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KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Definitions
Breast cancers detected due to clinical findings during interval between recommended screenings
Screening interval varies; range: 12-36 months
American College of Radiology (ACR) and American Cancer Society (ACS) recommend every year
Dutch, Scandinavian, Canadian, Australian, and New Zealand screening programs recommend every 2 years
Invitation to screen in Sweden every 18-24 months
UK NHS National Breast Screening Programme recommends every 3 years
Longer interval between screenings → higher rate of interval cancers
USA performs 2-view (MLO and CC) mammography; variable use of CC views in other programs
± suspicious finding on retrospective review of prior screening or recall study
"Missed cancer" if visible in retrospect at site of cancer and considered suspicious
Many such findings below threshold even in retrospect: Benign-appearing, similar to normal tissue
Many cancers occult on prior screening examination(s) even in retrospect = "true interval cancer"
Sometimes attributable to inferior quality of prior study
Suboptimal positioning, motion, other artifacts
Should not include cancers detected at early subsequent screening (e.g., 11 months in USA) or prophylactic mastectomy, though these are among false-negatives
Interval cancers can be mammographically occult, below threshold or missed on prior mammography, or new mammographic finding
Screening mammogram: Testing to detect cancer in women with no signs or symptoms of breast cancer
Diagnostic mammogram: Examination performed with monitoring by on-site radiologist
Typically includes US at time of examination, if indicated
Indications for diagnostic mammography
Symptomatic patient: Lump, nipple discharge or retraction, change in breast size or shape, skin thickening, focal pain, etc.
Recall from screening for additional imaging following perception of abnormality
Short-interval follow-up of findings deemed probably benign on prior work-up
Screen-detected cancers: Regular interval mammographic examination reveals breast cancer, and patient is asymptomatic with respect to breasts
Billing may be diagnostic but audited as screening
Prior biopsy for other benign lesions
Routine annual mammography in women with history of lumpectomy and radiation for breast cancer
Women with implants
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Kerlikowske K et al: Automated and clinical breast imaging reporting and data system density measures predict risk for screen-detected and interval cancers: a case-control study. Ann Intern Med. 168(11):757-765, 2018
Lee JM et al: Cumulative risk distribution for interval invasive second breast cancers after negative surveillance mammography. J Clin Oncol. 36(20):2070-2077, 2018
McCarthy AM et al: Breast cancer with a poor prognosis diagnosed after screening mammography with negative results. JAMA Oncol. 4(7):998-1001, 2018
Vreemann S et al: The frequency of missed breast cancers in women participating in a high-risk MRI screening program. Breast Cancer Res Treat. ePub, 2018
Destounis S et al: Using volumetric breast density to quantify the potential masking risk of mammographic density. AJR Am J Roentgenol. 208(1):222-227, 2017
Houssami N et al: The epidemiology, radiology and biological characteristics of interval breast cancers in population mammography screening. NPJ Breast Cancer. 3:12, 2017
Lekanidi K et al: Breast screening: what can the interval cancer review teach us? Are we perhaps being a bit too hard on ourselves? Eur J Radiol. 94:13-15, 2017
Wanders JOP et al: The effect of volumetric breast density on the risk of screen-detected and interval breast cancers: a cohort study. Breast Cancer Res. 19(1):67, 2017
McDonald ES et al: Effectiveness of digital breast tomosynthesis compared with digital mammography: outcomes analysis from 3 years of breast cancer screening. JAMA Oncol. 2(6):737-43, 2016
Holm J et al: Risk factors and tumor characteristics of interval cancers by mammographic density. J Clin Oncol. 33(9):1030-7, 2015
Song SE et al: Undiagnosed breast cancer: features at supplemental screening US. Radiology. 277(2):372-80, 2015
Houssami N et al: Risk factors for second screen-detected or interval breast cancers in women with a personal history of breast cancer participating in mammography screening. Cancer Epidemiol Biomarkers Prev. 22(5):946-61, 2013
Berg WA et al: Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 307(13):1394-404, 2012
Heijnsdijk EA et al: Differences in natural history between breast cancers in BRCA1 and BRCA2 mutation carriers and effects of MRI screening-MRISC, MARIBS, and Canadian studies combined. Cancer Epidemiol Biomarkers Prev. 21(9):1458-68, 2012
Corsetti V et al: Evidence of the effect of adjunct ultrasound screening in women with mammography-negative dense breasts: interval breast cancers at 1 year follow-up. Eur J Cancer. 47(7):1021-6, 2011
Kirsh VA et al: Tumor characteristics associated with mammographic detection of breast cancer in the Ontario breast screening program. J Natl Cancer Inst. 103(12):942-50, 2011
Haakinson DJ et al: A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J Surg. 200(6):712-7; discussion 717-8, 2010
Boyd NF et al: Mammographic density and the risk and detection of breast cancer. N Engl J Med. 356(3):227-36, 2007
Kerlikowske K et al: Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst. 99(5):386-95, 2007
Shen Y et al: Role of detection method in predicting breast cancer survival: analysis of randomized screening trials. J Natl Cancer Inst. 97(16):1195-203, 2005
Buist DS et al: Factors contributing to mammography failure in women aged 40-49 years. J Natl Cancer Inst. 96(19):1432-40, 2004
Anttinen J et al: Her-2/neu oncogene amplification and protein over-expression in interval and screen-detected breast cancers. Anticancer Res. 23(5b):4213-8, 2003
Ikeda DM et al: Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening. Radiology. 226(2):494-503, 2003
Wang SC: The Singapore National Breast Screening Programme: principles and implementation. Ann Acad Med Singapore. 32(4):466-76, 2003
Warren RM et al: Radiology review of the UKCCCR Breast Screening Frequency Trial: potential improvements in sensitivity and lead time of radiological signs. Clin Radiol. 58(2):128-32, 2003
Gilliland FD et al: Biologic characteristics of interval and screen-detected breast cancers. J Natl Cancer Inst. 92(9):743-9, 2000
Mandelson MT et al: Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst. 92(13):1081-7, 2000
Porter PL et al: Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst. 91(23):2020-8, 1999
Burrell HC et al: Screening interval breast cancers: mammographic features and prognosis factors. Radiology. 199(3):811-7, 1996
Related Anatomy
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
TERMINOLOGY
Definitions
Breast cancers detected due to clinical findings during interval between recommended screenings
Screening interval varies; range: 12-36 months
American College of Radiology (ACR) and American Cancer Society (ACS) recommend every year
Dutch, Scandinavian, Canadian, Australian, and New Zealand screening programs recommend every 2 years
Invitation to screen in Sweden every 18-24 months
UK NHS National Breast Screening Programme recommends every 3 years
Longer interval between screenings → higher rate of interval cancers
USA performs 2-view (MLO and CC) mammography; variable use of CC views in other programs
± suspicious finding on retrospective review of prior screening or recall study
"Missed cancer" if visible in retrospect at site of cancer and considered suspicious
Many such findings below threshold even in retrospect: Benign-appearing, similar to normal tissue
Many cancers occult on prior screening examination(s) even in retrospect = "true interval cancer"
Sometimes attributable to inferior quality of prior study
Suboptimal positioning, motion, other artifacts
Should not include cancers detected at early subsequent screening (e.g., 11 months in USA) or prophylactic mastectomy, though these are among false-negatives
Interval cancers can be mammographically occult, below threshold or missed on prior mammography, or new mammographic finding
Screening mammogram: Testing to detect cancer in women with no signs or symptoms of breast cancer
Diagnostic mammogram: Examination performed with monitoring by on-site radiologist
Typically includes US at time of examination, if indicated
Indications for diagnostic mammography
Symptomatic patient: Lump, nipple discharge or retraction, change in breast size or shape, skin thickening, focal pain, etc.
Recall from screening for additional imaging following perception of abnormality
Short-interval follow-up of findings deemed probably benign on prior work-up
Screen-detected cancers: Regular interval mammographic examination reveals breast cancer, and patient is asymptomatic with respect to breasts
Billing may be diagnostic but audited as screening
Prior biopsy for other benign lesions
Routine annual mammography in women with history of lumpectomy and radiation for breast cancer
Women with implants
IMAGING
General Features
Mammographic Findings
Ultrasonographic Findings
MR Findings
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
Kerlikowske K et al: Automated and clinical breast imaging reporting and data system density measures predict risk for screen-detected and interval cancers: a case-control study. Ann Intern Med. 168(11):757-765, 2018
Lee JM et al: Cumulative risk distribution for interval invasive second breast cancers after negative surveillance mammography. J Clin Oncol. 36(20):2070-2077, 2018
McCarthy AM et al: Breast cancer with a poor prognosis diagnosed after screening mammography with negative results. JAMA Oncol. 4(7):998-1001, 2018
Vreemann S et al: The frequency of missed breast cancers in women participating in a high-risk MRI screening program. Breast Cancer Res Treat. ePub, 2018
Destounis S et al: Using volumetric breast density to quantify the potential masking risk of mammographic density. AJR Am J Roentgenol. 208(1):222-227, 2017
Houssami N et al: The epidemiology, radiology and biological characteristics of interval breast cancers in population mammography screening. NPJ Breast Cancer. 3:12, 2017
Lekanidi K et al: Breast screening: what can the interval cancer review teach us? Are we perhaps being a bit too hard on ourselves? Eur J Radiol. 94:13-15, 2017
Wanders JOP et al: The effect of volumetric breast density on the risk of screen-detected and interval breast cancers: a cohort study. Breast Cancer Res. 19(1):67, 2017
McDonald ES et al: Effectiveness of digital breast tomosynthesis compared with digital mammography: outcomes analysis from 3 years of breast cancer screening. JAMA Oncol. 2(6):737-43, 2016
Holm J et al: Risk factors and tumor characteristics of interval cancers by mammographic density. J Clin Oncol. 33(9):1030-7, 2015
Song SE et al: Undiagnosed breast cancer: features at supplemental screening US. Radiology. 277(2):372-80, 2015
Houssami N et al: Risk factors for second screen-detected or interval breast cancers in women with a personal history of breast cancer participating in mammography screening. Cancer Epidemiol Biomarkers Prev. 22(5):946-61, 2013
Berg WA et al: Detection of breast cancer with addition of annual screening ultrasound or a single screening MRI to mammography in women with elevated breast cancer risk. JAMA. 307(13):1394-404, 2012
Heijnsdijk EA et al: Differences in natural history between breast cancers in BRCA1 and BRCA2 mutation carriers and effects of MRI screening-MRISC, MARIBS, and Canadian studies combined. Cancer Epidemiol Biomarkers Prev. 21(9):1458-68, 2012
Corsetti V et al: Evidence of the effect of adjunct ultrasound screening in women with mammography-negative dense breasts: interval breast cancers at 1 year follow-up. Eur J Cancer. 47(7):1021-6, 2011
Kirsh VA et al: Tumor characteristics associated with mammographic detection of breast cancer in the Ontario breast screening program. J Natl Cancer Inst. 103(12):942-50, 2011
Haakinson DJ et al: A significant number of women present with palpable breast cancer even with a normal mammogram within 1 year. Am J Surg. 200(6):712-7; discussion 717-8, 2010
Boyd NF et al: Mammographic density and the risk and detection of breast cancer. N Engl J Med. 356(3):227-36, 2007
Kerlikowske K et al: Longitudinal measurement of clinical mammographic breast density to improve estimation of breast cancer risk. J Natl Cancer Inst. 99(5):386-95, 2007
Shen Y et al: Role of detection method in predicting breast cancer survival: analysis of randomized screening trials. J Natl Cancer Inst. 97(16):1195-203, 2005
Buist DS et al: Factors contributing to mammography failure in women aged 40-49 years. J Natl Cancer Inst. 96(19):1432-40, 2004
Anttinen J et al: Her-2/neu oncogene amplification and protein over-expression in interval and screen-detected breast cancers. Anticancer Res. 23(5b):4213-8, 2003
Ikeda DM et al: Analysis of 172 subtle findings on prior normal mammograms in women with breast cancer detected at follow-up screening. Radiology. 226(2):494-503, 2003
Wang SC: The Singapore National Breast Screening Programme: principles and implementation. Ann Acad Med Singapore. 32(4):466-76, 2003
Warren RM et al: Radiology review of the UKCCCR Breast Screening Frequency Trial: potential improvements in sensitivity and lead time of radiological signs. Clin Radiol. 58(2):128-32, 2003
Gilliland FD et al: Biologic characteristics of interval and screen-detected breast cancers. J Natl Cancer Inst. 92(9):743-9, 2000
Mandelson MT et al: Breast density as a predictor of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst. 92(13):1081-7, 2000
Porter PL et al: Breast tumor characteristics as predictors of mammographic detection: comparison of interval- and screen-detected cancers. J Natl Cancer Inst. 91(23):2020-8, 1999
Burrell HC et al: Screening interval breast cancers: mammographic features and prognosis factors. Radiology. 199(3):811-7, 1996
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