Cabioğlu Neslihan, Gürdal Sibel Özkan, Kayhan Arda, Özaydın Nilüfer, Şahin Cennet, Can Ömür, Özçınar Beyza, Aykuter Gönül, Vatandaş Gülçin, Aribal Erkin, Özmen Vahit
Department of Surgery, Istanbul University, Istanbul Medical Faculty, Istanbul, Turkey.
Department of Surgery, Namık Kemal University, Faculty of Medicine, Tekirdag, Turkey.
JCO Glob Oncol. 2020 Jul;6:1103-1113. doi: 10.1200/GO.20.00145.
The Turkish Bahçeşehir Breast Cancer Screening Project was a 10-year, organized, population-based screening program carried out in Bahçeşehir county, Istanbul. Our aim was to examine the biologic features and outcome of screen-detected and interval breast cancers during the 10-year study period.
Between 2009 and 2019, 2-view mammograms were obtained at 2-year intervals for women aged 40 to 69 years. Clinicopathological characteristics including ER, PR, HER2-neu, and Ki-67 status were analyzed for those diagnosed with breast cancer.
In 8,758 screened women, 131 breast cancers (1.5%) were detected. The majority of patients (82.3%) had prognostic stage 0-I disease. Contrarily, patients with interval cancers (n = 15; 11.4%) were more likely to have a worse prognostic stage (II-IV disease; odds ratio [OR], 3.59, 95% CI, 0.9 to 14.5) and high Ki-67 scores (OR, 3.14; 95% CI, 0.9 to 11.2). Interval cancers detected within 1 year were more likely to have a luminal B (57.1% 31.9%) and triple-negative (14.3% 1%) subtype and less likely to have a luminal A subtype (28.6% 61.5%; = .04). Patients with interval cancers had a poor outcome in 10-year disease-specific (DSS) and disease-free survival (DFS) compared with those with screen-detected cancers (DSS: 68.2% 98.1%, = .002; DFS: 78.6% 96.5%, = .011).
Our findings suggest the majority of screen-detected breast cancers exhibited a luminal A subtype profile with an excellent prognosis. However, interval cancers were more likely to have aggressive subtypes such as luminal B subtype or triple-negative cancers associated with a poor prognosis requiring other preventive strategies.
土耳其巴赫切希尔乳腺癌筛查项目是一项为期10年、有组织的、基于人群的筛查计划，在伊斯坦布尔的巴赫切希尔县开展。我们的目的是在10年的研究期间，研究筛查发现的乳腺癌和间期乳腺癌的生物学特征及转归。
2009年至2019年期间，每2年为40至69岁的女性进行一次双视图乳房X光检查。对诊断为乳腺癌的患者分析其临床病理特征，包括雌激素受体（ER）、孕激素受体（PR）、人表皮生长因子受体2（HER2-neu）和Ki-67状态。
在8758名接受筛查的女性中，检测出131例乳腺癌（1.5%）。大多数患者（82.3%）处于预后较好的0-I期疾病。相反，间期癌患者（n = 15；11.4%）更有可能处于预后较差的阶段（II-IV期疾病；比值比[OR]，3.59，95%置信区间[CI]，0.9至14.5）且Ki-67评分较高（OR，3.14；95% CI，0.9至11.2）。1年内检测出的间期癌更有可能为腔面B型（57.1%对31.9%）和三阴性（14.3%对1%）亚型，而腔面A型亚型的可能性较小（28.6%对61.5%；P = 0.04）。与筛查发现的癌症患者相比，间期癌患者在10年疾病特异性生存率（DSS）和无病生存率（DFS）方面预后较差（DSS：68.2%对98.1%，P = 0.002；DFS：78.6%对96.5%，P = 0.011）。
我们的研究结果表明，大多数筛查发现的乳腺癌表现为腔面A型亚型，预后良好。然而，间期癌更有可能具有侵袭性亚型，如腔面B型亚型或三阴性癌，预后较差，需要其他预防策略。
