristics of the breast cancers detected in a population exposed to screening (including interval cancers) indicate a possible mortality reduction in the future.
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References
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prognosis between screen-detected and symptomatic breast cancers. British Journal of Cancer 104, 1680-1685.
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breast cancer screening programme in Northern Portugal using the European Guidelines. Cancer Epidemiology 39, 783-789.
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New England Journal of Medicine 353, 1784-1792.
Bucchi L., Barchielli A., Ravaioli A., Federico M., De Lisi V., Ferretti S., Paci E., Vettorazzi M., Patriarca S., Frigerio A. & Buiatti E. (2005)
Screen-detected vs clinical breast cancer: the advantage in the relative risk of lymph node metastases decreases with increasing
tumour size. British Journal of Cancer 92, 156-161.
Bucchi L., Puliti D., Ravaioli A., Cortesi L., De Lisi V., Falcini F., Ferretti S., Frigerio A., Mangone L., Petrella M., Petrucci C., Sassoli
De Bianchi P., Traina A., Tumino R., Zanetti R., Zorzi M. & Paci E. (2008) Breast screening: axillary lymph node status of interval
cancers by interval year. Breast 17, 477-483.
Bulliard J. L., Ducros C., Jemelin C., Arzel B., Fioretta G. & Levi F. (2009) Effectiveness of organised versus opportunistic mammography
screening. Annals of Oncology 20, 1199-1202.
Burke J. P., Power C., Gorey T. F., Flanagan F., Kerin M. J. & Kell M. R. (2008) A comparative study of risk factors and prognostic features
between symptomatic and screen detected breast cancer. European Journal of Surgical Oncology 34, 149-153.
Castro C., Bento M. J., Lunet N. & Campos P. (2012) Assessing the completeness of cancer registration using suboptimal death certificate
information. European Journal of Cancer Prevention 21, 478-479.
Day N. E., Williams D. R. & Khaw K. T. (1989) Breast cancer screening programmes: the development of a monitoring and evaluation
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Dijck J. & Schouten L. (2000) Use of cancer registry data: prerequesites, limitations and solutions. In: Evaluation and monitoring of
screening programmes (eds. Sankila, R., Démaret, E., Hakama, M., Lynge, E., Schouten, L. & Parkin, D. M.), pp. 43-57. Europe
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Domingo L., Jacobsen K. K., Von Euler-Chelpin M., Vejborg I., Schwartz W., Sala M. & Lynge E. (2013) Seventeen-years overview of
breast cancer inside and outside screening in Denmark. Acta Oncologica 52, 48-56.
Duffy S. W., Tabar L., Fagerberg G., Gad A., Grontoft O., South M. C. & Day N. E. (1991) Breast screening, prognostic factors and
survival--results from the Swedish two county study. British Journal of Cancer 64, 1133-1138.
Elston C. W. & Ellis I. O. (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer:
experience from a large study with long-term follow-up. Histopathology 19, 403-410.
Giordano L., Von Karsa L., Tomatis M., Majek O., De Wolf C., Lancucki L., Hofvind S., Nystrom L., Segnan N., Ponti A., Van Hal G.,
Martens P., Majek O., Danes J., Von Euler-Chelpin M., Aasmaa A., Anttila A., Becker N., Pentek Z., Budai A., Madai S., Fitzpatrick
P., Mooney T., Zappa M., Ventura L., Scharpantgen A., Hofvind S., Seroczynski P., Morais A., Rodrigues V., Bento M. J., Gomes
De Carvalho J., Natal C., Prieto M., Sanchez-Contador Escudero C., Zubizarreta Alberti R., Fernandez Llanes S. B., Ascunce N.,
Ederra Sanza M., Sarriugarte Irigoien G., Salas Trejo D., Ibanez Cabanell J., Wiege M., Ohlsson G., Tornberg S., Korzeniewska
M., De Wolf C., Fracheboud J., Patnick J. J., Lancucki L., Ducarroz S. & Suonio E. (2012) Mammographic screening programmes
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(1995) Aggressiveness of screen-detected breast cancers. Lancet 345, 221-224.
Hoff S. R., Klepp O. & Hofvind S. (2012) Asymptomatic breast cancer in non-participants of the national screening programme in
Norway: a confounding factor in evaluation? Journal of Medical Screening 19, 177-183.
Hofvind S., Lee C. I. & Elmore J. G. (2012) Stage-specific breast cancer incidence rates among participants and non-participants of a
population-based mammographic screening program. Breast Cancer Research and Treatment 135, 291-299.
Hofvind S., Sorum R. & Thoresen S. (2008) Incidence and tumor characteristics of breast cancer diagnosed before and after implementation
of a population-based screening-program. Acta Oncologica 47, 225-231.
Kalager M., Haldorsen T., Bretthauer M., Hoff G., Thoresen S. O. & Adami H. O. (2009) Improved breast cancer survival following
introduction of an organized mammography screening program among both screened and unscreened women: a populationbased
cohort study. Breast Cancer Research 11, R44.
Kim J., Lee S., Bae S., Choi M. Y., Lee J., Jung S. P., Kim S., Choe J. H., Kim J. H., Kim J. S., Lee J. E., Nam S. J. & Yang J. H. (2012)
Comparison between screen-detected and symptomatic breast cancers according to molecular subtypes. Breast Cancer Research
and Treatment 131, 527-540.
Lynge E., Tornberg S., Von Karsa L., Segnan N. & Van Delden J. J. (2012) Determinants of successful implementation of populationbased
cancer screening programmes. European Journal of Cancer 48, 743-748.
Mccann J., Stockton D. & Day N. (1998) Breast cancer in East Anglia: the impact of the breast screening programme on stage at diagnosis.
Journal of Medical Screening 5, 42-48.
Mook S., Van ‘T Veer L. J., Rutgers E. J., Ravdin P. M., Van De Velde A. O., Van Leeuwen F. E., Visser O. & Schmidt M. K. (2011)
Independent prognostic value of screen detection in invasive breast cancer. Journal of the National Cancer Institute 103, 585-597.
Nagtegaal I. D., Allgood P. C., Duffy S. W., Kearins O., Sullivan E. O., Tappenden N., Wallis M. & Lawrence G. (2011) Prognosis and
pathology of screen-detected carcinomas: how different are they? Cancer 117, 1360-1368.
Nagtegaal I. D. & Duffy S. W. (2013) Reduction in rate of node metastases with breast screening: consistency of association with tumor
size. Breast Cancer Research and Treatment 137, 653-663.
Narod S. A. (2012) Tumour size predicts long-term survival among women with lymph node-positive breast cancer. Current Oncology
(Toronto, Ont.) 19, 249-253.
Perry N., Broeders M., De Wolf C., Tornberg S., Holland R. & Von Karsa L. (2006) European guidelines for quality assurance in breast
cancer screening and diagnosis, 4th edn. Office for Official Publications of the European Communities, Luxembourg.
Roreno (2002). Mapas – comparações efectuadas entre cada distrito e a restante região. [Access Date: 2015/03/01 ]. Available from:
http://www.roreno.com.pt/pt/estatisticas/mapas.html.
Segnan N., Rosso S. & Ponti A. (2012) Is the breast cancer mortality decrease in Sweden due to screening or treatment? Not the right
question. Journal of the National Cancer Institute 104, 1040-1041.
Shen Y., Yang Y., Inoue L. Y., Munsell M. F., Miller A. B. & Berry D. A. (2005) Role of detection method in predicting breast cancer
survival: analysis of randomized screening trials. Journal of the National Cancer Institute 97, 1195-1203.
Stockton D. & Mccann J. (2001) Cancer registries in monitoring, evaluating and planning breast cancer screening programmes. In:
Evaluation and Monitoring of Screening Programmes (eds. Sankila, R., Démaret, E., Hakama, M., Lynge, E., Shouten, L. J. & Parkin,
D. M.), pp. 181-194. Office for Official Publications of the European Communities, Luxembourg.
Vanier A., Leux C., Allioux C., Billon-Delacour S., Lombrail P. & Molinie F. (2013) Are prognostic factors more favorable for breast
cancer detected by organized screening than by opportunistic screening or clinical diagnosis? A study in Loire-Atlantique (France).
Cancer Epidemiology 37, 683-687.
Welch H. G. (2010) Screening mammography--a long run for a short slide? New England Journal of Medicine 363, 1276-1278.
prognosis between screen-detected and symptomatic breast cancers. British Journal of Cancer 104, 1680-1685.
Baré M., Bonfill X., Andreu X. & On Behalf of the Breast Cancer Screening Programme of Sabadell-Cerdanyola Research Group
(2006) Relationship between the method of detection and prognostic factors for breast cancer in a community with a screening
programme. Journal of Medical Screening 13, 183-191.
Bento M. J., Goncalves G., Aguiar A., Castro C., Veloso V. & Rodrigues V. (2015) Performance indicators evaluation of the populationbased
breast cancer screening programme in Northern Portugal using the European Guidelines. Cancer Epidemiology 39, 783-789.
Berry D. A., Cronin K. A., Plevritis S. K., Fryback D. G., Clarke L., Zelen M., Mandelblatt J. S., Yakovlev A. Y., Habbema J. D., Feuer E.
J., Cancer I. & Surveillance Modeling Network C. (2005) Effect of screening and adjuvant therapy on mortality from breast cancer.
New England Journal of Medicine 353, 1784-1792.
Bucchi L., Barchielli A., Ravaioli A., Federico M., De Lisi V., Ferretti S., Paci E., Vettorazzi M., Patriarca S., Frigerio A. & Buiatti E. (2005)
Screen-detected vs clinical breast cancer: the advantage in the relative risk of lymph node metastases decreases with increasing
tumour size. British Journal of Cancer 92, 156-161.
Bucchi L., Puliti D., Ravaioli A., Cortesi L., De Lisi V., Falcini F., Ferretti S., Frigerio A., Mangone L., Petrella M., Petrucci C., Sassoli
De Bianchi P., Traina A., Tumino R., Zanetti R., Zorzi M. & Paci E. (2008) Breast screening: axillary lymph node status of interval
cancers by interval year. Breast 17, 477-483.
Bulliard J. L., Ducros C., Jemelin C., Arzel B., Fioretta G. & Levi F. (2009) Effectiveness of organised versus opportunistic mammography
screening. Annals of Oncology 20, 1199-1202.
Burke J. P., Power C., Gorey T. F., Flanagan F., Kerin M. J. & Kell M. R. (2008) A comparative study of risk factors and prognostic features
between symptomatic and screen detected breast cancer. European Journal of Surgical Oncology 34, 149-153.
Castro C., Bento M. J., Lunet N. & Campos P. (2012) Assessing the completeness of cancer registration using suboptimal death certificate
information. European Journal of Cancer Prevention 21, 478-479.
Day N. E., Williams D. R. & Khaw K. T. (1989) Breast cancer screening programmes: the development of a monitoring and evaluation
system. British Journal of Cancer 59, 954-958.
Dijck J. & Schouten L. (2000) Use of cancer registry data: prerequesites, limitations and solutions. In: Evaluation and monitoring of
screening programmes (eds. Sankila, R., Démaret, E., Hakama, M., Lynge, E., Schouten, L. & Parkin, D. M.), pp. 43-57. Europe
Against Cancer Programme, Brussels, Luxembourg.
Domingo L., Jacobsen K. K., Von Euler-Chelpin M., Vejborg I., Schwartz W., Sala M. & Lynge E. (2013) Seventeen-years overview of
breast cancer inside and outside screening in Denmark. Acta Oncologica 52, 48-56.
Duffy S. W., Tabar L., Fagerberg G., Gad A., Grontoft O., South M. C. & Day N. E. (1991) Breast screening, prognostic factors and
survival--results from the Swedish two county study. British Journal of Cancer 64, 1133-1138.
Elston C. W. & Ellis I. O. (1991) Pathological prognostic factors in breast cancer. I. The value of histological grade in breast cancer:
experience from a large study with long-term follow-up. Histopathology 19, 403-410.
Giordano L., Von Karsa L., Tomatis M., Majek O., De Wolf C., Lancucki L., Hofvind S., Nystrom L., Segnan N., Ponti A., Van Hal G.,
Martens P., Majek O., Danes J., Von Euler-Chelpin M., Aasmaa A., Anttila A., Becker N., Pentek Z., Budai A., Madai S., Fitzpatrick
P., Mooney T., Zappa M., Ventura L., Scharpantgen A., Hofvind S., Seroczynski P., Morais A., Rodrigues V., Bento M. J., Gomes
De Carvalho J., Natal C., Prieto M., Sanchez-Contador Escudero C., Zubizarreta Alberti R., Fernandez Llanes S. B., Ascunce N.,
Ederra Sanza M., Sarriugarte Irigoien G., Salas Trejo D., Ibanez Cabanell J., Wiege M., Ohlsson G., Tornberg S., Korzeniewska
M., De Wolf C., Fracheboud J., Patnick J. J., Lancucki L., Ducarroz S. & Suonio E. (2012) Mammographic screening programmes
in Europe: organization, coverage and participation. Journal of Medical Screening 19 (Suppl 1), 72-82.
Greene F. L., Page D. L. & Fleming I. D. (2002) AJCC Cancer Staging Handbook, 6th edn, Springer, New York, NY.
Hakama M., Holli K., Isola J., Kallioniemi O. P., Karkkainen A., Visakorpi T., Pukkala E., Saarenmaa I., Geiger U., Ikkala J. & Et Al.
(1995) Aggressiveness of screen-detected breast cancers. Lancet 345, 221-224.
Hoff S. R., Klepp O. & Hofvind S. (2012) Asymptomatic breast cancer in non-participants of the national screening programme in
Norway: a confounding factor in evaluation? Journal of Medical Screening 19, 177-183.
Hofvind S., Lee C. I. & Elmore J. G. (2012) Stage-specific breast cancer incidence rates among participants and non-participants of a
population-based mammographic screening program. Breast Cancer Research and Treatment 135, 291-299.
Hofvind S., Sorum R. & Thoresen S. (2008) Incidence and tumor characteristics of breast cancer diagnosed before and after implementation
of a population-based screening-program. Acta Oncologica 47, 225-231.
Kalager M., Haldorsen T., Bretthauer M., Hoff G., Thoresen S. O. & Adami H. O. (2009) Improved breast cancer survival following
introduction of an organized mammography screening program among both screened and unscreened women: a populationbased
cohort study. Breast Cancer Research 11, R44.
Kim J., Lee S., Bae S., Choi M. Y., Lee J., Jung S. P., Kim S., Choe J. H., Kim J. H., Kim J. S., Lee J. E., Nam S. J. & Yang J. H. (2012)
Comparison between screen-detected and symptomatic breast cancers according to molecular subtypes. Breast Cancer Research
and Treatment 131, 527-540.
Lynge E., Tornberg S., Von Karsa L., Segnan N. & Van Delden J. J. (2012) Determinants of successful implementation of populationbased
cancer screening programmes. European Journal of Cancer 48, 743-748.
Mccann J., Stockton D. & Day N. (1998) Breast cancer in East Anglia: the impact of the breast screening programme on stage at diagnosis.
Journal of Medical Screening 5, 42-48.
Mook S., Van ‘T Veer L. J., Rutgers E. J., Ravdin P. M., Van De Velde A. O., Van Leeuwen F. E., Visser O. & Schmidt M. K. (2011)
Independent prognostic value of screen detection in invasive breast cancer. Journal of the National Cancer Institute 103, 585-597.
Nagtegaal I. D., Allgood P. C., Duffy S. W., Kearins O., Sullivan E. O., Tappenden N., Wallis M. & Lawrence G. (2011) Prognosis and
pathology of screen-detected carcinomas: how different are they? Cancer 117, 1360-1368.
Nagtegaal I. D. & Duffy S. W. (2013) Reduction in rate of node metastases with breast screening: consistency of association with tumor
size. Breast Cancer Research and Treatment 137, 653-663.
Narod S. A. (2012) Tumour size predicts long-term survival among women with lymph node-positive breast cancer. Current Oncology
(Toronto, Ont.) 19, 249-253.
Perry N., Broeders M., De Wolf C., Tornberg S., Holland R. & Von Karsa L. (2006) European guidelines for quality assurance in breast
cancer screening and diagnosis, 4th edn. Office for Official Publications of the European Communities, Luxembourg.
Roreno (2002). Mapas – comparações efectuadas entre cada distrito e a restante região. [Access Date: 2015/03/01 ]. Available from:
http://www.roreno.com.pt/pt/estatisticas/mapas.html.
Segnan N., Rosso S. & Ponti A. (2012) Is the breast cancer mortality decrease in Sweden due to screening or treatment? Not the right
question. Journal of the National Cancer Institute 104, 1040-1041.
Shen Y., Yang Y., Inoue L. Y., Munsell M. F., Miller A. B. & Berry D. A. (2005) Role of detection method in predicting breast cancer
survival: analysis of randomized screening trials. Journal of the National Cancer Institute 97, 1195-1203.
Stockton D. & Mccann J. (2001) Cancer registries in monitoring, evaluating and planning breast cancer screening programmes. In:
Evaluation and Monitoring of Screening Programmes (eds. Sankila, R., Démaret, E., Hakama, M., Lynge, E., Shouten, L. J. & Parkin,
D. M.), pp. 181-194. Office for Official Publications of the European Communities, Luxembourg.
Vanier A., Leux C., Allioux C., Billon-Delacour S., Lombrail P. & Molinie F. (2013) Are prognostic factors more favorable for breast
cancer detected by organized screening than by opportunistic screening or clinical diagnosis? A study in Loire-Atlantique (France).
Cancer Epidemiology 37, 683-687.
Welch H. G. (2010) Screening mammography--a long run for a short slide? New England Journal of Medicine 363, 1276-1278.
Published
2020-07-02
How to Cite
BENTO, Maria José et al.
CLINICOPATHOLOGICAL CHARACTERISTICS OF BREAST CANCERS DIAGNOSED IN PARTICIPANTS, NON-PARTICIPANTS AND NOT INVITED TO THE BREAST CANCER SCREENING PROGRAMME IN NORTHERN PORTUGAL (2003-2008): PART ONE EVALUATION.
Revista Portuguesa de Cirurgia, [S.l.], n. 47, p. 31-40, july 2020.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/807>. Date accessed: 01 may 2024.
doi: https://doi.org/10.34635/rpc.807.
Section
Original Papers
