Medical Oncology Unit, University Hospital of Parma, Via Gramsci 14, 43100 Parma, Italy.
J Clin Oncol. 2012 Jul 1;30(19):2362-8. doi: 10.1200/JCO.2011.37.6434. Epub 2012 May 14.
To determine whether human epidermal growth factor receptor 2 (HER2) -positive status is associated with risk of breast cancer diagnosis in the interval between mammographic screening, we estimated the distribution of features of aggressive tumor behavior in a general population with newly diagnosed breast cancer and known screening status.
We evaluated all invasive breast cancers (N = 641) that were systematically collected by the Parma Province Cancer Registry and diagnosed in women age 50 to 69 years from 2004 to 2007. From this population, 292 screen-detected cancers and 48 interval cases with negative screening mammograms on expert rereading (true interval cancers) were selected for study purposes. Unconditional logistic regression adjusted for age and tumor size was used to determine whether interval cancers were associated with selected clinicobiologic characteristics.
Tumors with a high histologic grade (odds ratio [OR], 1.8; 95% CI, 1.2 to 3.8), high proliferative rate (OR, 2.4; 95% CI, 1.2 to 4.5), negative estrogen receptor status (OR, 1.6; 95% CI, 1.1 to 3.1), or HER2-positive status (OR, 3.4; 95% CI, 1.7 to 7.1) were more likely to be diagnosed in the interval between screening. Women age less than 60 years with HER2-positive breast cancer were four times more likely to be diagnosed in the interval between screening compared with only a two-fold increased risk for older women.
This population-based cancer registry study demonstrated that HER2-positive tumors account for a substantial proportion of mammographic screening failure. The distribution of biologic characteristics in screen-detected cancers differs from that observed in interval cancers and may account in part for the more aggressive behavior of interval-detected cases.
为了确定人表皮生长因子受体 2（HER2）阳性状态是否与乳腺筛查间期乳腺癌的诊断风险相关，我们评估了在已知筛查状态下新诊断为乳腺癌且具有侵袭性肿瘤行为特征的一般人群中的分布。
我们评估了由帕尔马省癌症登记处系统收集的所有浸润性乳腺癌（N=641），这些乳腺癌患者年龄为 50 至 69 岁，诊断时间为 2004 年至 2007 年。从该人群中，选择了 292 例筛查发现的癌症和 48 例在专家重新阅读时阴性的筛查间隔期乳腺癌（真正的间隔期癌症）进行研究。使用条件逻辑回归来调整年龄和肿瘤大小，以确定间隔期癌症是否与所选临床生物学特征相关。
高组织学分级（比值比[OR]，1.8；95%置信区间[CI]，1.2 至 3.8）、高增殖率（OR，2.4；95%CI，1.2 至 4.5）、雌激素受体阴性（OR，1.6；95%CI，1.1 至 3.1）或 HER2 阳性（OR，3.4；95%CI，1.7 至 7.1）的肿瘤更有可能在筛查间期被诊断。与老年女性相比，年龄小于 60 岁的 HER2 阳性乳腺癌女性在筛查间期被诊断的可能性高出四倍。
这项基于人群的癌症登记研究表明，HER2 阳性肿瘤是乳腺筛查失败的一个重要原因。在筛查发现的癌症中，生物学特征的分布与在间隔期发现的癌症不同，这可能部分解释了间隔期发现的病例更具侵袭性的行为。
