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ABSTRACT: Does breast cancer grade worsen with time? Evidence
from breast screening
[10/22/2001; Breast Cancer Research and Treatment]
It has been suggested that alteration of the distribution
of histological grades, that has been found in screening programmes,
is evidence for progression in histological grade with increasing
size.
A predictive model, that was based upon estimated growth
data from an unselected series of 98 new primary breast cancers,
is used to estimate the proportions of tumors that would be diagnosed
according to limiting screen diagnostic and clinical diagnostic
sizes after particular screening intervals; windows of opportunity
are created.
The results show that the limitations imposed by
time and size criteria alter the distribution of growth rates
of tumours that may appear in the windows.
Small screen diagnostic
sizes and short screening intervals allow only the most rapidly
growing tumours to reach large sizes.
This produces an apparent
association of grade 3 tumours with large size. Interval cancers
are also likely to be more rapidly growing while the more slowly
growing tumours will be diagnosed at the subsequent screen to
produce a spurious association of slowly growing grade 1 tumours
with small size.
We conclude that the evidence from screening
does not support the thesis of progression of histological grade
with the ageing of the tumour, since the changes that have been
observed are predictable from a simple model based upon patterns
of tumour growth rates and the relationships between growth rate
and histology.
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