Swedish Cancer Institute Study Finds Patient-Detected Breast Cancer Has Higher Recurrence, Mortality

Swedish Cancer Institute Study Finds Patient-Detected Breast Cancer Has Higher Recurrence, Mortality Risk than Mammography-Detected Breast Cancer

SEATTLE, Feb. 7, 2007 – A recent study by Drs. Henry Kaplan of the Swedish Cancer Institute and Judith Malmgren of HealthSTAT Consulting Inc. found that patient-detected breast cancer appears to be a more virulent form of breast cancer than mammography-detected breast cancer with a higher rate of recurrence and mortality risk despite often times more aggressive treatment.

The study found that out of 2,459 breast cancer cases of women between the ages of 40 and 93 seen at the Swedish Cancer Institute between 1990 and 1999, 41 percent of cases had come to the community cancer-care center because they discovered the breast cancer themselves by finding a lump or by noticing an incidental change in the way their breast looked or felt; while 49 percent were detected through mammography, and just 10 percent were detected by a physician.

However, although patients with patient-detected breast cancer received more aggressive treatment (combined radiation and chemotherapy; patient detected, 49 percent vs. mammography detected, 23 percent), these same women were twice as likely to have a recurrence of breast cancer (five-year recurrence rate: patient detected, 13 percent vs. mammography detected, 6 percent) and more than twice as likely to die from breast cancer as women whose breast cancer was found by a mammogram (five-year, disease-specific mortality rate: patient detected, 13 percent vs. mammography detected, 5 percent).

"While patient detection plays a significant role in breast cancer discovery, given the current medical environment with mammography screening readily available, it is prudent to remind women that manual self breast examination is merely just a way to fill the gap," said Dr. Judith Malmgren. "In light of our findings, it is essential that women meet with their doctors to establish a regular breast health awareness routine."

Further, Drs. Kaplan and Malmgren found that just 26 percent of the patient-detected breast cancers were not visible by mammography. It appeared that mammography was an effective tool for detecting a more homogeneous type of breast cancer, whereas patient-detected breast cancer was more heterogeneous with different biologic characteristics. They reason that the higher mortality rate in the patient-detected breast cancer cases might be related to the higher prevalence of unfavorable prognostic characteristics, which ultimately led to the cancers not being visible during a mammogram and that patient-detected tumor size was significantly larger than mammography detected (2.68 cm compared with 1.45 cm).

"Although screening breast mammography is readily available in the United States, it is important that women learn to examine their breasts and do so regularly," said Dr. Kaplan.

Full results of the study were published in the June 2006 edition of Clinical Breast Cancer: Kaplan HG, Malmgren JA. Disease specific survival in patient-detected breast cancer; 7(2):133-140.


About Swedish Cancer Institute
Swedish Cancer Institute (SCI) opened in 1932 as the first dedicated cancer-care center west of the Mississippi. Today, it is the largest and most comprehensive cancer-treatment program in the Pacific Northwest, caring for more people with more types of cancer than any other provider in the region. The Institute has a presence on all three of Swedish's hospital campuses: First Hill, Ballard and Cherry Hill (formerly Providence). A true multidisciplinary program, the SCI offers a wide range of advanced cancer-treatment options in chemotherapy, radiation therapy and surgery – backed by extensive diagnostic capabilities, patient education and support-group services. The SCI's clinical-research arm encompasses industry-sponsored and cooperative group therapeutic trials, cancer screening and prevention trials, and investigator-initiated trials. Breast-cancer screening and diagnostics are available through the Swedish Breast Care Centers and mobile mammography units. Swedish radiation therapy is offered at area hospitals including Stevens Hospital (Edmonds); Valley Medical Center (Renton); Highline Community Hospital (Burien) and Northwest Hospital (North Seattle). SCI also has a new medical oncology clinic in East King County near Issaquah.

About Swedish
Swedish is the largest, most comprehensive, nonprofit health provider in the Pacific Northwest. Founded in 1910, it now has more than 7,200 employees and a medical staff of almost 2,300 physicians, most of which are private practitioners. Swedish now encompasses three hospital campuses -- First Hill, Cherry Hill (formerly Providence) and Ballard – totaling 1,245 licensed beds, a freestanding emergency room and specialty center in Issaquah, Swedish Home Care Services and Swedish Physicians – a network of 12 primary-care clinics located throughout the Greater Seattle area. In addition to general medical and surgical care, Swedish is known as a regional referral center, providing specialized treatment in areas such as cardiovascular care, cancer care, orthopedics, high-risk obstetrics, neurological care, sleep medicine, pediatrics, organ transplantation and clinical research. For more information, visit www.swedish.org

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