Association of symptoms and breast cancer in population-based mammography screening in Finland

作者：Singh Deependra^*; Malila Nea; Pokhrel Arun; Anttila Ahti

来源：International Journal of Cancer, 2015, 136(6): E630-E637.

DOI：10.1002/ijc.29170

• breast cancer symptoms
• screening
• clinical breast examination
• lump
• scar

The study purpose was to assess association of symptoms at screening visits with detection of breast cancer among women aged 50-69 years during the period 2006-2010. Altogether 1.2 million screening visits were made and symptoms (lump, retraction, secretion etc.) were reported either by women or radiographer. Breast cancer risk was calculated for each symptom separately using logistic regression [odds ratio (OR)] and 95% confidence intervals (CIs). Of the 1,198,410 screening visits symptoms were reported in 298,220 (25%) visits. Breast cancer detection rate for women with and without symptoms was 7.8 per 1,000 and 4.7 per 1,000 screening visits, respectively, whereas lump detected 32 cancers per 1,000 screens. Women with lump or retraction had an increased risk of breast cancer, OR=6.47, 95% CI 5.89-7.09 and OR=2.19, 95% CI 1.92-2.49, respectively. The sensitivity of symptoms in detecting breast carcinoma was 35.5% overall. Individual symptoms sensitivity and specificity ranged from, 0.66 to 14.8% and 87.4 to 99.7%, respectively. Of 5,541 invasive breast cancers, 1,993 (36%) reported symptoms at screen. Breast cancer risk among women with lump or retraction was higher in large size tumors (OR=9.20, 95% CI 8.08-10.5) with poorly differentiated grades (OR=5.91, 95% CI 5.03-6.94) and regional lymph nodes involvement (OR=6.47, 95% CI 5.67-7.38). This study was done in a setting where breast tumors size is generally small, and symptoms sensitivity and specificity in diagnosing breast tumors were limited. Importance of breast cancer symptoms in the cancer prevention and control strategy needs to be evaluated also in other settings.
What's New? A key component of breast cancer screening programs is the collection of data on symptoms at the time of screening visit. In many cases, however, the data are not subsequently analyzed for relationships between symptoms and breast cancer diagnosis. Based on analysis of data from 1.2 million screening visits recorded in the Finnish Cancer Registry, the present report describes a significant association between breast cancer risk and symptoms either self-reported by patients or detected by radiographers. Risk was highest for breast lumps reported at screening. Importantly, the findings also highlight limitations regarding the clinical significance of symptoms.

• 出版日期2015-3-15