A Very Favourable Mammographic Screening Impact on Breast Cancer Characteristics and Treatment Modalities in France. Analysis of 2806 Cases.
Authors: B. Cutuli, F. Dalenc, J. Guastalla, T. Petit, J. Gligorov, A. Amrate
Journal: Cancer Research (2009)

Abstract Introduction In 2005, 49800 new breast cancers (BC) occurred in France, representing the first (36%) female cancer. The new national screening program was displayed in all regions in 2003-2004, including women from 50 to 74 years old.Material and methods In 2001-2002, a first National Survey (NS1) was conducted, including 1159 new BC in France. In 2007-2008, we performed a second national survey (NS2) including 1647 BC in order to compare all epidemiological clinico-pathological features and treatment modalities. Both studies were multicentric, prospective and non selective. There were respectively 124 and 130 involved physicians working in cancer centres, general or teaching hospitals and private clinics.Results The main results are shown in table 1. Median age remained constant (58 years), but with increased rates in women under 40 (from 5.6% to 7%) and older than 70 (from 20.4% to 22.4%). A three-fold increase (+ 15.8%) of T0 lesion (screening detected) was observed in NS2, with a concomitant T2 decrease (- 8.7%) and a stable rate of T3T4 and metastatic forms (3.6%). Concomitant pT1a-b rate increased (+ 9.4%) and pN+ rate dramatically decreased (- 12.1%), especially pN&amp;gt;3 (- 6%).Hormone receptors positivity and SBR grade distribution were similar. Her2 over-expression decreased from 20.6% to 12.4%, but dosages were performed in 31% (NS1) and 91% (NS2) of BC, respectively. The mastectomy rate was identical but axillary dissection decreased from 80% to 42.6%, whereas SLNB increased from 2.7% to 41%.Radiotherapy rates were identical, both after mastectomy and conservative surgery, but with a decrease in nodal volumes treatment. A 7.7% decrease in chemotherapy (CT) and a 6% increase in hormonotherapy (HT) were observed.A detailed analysis of age and HRT influence will be presented, as well as modifications in CT and HT prescriptions.Conclusion In the last decade, the widespread use of mammography strongly modified the clinico-pathological features of BC (e.g. pN+ and Her 2+++ rates) with resulting reduction treatment heaviness, especially in post-menopausal women. Thus, we can assume that in the coming years, increasing survival rates will be observed.Clinical pathological features and treatment comparison in both national surveysCLINICALNS1 (2001-2002)NS2 (2007-2008)pMedian age57 y58 yNST08.6%24.4%&amp;lt;0.001T149.5%42.3%NST232.5%23.8%&amp;lt;0.001T3T47.6%8.8%&amp;lt;0.001Tx1.8%0.7%&amp;lt;0.005N076.7%81.2%&amp;lt;0.001M+3.5%3.6%NSHISTOPATHOLOGICAL Median size (mm)1815&amp;lt;0.001pT1a2.44NSpT1b16.522.3&amp;lt;0.001pT1c43.442.5NSpT234.227&amp;lt;0.001pT3T43.33.2NSpN+44.432.3&amp;lt;0.001pN1-329.522.6&amp;lt;0.001pN&amp;gt;314.98.9&amp;gt;0.001ER+79.783.7&amp;lt;0.001PgR+69.772.5NSHR+ (Total)83.985.3NSHer2+++20.612.4&amp;lt;0.01TREATMENT Surgery Mastectomy77.5%77.3%NSCon. surgery22.5%22.7%NSAxillary dissection80%42.6%&amp;lt;0.001Sentinel L.N.B.2.7%41%&amp;lt;0.001SLNB+AD15.4%16.4%NSRadiotherapy After BCS98%97.4%NSAfter mastectomy89%89.5%NSChemotherapy (adj.)58.7%51%&amp;lt;0.001Hormonal treatment (adj.)76.5%82.5%&amp;lt;0.001 Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 4006.