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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
- Screening interval varies; range: 12-36 months
- 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
- Billing may be diagnostic but audited as screening
- Breast cancers detected due to clinical findings during interval between recommended screenings
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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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
- Screening interval varies; range: 12-36 months
- 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
- Billing may be diagnostic but audited as screening
- Breast cancers detected due to clinical findings during interval between recommended screenings
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
