Clinical Study

BJC Open article

British Journal of Cancer (2008) 98, 1741–1744. doi:10.1038/sj.bjc.6604368 www.bjcancer.com
Published online 27 May 2008

Screen-detected vs symptomatic breast cancer: is improved survival due to stage migration alone?

G C Wishart1, D C Greenberg2, P D Britton1, P Chou3, C H Brown2, A D Purushotham4 and S W Duffy3

  1. 1Cambridge Breast Unit, Box 97, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK
  2. 2Eastern Cancer Registration and Information Centre (ECRIC) Unit C, Magog Court, Shelford Bottom, Hinton Way, Cambridge CB22 3AD, UK
  3. 3Cancer Research UK Centre for Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
  4. 4King's College London, Department of Academic Oncology, Guy's Hospital, Guy's and St Thomas’ NHS Foundation Trust, 3rd Floor, Thomas Guy House, St Thomas Street, London SE1 9RT, UK

Correspondence: GC Wishart, E-mail: gordon.wishart@addenbrookes.nhs.uk

Received 7 January 2008; Revised 25 March 2008; Accepted 28 March 2008

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Abstract

This paper examines whether screen-detected breast cancer confers additional prognostic benefit to the patient, over and above that expected by any shift in stage at presentation. In all, 5604 women (aged 50–70 years) diagnosed with invasive breast cancer between 1998 and 2003 were identified by the Eastern Cancer Registration and Information Centre (ECRIC) and mammographic screening status was determined. Using proportional hazards regression, we estimated the effect of screen detection compared with symptomatic diagnosis on 5-year survival unadjusted, then adjusted for age and Nottingham Prognostic Index (NPI). A total of 72% of the survival benefit associated with screen-detected breast cancer can be accounted for by age and shift in NPI. Survival analysis by continuous NPI showed a small but systematic survival benefit for screen-detected cancers at each NPI value. These data show that although most of the screen-detected survival advantage is due to a shift in NPI, the mode of detection does impact on survival in patients with equivalent NPI scores. This residual survival benefit is small but significant, and is likely to be due to differences in tumour biology. Current prognostication tools may, therefore, overestimate the benefit of systemic treatments in screen-detected cancers and lead to overtreatment of these patients.

Keywords:

breast cancer; breast screening; survival

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