Detection methods predict differences in biology and survival in breast cancer patients
1 Research Unit, Hospital Costa del Sol, University of Málaga, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Carretera de Cádiz Km 187, 29600, Marbella, Málaga, Spain
2 Department of Pathology, Hospital Costa del Sol, 29600, Marbella, Málaga, Spain
3 Department of Surgery, Hospital Costa del Sol, 29600, Marbella, Málaga, Spain
4 Department of Radiology, Hospital Clinico Universitario Virgen de la Victoria, Campus Universitario Teatinos, 29010, Málaga, Spain
5 Department of Radiology, Hospital Costa del Sol, 29600, Marbella, Málaga, Spain
6 Epidemiology and Evaluation Department. IMIM Hospital del Mar, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC). Parc de Salut Mar, Universitat Autònoma de Barcelona, Catalonia, Spain
7 Unit of Public Health and Environmental Care, Department of Preventive Medicine, CIBER ESP, University of Valencia, Valencia, Spain
8 Department of Medical Oncology, Hospital Costa del Sol, Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), 29600, Marbella, Málaga, Spain
BMC Cancer 2012, 12:604 doi:10.1186/1471-2407-12-604Published: 17 December 2012
The aim of this study was to measure the biological characteristics involved in tumorigenesis and the progression of breast cancer in symptomatic and screen-detected carcinomas to identify possible differences.
For this purpose, we evaluated clinical-pathological parameters and proliferative and apoptotic activities in a series of 130 symptomatic and 161 screen-detected tumors.
After adjustment for the smaller size of the screen-detected carcinomas compared with symptomatic cancers, those detected in the screening program presented longer disease-free survival (RR = 0.43, CI = 0.19-0.96) and had high estrogen and progesterone receptor concentrations more often than did symptomatic cancers (OR = 3.38, CI = 1.72-6.63 and OR = 3.44, CI = 1.94-6.10, respectively). Furthermore, the expression of bcl-2, a marker of good prognosis in breast cancer, was higher and HER2/neu expression was lower in screen-detected cancers than in symptomatic cancers (OR = 1.77, CI = 1.01-3.23 and OR = 0.64, CI = 0.40-0.98, respectively). However, when comparing prevalent vs incident screen-detected carcinomas, prevalent tumors were larger (OR = 2.84, CI = 1.05-7.69), were less likely to be HER2/neu positive (OR = 0.22, CI = 0.08-0.61) and presented lower Ki67 expression (OR = 0.36, CI = 0.17-0.77). In addition, incident tumors presented a shorter survival time than did prevalent ones (RR = 4.88, CI = 1.12-21.19).
Incident carcinomas include a variety of screen-detected carcinomas that exhibit differences in biology and prognosis relative to prevalent carcinomas. The detection method is important and should be taken into account when making therapy decisions.