Breast awareness

[Joan M]

From the May, NCI bulletin

Breast Cancers Arising between Mammograms Have Aggressive Features

Breast cancers that are discovered in the period between regular screening mammograms—known as interval cancers—are more likely to have features associated with aggressive behavior and a poor prognosis than cancers found via screening mammograms. These high-risk features include higher stage and grade, larger size, and lack of estrogen receptors (ER) and progesterone receptors (PR), researchers reported online May 3 in the Journal of the National Cancer Institute.

The results highlight the need for more sensitive screening methods and for women to monitor their breast health between mammograms, concluded Dr. Victoria Kirsh of Cancer Care Ontario and her colleagues.

The researchers compared the traits of breast cancers in women who had been screened in the Ontario Breast Screening Program between 1994 and 2002. The analysis included 87 women who had "missed" interval cancers, 288 women who had true interval cancers, and 450 women whose cancers were detected by screening mammography. Missed interval cancers were cancers that could have been detected by mammography but were overlooked due to error or difficulty in reading the x-ray films. True interval cancers were not detectible at the time of last screening, even on review.

Some clear differences between the tumors were found. Compared with screen-detected cancers, true interval cancers were almost four times as likely to be larger than 2 cm in diameter, more than four times as likely to be stage III or IV instead of stage I, more than three times as likely to be poorly differentiated (to have very abnormal-looking cells), about three times as likely to have a high proliferative rate (to be growing quickly), and about twice as likely to be estrogen receptor negative and progesterone receptor negative. Missed interval cancers were also more likely to be large, to be poorly differentiated, and to have invaded the lymph nodes than screen-detected cancers.

Women in the study were older than age 50 and predominantly white. It is not clear whether these results would be similar in younger women or in a more diverse population.

"A small number of cancers will not be detected by mammography," explained co-author Dr. Anna Chiarelli in an e-mail. This study, she continued, serves as a general reminder that "women should be 'breast aware' and see their health care provider if breast symptoms arise between mammograms."
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Joan

[KDR]

"Breast cancers that are discovered in the period between regular screening mammograms—known as interval cancers—are more likely to have features associated with aggressive behavior and a poor prognosis than cancers found via screening mammograms."

Hi, Joan
I'm not really sure what this means. Do you?
Does this information translate to discovering a cancer a few months after a "normal" mammogram?
Thanks,
Karen

[Jackie07]

They were just too polite to say it out-right that many films have been misread and the cancer wasn't found until it's palpable.

Who are the ones to ask for a mammagram/ultrasound in between regular scans? They have to be the women who have noticed something 'abnormal' with their breast.

I had three 'normal' mammagrams after my first bout of breast cancer in 2003. It wasn't until I had lost several jobs and feeling very tired/exhausted that I asked to see my breast surgeon (per a Weekend Clinic physician's advice) Because the surgeon paid special attention to it, even though the radiologist who read the film still dismissed the 'shadows' as 'scar tissue', we were able to catch the 2+ cm tumor when there were only two lymphnodes involved.

They are more aggressive because only the fast-growing ones would have been discovered before the next 'regular' mammagram. Because of the misconception of women being hypochondriacs, physicians simply 'goofed'. And none of them want to admit their fault/imperfection.

[Debbie L.]

This article is talking about (or perhaps around) several issues.

One, the main one, is that all breast cancer is not the same. The more aggressive (more life-threatening) breast cancers grow more quickly (we do not know exactly HOW quickly) and they are more likely to be metastatic (micro/occult or full-on) early in that process. These cancer are less likely to have their course changed by "early detection", whether by mammography, self exam or any other method. Being ultra-vigilant between mammography will probably not help defeat these cancers. They are out that darn barn door very early-on.

The slower a cancer grows, in general, the less is its threat to life, and the MORE likely that it will be detected via mammography. This fact, combined with the above one, skews all stats about mammography and any current early detection imaging, making mammography appear to offer more benefit than it does. THAT is what this article is pointing out. It's not about "missed" cancers on mammogram, it's about cancers that grow rapidly and thus behave differently from most mammographically-detected cancers.

Some cancers are so slow growing that they may never threaten life (and thus the person endures treatment and the associated risks but receives no benefit). Some cancers are so fast-growing that they will always threaten life -- they can not be detected "early" enough (with our current knowledge although perhaps Herceptin-susceptible cancers are excepted). It's the in-between cancers where early detection can make a difference, by initiating treatment in time to control and eradicate them. We know this, but we do not know how to tell reliably which cancers are which. We know more than they did 20 years ago, about which are which -- but still not enough to spare women treatment that doesn't benefit them nor to save women with the more aggressive cancers.

Lani or others, I wonder if anyone has looked at method of detection for HER2+ cancers? I would suspect that within this group, especially within the group of HER2+/ERPR- ones -- there is higher proportion of those interval-detected cancers.

This is not to say that mammographic interpretation never missed things. That happens. This is to say that if there is a way to prevent deaths from those very-aggressive cancers, it's not mammography and it's not self-exam. I hope we can find out what it is -- whether that involves new methods of detection or new methods of treatment.

Debbie Laxague

[Joan M]

The NCI's description of an interval cancer, a term I've never heard before, describes exactly what happened in my case.

I normally go for a mammogram every year. Yet in the year of my diagnosis, 16 months went by rather than 12. And I had a lump at 15 months, which I thought was just another cyst, because I used to get cysts fairly regularly.

By the time of my mastectomy, there were two tumors - an invasive tumor that was 2.6 cm and DCIS (all mixed together), and I had 7 positive lymph nodes. The tumor was ER-/PR- and HER2+. I was stage 2b.

I always felt that my tumors seemed to "suddenly" appear, even though it was 16 months between mammograms.

Karen, Yes. That's what I interpreted the story to mean.

Joan

[KDR]

I don't know if there's any truth to it, but I have heard from other survivors that sometimes the most aggressive cancers respond especially well to treatment.
Thanks, Joan, for your interpretation. Hope you are well. Was thinking of you today as I gardened.
Karen