Association of symptoms and interval breast cancers in the mammography-screening programme: population-based matched cohort study

Abstract

BACKGROUND: We assessed the association between symptoms reported at breast cancer screening visits and interval cancers (ICs) in a prospective manner. METHODS: This population-based matched cohort study uses data of the Finnish National Breast Cancer Screening Programme that invites women aged 50-69 years old during 1992-2012. Subjects who attended screening with symptoms were matched with asymptomatic reference cohorts based on age at screening visit, year of invitation, number of invited visits and municipality of invitation. The primary outcome was ICs. RESULTS: Women with a lump had a threefold (hazard ratio 3.7, 95% confidence interval (CI) 3.0-4.6) risk of ICs and a higher risk (hazard ratio 1.7, 95% CI 1.4 to 2.0) at the subsequent visit compared with those without a lump. The fatal interval cancer risk increased by 0.39 per 1000 screens with a lump. The cumulative incidences of interval cancer increased within a month of a mammography-negative visit with a lump and after about 6 months of the visit with retraction or nipple discharge. CONCLUSION: Women with breast symptoms have a clearly increased risk of interval breast cancer after the screening visit. Our findings indicate the need for different screening strategies in symptomatic women.