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Breast Cancer Research and Treatment

, Volume 144, Issue 1, pp 103–111

First Online: 28 January 2014Received: 19 December 2013Accepted: 27 December 2013DOI: 10.1007-s10549-013-2830-5

Cite this article as: Drukker, C.A., Schmidt, M.K., Rutgers, E.J.T. et al. Breast Cancer Res Treat 2014 144: 103. doi:10.1007-s10549-013-2830-5


Overdiagnosis of breast cancer, i.e. the detection of slow-growing tumors that would never have caused symptoms or death, became more prevalent with the implementation of population-based screening. Only rough estimates have been made of the proportion of patients that are overdiagnosed and identification of those patients is difficult. Therefore, the aim of this study is to evaluate whether tumor biology can help identify patients with screen-detected tumors at such a low risk of recurrence that they are likely to be overdiagnosed. Furthermore, we wish to evaluate the impact of the transition from film-screen mammography FSM to the more sensitive full-field digital mammography FFDM on the biology of the tumors detected by each screening-modality. All Dutch breast cancer patients enrolled in the MINDACT trial EORTC-10041 accrued 2007–2011, who participated in the national screening program biennial screening ages 50–75 were included n = 1,165. We calculated the proportions of high-, low- and among those the ultralow-risk tumors according to the 70-gene signature for patients with screen-detected n = 775 and interval n = 390 cancers for FSM and FFDM. Screen-detected cancers had significantly more often a low-risk tumor biology 68 % of which 54 % even an ultralow-risk compared to interval cancers 53 % low-, of which 45 % ultralow-risk p = 0.001 with an OR of 2.33 p < 0.0001; 95 % CI 1.73–3.15. FFDM detected significantly more high-risk tumors 35 % compared to FSM 27 % p = 0.011. Aside from favorable clinico-pathological factors, screen-detected cancers were also more likely to have a biologically low-risk or even ultralow-risk tumor. Especially for patients with screen-detected cancers the use of tools, such as the 70-gene signature, to differentiate breast cancers by risk of recurrence may minimize overtreatment. The recent transition in screening-modalities led to an increase in the detection of biologically high-risk cancers using FFDM.

KeywordsBreast cancer Screening 70-Gene signature Film-screen mammography Full-field digital mammography Electronic supplementary materialThe online version of this article doi:10.1007-s10549-013-2830-5 contains supplementary material, which is available to authorized users.

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Author: C. A. Drukker - M. K. Schmidt - E. J. T. Rutgers - F. Cardoso - K. Kerlikowske - L. J. Esserman - F. E. van Leeuwen


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