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Breast

E64: Comparison of characteristics between asymptomatic/screen-detected breast cancer versus symptomatic breast cancer

Introduction: Breast cancer (BC) screening for women in Korea has increased leading to increased rate of early stage BC diagnosis. While little is known about the differences between screen-detected and symptomatic tumors, we aimed to investigate the clinic-pathological, biological differences.

Methods:

We retrospectively reviewed data of patients diagnosed between January 1, 1990 and December 31, 2021 from a single institute. We compared the clinic-pathological features of tumors and assessed yearly trends regarding the proportion of screen-detected cases during the study period. Also assessed the whether screen-detected versus symptomatic breast cancers differed in outcome.

Results:

We found that 36.1 % (15010/41585) of cancers were detected by screening. Asymptomatic tumors detected by screening were more likely to have favorable prognostic features than symptomatic tumors (Tis/T1 84.7% vs 58.1%; p< 0.001, node negative: 82.8% vs 64.2%; p< 0.001, hormone receptor-positive 70.3% vs 56.8%; p< 0.001, HER2 negative 68.5% vs 61.9%; p< 0.001 respectively). Patients initially presented with symptom were more likely to undergo neoadjuvant chemotherapy (18.7% vs 5.6%) All these findings were statistically significant (p< 0.001). Proportion of symptomatic BC diagnosis different throughout different age groups. While youngest (< 40yr) age group patients had greater proportion of symptomatic BC diagnosis (19.9% and 7.7%; p< 0.001). The proportion of BC detected by screening significantly increased throughout the time-period (~2000, 2001-2005, 2006-2010, 2011-2015, 2016-2021 with 2.8%, 6.0%, 18.2%, 28.4%, 44.5%). The most common symptom that led to the diagnosis of BC was palpable breast lump, accounting for 87.6%, followed by breast pain, and nipple discharge. The presence or absence of symptoms at the time of diagnosis acts as an independent risk factor for recurrence-free survival only in HR+ / HER2- subtype (HR 0.82, 95% CI 0.75–0.90).

Conclusions:

This study demonstrated the rate of screen-detected BC in Korea increased substantially since 1990s. Screen-detected tumors displayed low-risk phenotypes compared to symptomatic BC. The differences in biological characteristics between screen-detected and symptomatic BC may account in part for the limited efficacy of BC screening programs aimed at improving breast cancer mortality. Also, we need better strategies for BC diagnosis for younger age group.

Learning Objectives:

  • Upon completion, participant will be able to list the difference between symptomatic and asymptomatic breast cancer.
  • Upon completion, participant will be able to list early symptoms of breast cancer.
  • Upon completion, participant will be able to demonstrate changes in the rate of breast cancer screening over time.