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5 September 2008
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Prognostic factors linked to large breast tumors identified
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MedWire News: Overweight breast cancer patients with high-grade tumors that are detected symptomatically are more likely to present with advanced stage disease than patients with other characteristics, an Australian study has found.
The researchers urge greater participation in screening programmes and also emphasize the benefits of "maintaining a healthy weight throughout adult life - in this case to improve prospects of avoiding diagnosis with a large breast cancer."
Despite the introduction of mammographic screening in Australia in 1991, women continue to present with advanced breast cancers, as elsewhere, Anne Kricker (University of Sydney, New South Wales) and colleagues note.
While only 25% of cancers detected in 1997 by the national screening program, BreastScreen Australia, were 2 cm in diameter or larger, they account for a high proportion (41%) of all breast cancers diagnosed in the population.
"Given the capacity for screening to detect cancers when they are small and before they progress, we asked why so many breast cancers in Australia are not diagnosed and treated definitively until they are 2 cm or larger," Kricker et al comment, adding: "In principle, the answer lies in 3 broad areas: the health system, the woman herself and the cancer."
The researchers identified 1459 women, aged 22-69 years, diagnosed with breast cancer between March 2002 and December 2003 in the population-based cancer registries in the Australian States of Victoria, New South Wales, and Queensland.
In all, 35% of breast cancers were detected by a routine mammogram, with the remaining 65% being diagnosed after a clinical examination following a breast symptom. The likelihood of women being diagnosed with a tumor ≥2 cm in diameter were significantly reduced if that tumor was detected by mammogram rather than symptomatically (odds ratio[OR]=0.27).
Most women (82%) reported at least one mammogram up to 4.5 years before diagnosis and 57% had one up to 2 years before, excluding diagnosis mammograms.
Compared with patients with low-grade cancer, those with moderate-grade disease had an increased risk for being diagnosed with a ≥2 cm tumor (OR=2.00), as did those with high-grade cancers (OR=3.67).
Relative to patients with a healthy body mass index (BMI) of ≤25 kg/m2, those who were overweight (BMI=25-29 kg/m2) or obese (BMI≥30 kg/m2) were more likely to present with a tumor ≥2 cm in diameter.
The population attributable fractions (PAF) for a ≥2 cm cancer was 42% for detection by clinical examination, 29% for having a moderate- or high-grade cancer, 11% for having a BMI ≥25 kg/m2, and 4% for lack of regular mammograms in the past 4.5 years.
They explain: "Each PAF can be interpreted as the proportion of ≥2 cm breast cancers that would be eliminated if the level of exposure to the relevant risk factor in the whole study population was shifted from the high- to the low-risk level."
Discussing their findings in the International Journal of Cancer, Kricker et al comment: "Although women need to be aware of the potential harms of screening, our study suggests that greater participation could help some women avoid diagnosis with a large breast cancer."
Int J Cancer 2008; Advance online publication
http://www3.interscience.wiley.com/journal/29331/home
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