Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II

Samantha Puvanesarajah, Susan M. Gapstur, Alpa V. Patel, Mark E. Sherman, W. Dana Flanders, Ted Gansler, Melissa A. Troester, Mia M. Gaudet

Research output: Contribution to journalArticle

Abstract

Purpose: 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. Methods: 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. Results: Controlling for prognostic factors, symptom detection was associated with higher risk of breast cancer-specific death up to 5 years after diagnosis (HR≤5years = 1.88, 95% CI 1.21–2.91) this association was attenuated in subsequent follow-up (HR>5years = 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≤5years = 2.42, 95% CI 1.19–4.93) and for women with grade 1 or 2 tumors (HR≤5years = 2.72, 95% CI 1.33–5.57). In subsequent follow-up, associations were closer to the null. Conclusions: 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.

Original languageEnglish (US)
JournalBreast Cancer Research and Treatment
DOIs
StatePublished - Jan 1 2019

Fingerprint

Breast Neoplasms
Mortality
Neoplasms
Confidence Intervals
Survival
Proportional Hazards Models
Estrogen Receptors
Population

Keywords

  • Breast
  • Breast neoplasms/mortality
  • Epidemiology
  • Mammography
  • Survival analysis

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II. / Puvanesarajah, Samantha; Gapstur, Susan M.; Patel, Alpa V.; Sherman, Mark E.; Flanders, W. Dana; Gansler, Ted; Troester, Melissa A.; Gaudet, Mia M.

In: Breast Cancer Research and Treatment, 01.01.2019.

Research output: Contribution to journalArticle

Puvanesarajah, Samantha ; Gapstur, Susan M. ; Patel, Alpa V. ; Sherman, Mark E. ; Flanders, W. Dana ; Gansler, Ted ; Troester, Melissa A. ; Gaudet, Mia M. / Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II. In: Breast Cancer Research and Treatment. 2019.
@article{ebca3c722b9449829495b260a7ccb091,
title = "Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II",
abstract = "Purpose: 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. Methods: 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. Results: Controlling for prognostic factors, symptom detection was associated with higher risk of breast cancer-specific death up to 5 years after diagnosis (HR≤5years = 1.88, 95{\%} CI 1.21–2.91) this association was attenuated in subsequent follow-up (HR>5years = 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≤5years = 2.42, 95{\%} CI 1.19–4.93) and for women with grade 1 or 2 tumors (HR≤5years = 2.72, 95{\%} CI 1.33–5.57). In subsequent follow-up, associations were closer to the null. Conclusions: 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.",
keywords = "Breast, Breast neoplasms/mortality, Epidemiology, Mammography, Survival analysis",
author = "Samantha Puvanesarajah and Gapstur, {Susan M.} and Patel, {Alpa V.} and Sherman, {Mark E.} and Flanders, {W. Dana} and Ted Gansler and Troester, {Melissa A.} and Gaudet, {Mia M.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10549-019-05322-9",
language = "English (US)",
journal = "Breast Cancer Research and Treatment",
issn = "0167-6806",
publisher = "Springer New York",

}

TY - JOUR

T1 - Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II

AU - Puvanesarajah, Samantha

AU - Gapstur, Susan M.

AU - Patel, Alpa V.

AU - Sherman, Mark E.

AU - Flanders, W. Dana

AU - Gansler, Ted

AU - Troester, Melissa A.

AU - Gaudet, Mia M.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Purpose: 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. Methods: 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. Results: Controlling for prognostic factors, symptom detection was associated with higher risk of breast cancer-specific death up to 5 years after diagnosis (HR≤5years = 1.88, 95% CI 1.21–2.91) this association was attenuated in subsequent follow-up (HR>5years = 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≤5years = 2.42, 95% CI 1.19–4.93) and for women with grade 1 or 2 tumors (HR≤5years = 2.72, 95% CI 1.33–5.57). In subsequent follow-up, associations were closer to the null. Conclusions: 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.

AB - Purpose: 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. Methods: 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. Results: Controlling for prognostic factors, symptom detection was associated with higher risk of breast cancer-specific death up to 5 years after diagnosis (HR≤5years = 1.88, 95% CI 1.21–2.91) this association was attenuated in subsequent follow-up (HR>5years = 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≤5years = 2.42, 95% CI 1.19–4.93) and for women with grade 1 or 2 tumors (HR≤5years = 2.72, 95% CI 1.33–5.57). In subsequent follow-up, associations were closer to the null. Conclusions: 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.

KW - Breast

KW - Breast neoplasms/mortality

KW - Epidemiology

KW - Mammography

KW - Survival analysis

UR - http://www.scopus.com/inward/record.url?scp=85068799213&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85068799213&partnerID=8YFLogxK

U2 - 10.1007/s10549-019-05322-9

DO - 10.1007/s10549-019-05322-9

M3 - Article

C2 - 31264062

AN - SCOPUS:85068799213

JO - Breast Cancer Research and Treatment

JF - Breast Cancer Research and Treatment

SN - 0167-6806

ER -