2025-03-28 カロリンスカ研究所(KI)
<関連情報>
- https://news.ki.se/three-out-of-ten-breast-cancers-are-detected-between-screenings
- https://jamanetwork.com/journals/jamaoncology/article-abstract/2832064
間歇的乳癌とスクリーニング検出乳癌の発生率と危険因子 Incidence and Risk Factors of Interval and Screen-Detected Breast Cancer
Yuqi Zhang, PhD; Juan Rodriguez, PhD; Xinhe Mao, PhD; et al
JAMA Oncology Published:March 27, 2025
DOI:10.1001/jamaoncol.2025.0167
Key Points
Question What factors are associated with incidence of interval breast cancer (IntCa) among women attending screening?
Findings In this population-based cohort of 527 144 women, incidence of IntCa increased, with 30% of screened patients with breast cancer receiving a diagnosis of IntCa. Factors associated with increased risk of IntCa included family history of breast cancer (especially IntCa), hereditary breast and ovarian cancers, colorectal, and testicular cancers as well as having dense breasts, hormone replacement therapy, older age at first childbirth, and higher education level.
Meaning The findings of this study identify women at increased risk of IntCa and may be used to individualize future breast cancer screening programs.
Abstract
Importance Mammographic screening is the only proven method for early detection and mortality reduction of breast cancer (BC). However, many patients are missed at prior screening; thus, they receive their diagnosis between the interval of screening rounds, called interval cancer (IntCa). Some IntCas are fast growing between screening rounds.
Objective To investigate the incidence and proportion of IntCa and screen-detected breast cancer (ScrCa) and identify factors associated with IntCa.
Design, Setting, and Participants This population-based cohort study was conducted from January 1989 to March 2020, with follow-up until 2020 and a mean (SD) follow-up of 13 (8.3) years. The statistical analysis was performed from February 2023 to June 2024. It included cancer-free women (N = 527 144) residing in Stockholm, Sweden, who were invited to undergo mammography screening (aged 40-74 years) during 1989 to 2020. An additional cohort of women were included who were participating in the Karolinska Mammography Project for Risk Prediction of Breast Cancer study and had mammography data available.
Exposures Family cancer history (defined from the Swedish Multi-Generation Register and Cancer Register), mammographic density, and various demographic, reproductive, and other factors (multiple Swedish registers).
Main Outcomes and Measures Incidence of ScrCa and IntCa (defined from the Swedish Cancer Register in conjunction with individual screening histories).
Results A total of 29 049 women (5.5%) received a diagnosis of BC, of whom 10 631 (2.0%) had ScrCa and 4369 (0.8%) IntCa. ScrCa and IntCa incidences increased during the period. The proportion of IntCa among screened patients with BC was around 30%, which decreased with older age. Factors associated with increased risk of IntCa included older age at first childbirth, higher education level, hormone replacement therapy, and higher mammographic density. Risk estimates of family cancer history on IntCa were family history of BC (hazard ratio [HR], 1.85; 95% CI, 1.72-1.99), family history of IntCa (HR, 2.92; 95% CI, 2.39-3.55), and hereditary breast and ovarian cancers (HR, 1.45; 95% CI, 1.36-1.54), with risk further elevated with the number of relatives who received a diagnosis when younger than the median age. Women with IntCa were more likely to have estrogen receptor (ER)–negative cancers than women with ScrCa (22% vs 11%), and having family history of ER-negative BC was associated with 3-fold risk for ER-negative IntCa.
Conclusions and Relevance The results of this cohort study suggest that IntCa rates have not decreased with age-based screening, and implementing risk-based screening considering IntCa-specific risk factors is necessary for improving outcomes.
