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Why do large breast cancers still present in a population offered screening?

Kricker, Anne , Newman, Beth M., Gertig, Dorota M. , Goumas, Chris , Armes, Jane , & Armstrong, Bruce K. (2008) Why do large breast cancers still present in a population offered screening? International Journal of Cancer, 123(12), pp. 2907-2914.

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Abstract

Rates of large breast cancers should decrease in a population that is offered mammography screening, but women continue to present with them. We sought an explanation in a population-based epidemiological study of 1,459 women diagnosed with invasive breast cancer in 2002-2003 in Australia; breast cancers were 2 cm in 766 women (53%) and 11-1.9 cm in a comparison group (693, 47%). We interviewed the women about their personal, mammogram and breast histories in the years before diagnosis and collected biological characteristics of tumors and mammogram dates from medical records. The strongest correlate of breast cancer size at diagnosis was the method of detection: the odds of a 2 cm breast cancer was substantially lower for detection by a screening mammogram (OR = 0.27, 95% CI 0.21-0.34; p < 0.001) than for detection after a breast symptom. Higher BMI (ORs 1.6 for 25 kg/m2), higher cancer grade (ORs of 1.6 for moderate, 2.89 for high grade) and lobular type (OR 2.09, 95% CI 1.45-3.0) were also independent correlates (p < 0.001) of a 2 cm breast cancer. HRT use strongly reduced the odds but only in cancers detected after a breast symptom (OR = 0.49, 95% CI 0.33-0.74; p = 0.002), not in those detected by a screening mammogram. As assessed from their proportional contribution to 2 cm breast cancers in our study population, lack of mammogram detection, BMI 25 kg/m2 and moderate or high grade of the cancer were the most important factors with population attributable fractions of 42%, 11% and 29% respectively; the first 2 are amenable to intervention.

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7 citations in Web of Science®

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ID Code: 18558
Item Type: Journal Article
Additional URLs:
Keywords: Advanced breast cancer, Mammogram detection, BMI, HRT, Cancer grade
DOI: 10.1002/ijc.23829
ISSN: 0020-7136
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > PUBLIC HEALTH AND HEALTH SERVICES (111700) > Epidemiology (111706)
Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > ONCOLOGY AND CARCINOGENESIS (111200) > Cancer Diagnosis (111202)
Australian and New Zealand Standard Research Classification > STUDIES IN CREATIVE ARTS AND WRITING (190000) > FILM TELEVISION AND DIGITAL MEDIA (190200) > Electronic Media Art (190203)
Divisions: Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Current > Schools > School of Public Health & Social Work
Deposited On: 05 May 2009 14:50
Last Modified: 29 Feb 2012 23:49

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