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A case-case analysis of women with breast cancer: predictors of interval vs screen-detected cancer

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

The Breast Cancer Surveillance Consortium (BCSC) model is a widely used risk model that predicts 5- and 10-year risk of developing invasive breast cancer for healthy women aged 35–74 years. Women with high BCSC risk may also be at elevated risk to develop interval cancers, which present symptomatically in the year following a normal screening mammogram. We examined the association between high BCSC risk (defined as the top 2.5% by age) and breast cancers presenting as interval cancers.

Methods

We conducted a case-case analysis among women with breast cancer in which we compared the mode of detection and tumor characteristics of patients in the top 2.5% BCSC risk by age with age-matched (1:2) patients in the lower 97.5% risk. We constructed logistic regression models to estimate the odds ratio (OR) of presenting with interval cancers, and poor prognosis tumor features, between women from the top 2.5% and bottom 97.5% of BCSC risk.

Results

Our analysis included 113 breast cancer patients in the top 2.5% of risk for their age and 226 breast cancer patients in the lower 97.5% of risk. High-risk patients were more likely to have presented with an interval cancer within one year of a normal screening, OR 6.62 (95% CI 3.28–13.4, p < 0.001). These interval cancers were also more likely to be larger, node positive, and higher stage than the screen-detected cancers.

Conclusion

Breast cancer patients in the top 2.5% of BCSC risk for their age were more likely to present with interval cancers. The BCSC model could be used to identify healthy women who may benefit from intensified screening.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

Code availability

Code used in this analysis will be made available from the corresponding author on reasonable request.

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Acknowledgements

We are extremely grateful to Karla Kerlikowske and her team at the San Francisco Mammography Registry (SFMR) for their guidance contextualizing this research and their willingness to collaborate. The SFMR provided access to data that were not ultimately used in this study. We would also like to thank Ann Griffin from the UCSF Cancer Registry and Patrick Wang from the UCSF Breast Care Center Internship Program. Data collection and sharing was supported by the National Cancer Institute-funded BCSC (HHSN261201100031C). You can learn more about the BCSC at: http://www.bcsc-research.org/. Yiwey Shieh was supported by funding from the National Cancer Institute (1K08CA237829) and the MCL consortium. Dr. Esserman is supported by funding from the NCI MCL consortium (U01CA196406). We would also like to thank the dedicated Athena investigators and advocates for their continued work and support.

Funding

Yiwey Shieh was supported by funding from the National Cancer Institute (1K08CA237829) and the MCL consortium. Laura Esserman is supported by funding from the NCI MCL consortium (U01CA196406).

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Authors and Affiliations

  1. University of California San Francisco, 2340 Sutter Street, N415, San Francisco, CA, 94143-0808, USA

    Nickolas Dreher, Madeline Matthys, Edward Hadeler, Yiwey Shieh, Irene Acerbi, Fiona M. McAuley, Michelle Melisko, Jeffrey A. Tice, Laura J. Esserman & Laura J. van’t Veer

  2. The Icahn School of Medicine at Mount Sinai, New York, NY, USA

    Nickolas Dreher

  3. University of Miami Miller School of Medicine, Miami, FL, USA

    Edward Hadeler

  4. Karolinska Institutet, Stockholm, Sweden

    Martin Eklund

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  1. Nickolas Dreher
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  2. Madeline Matthys
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  4. Yiwey Shieh
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  11. Laura J. van’t Veer
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by ND, MM, and EH. The first draft of the manuscript was written by ND and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Nickolas Dreher.

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Conflicts of interest

The authors declare no potential conflicts of interest.

Ethical approval

This work was approved by the UCSF Institutional Review Board and the study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments.

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All participants consented to have their data used for research that may result in publication.

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All participants consented to have their data used for research that may result in publication.

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Dreher, N., Matthys, M., Hadeler, E. et al. A case-case analysis of women with breast cancer: predictors of interval vs screen-detected cancer. Breast Cancer Res Treat 191, 623–629 (2022). https://doi.org/10.1007/s10549-021-06451-w

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