Screen-detected breast cancer: does presence of minimal signs on prior mammograms predict staging or grading of cancer?

Abstract

Aim: To investigate whether the presence of minimal signs on prior mammograms predict staging or grading of cancer.

Materials and methods: The previous mammograms of 148 consecutive patients with screen-detected breast cancer were examined. Women with an abnormality visible (minimal signs) on both current and prior mammograms formed the study group; the remaining patients formed the control group. Age, average size of tumour, tumour characteristic, histopathology, grade, and lymph node status were compared between the two groups, using Fisher's exact test. Cases in which earlier diagnosis would have made a significant prognostic difference were also evaluated.

Results: Eighteen percent of patients showed an abnormality at the site of the tumour on previous mammograms. There was no statistically significant difference between the two groups with respect to age, average size of tumour, histopathology, grade or lymph node status with p-values being 0.609, 0.781, 0.938, and 0.444, respectively. The only statistically significant difference between the two groups was tumour characteristics with more microcalcifications associated with either mass or asymmetrical density seen in the study group (p=0.003). Five patients in the study group showed lymph node positivity and were grade 3, and therefore, may have had possible gain from earlier diagnosis.

Conclusion: The present study did not demonstrate a statistical difference in grading or staging between the group that showed "minimal signs" on prior mammograms versus normal prior mammograms. Microcalcification seems to be the most common characteristic seen in the missed cancer and a more aggressive management approach is suggested for breast microcalcifications.