Self-reported symptoms among participants in a population-based screening program. (December 2020)

• Record Type: Journal Article
• Authors: Larsen, Marthe; Lilleborge, Marie; Vigeland, Einar; Hofvind, Solveig
• Is Part Of: Breast. Volume 54(2020)
• Page Start: 56
• Page End: 61
• Publication Date: 2020-12
• Subjects: Breast cancer -- Screening -- Symptoms -- Interval breast cancer -- Tumour characteristics -- Lump; Breast neoplasm -- Mass Screening -- Signs and Symptoms -- Prognosis; Breast -- Diseases -- Periodicals; Breast -- Tumors -- Periodicals; Breast -- Periodicals; Electronic journals; Periodicals; 616
• DOI: 10.1016/j.breast.2020.08.015
• Languages: English
• ISSNs: 0960-9776

Abstract

Abstract: Background: A limited number of studies have explored the association between self-reported symptoms and the risk of breast cancer among participants of population based screening programs. Methods: We performed descriptive statistics on recall, screen-detected and interval cancer, positive predictive value and histopathological tumour characteristics by symptom group (asymptomatic, lump, and skin or nipple changes) as reported from 785, 642 women aged 50–69 when they attended BreastScreen Norway 1996–2016. Uni- and multivariable mixed effects logistic regression models were used to analyze the association between symptom group and screen-detected or interval cancer. Results were presented as odds ratios and 95% confidence intervals (CI). Results: A lump or skin/nipple change was reported in 6.2% of the 3, 307, 697 examinations. The rate of screen-detected cancers per 1000 examinations was 45.2 among women with a self-reported lump and 5.1 among asymptomatic women. Adjusted odds ratio of screen-detected cancer was 10.1 (95% CI: 9.3–11.1) and 2.0 (95% CI: 1.6–2.5) for interval cancer among women with a self-reported lump versus asymptomatic women. Tumour diameter, histologic grade and lymph node involvement of screen-detected and interval cancer were less prognostically favourable for women with a self-reported lump versus asymptomatic women. Conclusion: Despite targeting asymptomatic women, 6.2% of the screening examinations in BreastScreen Norway was performed among women who reported a lump or skin/nipple change when they attended screening. The odds ratio of screen-detected cancer was higher for women with versus without symptoms. Standardized follow-up guidelines might be beneficial for screening programs in order to take care of women reporting signs or symptoms of breast cancer when they attend screening. Highlights: 6.2% of the exams were registered with symptoms in BreastScreen Norway. 45.2 per 1000 exams with a lump were diagnosed with screen-detected cancer. Tumor characteristics were less favourable for screen-detected cancer following a self-reported lump. 9.7 per 1000 exams with a lump, but no mammographic findings resulted in a screen-detected cancer.