Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA.
Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA.
Breast Cancer Res Treat. 2019 Oct;177(3):679-689. doi: 10.1007/s10549-019-05322-9. Epub 2019 Jul 1.
In a screened population, breast cancer-specific mortality is lower for screen-detected versus symptom-detected breast cancers; however, it is unclear whether this association varies by follow-up time and/or tumor characteristics. To further understand the prognostic utility of mode of detection, we examined its association with breast cancer-specific mortality, overall and by follow-up time, estrogen receptor status, tumor size, and grade.
In the Cancer Prevention Study-II Nutrition Cohort, 3975 routinely screened women were diagnosed with invasive breast cancer (1992-2015). Among 2686 screen-detected and 1289 symptom-detected breast cancers, 206 and 209 breast cancer deaths, respectively, occurred up to 24 years post diagnosis. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from Cox proportional hazard regression models.
Controlling for prognostic factors, symptom detection was associated with higher risk of breast cancer-specific death up to 5 years after diagnosis (HR = 1.88, 95% CI 1.21-2.91) this association was attenuated in subsequent follow-up (HR = 1.26, 95% CI 0.98-1.63). Within tumor characteristic strata, there was a 1.3-2.7-fold higher risk of breast cancer death associated with symptom-detected cancers ≤ 5 years of follow-up, although associations were only significant for women with tumors < 2 cm (HR = 2.42, 95% CI 1.19-4.93) and for women with grade 1 or 2 tumors (HR = 2.72, 95% CI 1.33-5.57). In subsequent follow-up, associations were closer to the null.
Screen detection is a powerful prognostic factor for short-term survival. Among women who survived at least 5 years after breast cancer diagnosis, other clinical factors may be more predictive of breast cancer survival.
在筛查人群中，与症状检测相比，筛查检测发现的乳腺癌特异性死亡率较低；然而，尚不清楚这种关联是否随随访时间和/或肿瘤特征而变化。为了进一步了解检测方式的预后作用，我们检查了其与乳腺癌特异性死亡率的关系，包括总体情况以及随随访时间、雌激素受体状态、肿瘤大小和分级的变化。
在癌症预防研究-II 营养队列中，3975 名常规筛查女性被诊断患有浸润性乳腺癌（1992-2015 年）。在 2686 例筛查发现和 1289 例症状发现的乳腺癌中，分别有 206 例和 209 例乳腺癌死亡，随访时间最长达 24 年。使用 Cox 比例风险回归模型计算风险比（HR）和 95%置信区间（CI）。
在控制预后因素后，症状检测与诊断后 5 年内乳腺癌特异性死亡风险增加相关（HR=1.88，95%CI 1.21-2.91），这种关联在随后的随访中减弱（HR=1.26，95%CI 0.98-1.63）。在肿瘤特征分层中，与症状检测发现的≤5 年随访的乳腺癌相比，与症状检测发现的癌症相关的乳腺癌死亡风险高 1.3-2.7 倍，尽管这些关联仅在肿瘤<2cm（HR=2.42，95%CI 1.19-4.93）和肿瘤 1 级或 2 级的女性中具有统计学意义（HR=2.72，95%CI 1.33-5.57）。在随后的随访中，相关性更接近零。
筛查检测是短期生存的有力预后因素。在乳腺癌诊断后至少存活 5 年的女性中，其他临床因素可能更能预测乳腺癌的生存。
