Clinical-pathologic characteristics and outcomes of true interval compared to screen-detected breast cancer among participants in a Canadian breast screening program: A nested case-control study
Bibliographic record
Abstract
6528 Background: It has been hypothesized that, compared to screen-detected breast cancer (Scr), true interval breast cancers (Int) are associated with adverse prognostic factors and outcomes. Data has remained controversial due to failure to control for age at diagnosis and screening interval as well as lack of information regarding adjuvant therapies and inclusion of other categories of interval cancers (e.g., missed or noncompliant). Methods: A case-control study nested among participants of the population-based Nova Scotia Breast Screening Program diagnosed with invasive disease between the ages 40–69 in the period 1991–2006 was performed. Ints were validated by blinded review of the pre-diagnostic screening mammogram by 3 mammographers, 2 or 3 of whom had to agree that it was negative for inclusion as a true Int. Scrs were matched to Ints on a 2:1 basis by 5 year age group at diagnosis and screening interval (40–49 yo, annual; 50–69 yo + family history, annual; 50–69 yo - family history, biennial). Results: 243 true Ints were observed and matched to 485 Scrs. The Table presents (i) univariate analysis of selected pathology variables for the entire cohort of Ints vs Scrs (ii) multivariate analysis of these selected variables. In addition to standard adjuvant hormonal, radiation and trastuzumab therapies, 62.4% of Ints received standard adjuvant chemotherapy (adjC) vs. 30.6% of Scrs. 5 year disease-free (DFS) and overall (OS) survival rates for Int vs Scr were 82.6% vs 92.3% and 87.2% vs 93.3% respectively. Cox proportional hazards modeling for (i) DFS shows HR=1.96 (p=0.0024) for Int vs Scr, dropping to HR=1.57 (p=0.0556) after adjusting for adjC received and (ii) OS shows HR=1.99 (p=0.0028) for Int vs Scr, dropping to 1.61 (p=0.0487) after adjusting for adjC received. Conclusions: True Ints present with more adverse prognostic factors compared to Scrs. Despite more use of adjC, outcomes are significantly poorer. [Table: see text] No significant financial relationships to disclose.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".