Twenty-year follow-up of the breast cancers diagnosed during the Breast Cancer Detection Demonstration Project.

This study reports on the 20-year follow-up of the women diagnosed with breast cancer in the Breast Cancer Detection Demonstration Project (BCDDP) between 1973 and 1980. This project provided 5 years of screening with physical examination and two-view mammography for 280,000 volunteer women across the United States. Based on a 96% follow-up from 1993 to 1995 of the 4,051 women with breast cancer available for analysis, 2,658 (66%) were alive and 1,393 (34%) were dead. A high proportion of the cancers were detected by mammography alone, and 28.6% of all the cancers were smaller than 1.0 cm. Survival rates were calculated by life table method with deaths from breast cancer as the outcome. The adjusted survival rate for the entire group was 80.5%, and the observed survival rate was 61.7%. Adjusted and observed survival rates were 97.2% and 78.5%, respectively, for women with non-invasive cancers and 78.2% and 59.3%, respectively, for those with invasive cancers. Lymph node status and the size of the cancer at diagnosis were prognostic indicators of survival in the BCDDP Women with invasive cancers and negative lymph nodes had an 85.5% breast cancer survival rate and a 65.6% observed survival rate. Adjusted survival rates for women with invasive breast cancers were 90.2% for cancers smaller than 1 cm, 80.5%, for cancers 1.0 to 1.9 cm, 70.5% for cancers 2.0 to 4.9 cm, and 60.6% for cancers larger than 5 cm. Women 40 to 49 years of age demonstrated a greater survival with noninvasive or invasive cancers smaller than 5.0 cm compared with women 50 to 59 and 60 to 69 years of age at diagnosis. These results from the BCDDP are discussed in the context of the recent decline in breast cancer incidence and mortality in the United States.

Twenty-year follow-up breast screening project.

Routine yearly breast screening with mammograms and physical examination can usually detect very small nonpalpable cancers that have a high survival rate. Routine breast screening with mammography and physical examination of asymptomatic women is the best method of controlling breast cancer at present.

Twenty-year review of a breast cancer screening project. Ninety-five percent survival of patients with nonpalpable cancers.

BACKGROUND: In 1973, the Breast Cancer Detection Demonstration Project at the Georgia Baptist Medical Center began screening supposedly asymptomatic women for breast cancer. The project has been reviewed and now 20 years later, the follow-up of those women with detected cancer who were matched with a group of the original cohort with negative screens is reported. Early criticism of the project was its "lead-time bias," which, after 20 years, should pose no problem. METHODS: Approximately 9043 women were screened for 5 years. The remainder of the total of 10,000 women were screened at the Emory University Department of Radiology. The 128 patients who were found to have breast cancer were observed for over 20 years. A matched group of 1609, who had negative results when originally screened, were also observed for 20 years. RESULTS: After 20 years, approximately 86% of the 128 women diagnosed with breast cancer were still free of disease, including 88.3% of women with lesions of less than 1.1 cm and 95.1% of those with nonpalpable carcinomas. CONCLUSIONS: Over 95% of the 67 women with nonpalpable lesions were alive after 20 years of follow-up. Women not screened yearly tend to have larger lesions than those screened on a regular basis. Regular screening is currently the best way to control this disease.

Colorectal and gynecological malignancies: comparison of B72.3 monoclonal antibody imaging, CT, and serum tumor antigens.

Noninvasive B72.3 monoclonal antibody imaging provides beneficial information that may influence therapeutic and surgical decisions, and may clarify other clinical, laboratory, and CT scan findings. Intraoperative localization of tumor sites with a hand-held gamma probe holds promise as a further advantage of this technique.

Routine breast screening for cancer.

Breast screening for cancer has increased the survival for women over age 50 as well as those younger than 50 years old. The 13-year average follow-up period disproves the claim that the survival gain is due to lead-time bias. The information brought forth in this presentation proves that higher-risk women must be screened in order to reduce the constant death rate from breast cancer.

Routine breast screening. Survival after 10.5 years follow-up.

Beginning in 1973, the Breast Cancer Detection Demonstration Project at Georgia Baptist Medical Center screened 8058 supposedly asymptomatic volunteers. Those screenees found to have cancer were treated by various surgeons, using all types of treatment with varying expertise. There has been 100% follow-up after 10.5 years. The overall survival is 90.8%. The women over 50 in all categories survived longer than the younger age group. Those women with lesions 1 cm or smaller survived longer than those with larger lesions. The women whose tumor was not palpable clinically and was discovered by roentgenogram had the best survival rates (96.8%). In the less-than-50 age group whose cancer was detected by roentgenogram alone, 88.2% survived 10.5 years, while 100% of the older group is still living. These results do not consider the type of therapy nor the skill with which it was administered and is the result of routine screening only.

Five-year-plus survival of breast screenees.

Seven years have elapsed since the first group of screenees were examined in the Georgia Baptist Medical Center (BCDDP). Of 8058 women studied, 135 had cancer. Forty-five percent of the tumors were found by x-ray alone. In 912 biopsies, 10.9% had axillary metastases and 8.5% had bilateral cancer. Among patients under 50 years of age, 26 had cancer lesions of which were less than 1 cm in diameter. There were 21 in situ carcinomas. Among those over 50 years of age, 46 had lesions 16 of which were 1 cm or less in diameter. There were 26 in situ carcinomas. Three of this latter group have died. Of those women undergoing surgery five or more years ago, 21 were in the group of patients under 50 years of age; one has died. Thirty-eight were in the group over 50 years of age and two have died. This is a 94.2% five-year survival rate. Two others are living with metastatic lesions, a five-year disease-free rate of 93.01%.

The treatment of nonpalpable carcinoma of the breast.

Screening programs have discovered an increasing number of non-palpable breast cancers. There are several methods of locating these lesions by measuring the distance from the nipple and either excising an adequate margin around the measured point or more accurately locating it with a needle and further x-rays. The lesion, one excised, should be submitted for specimen radiography and compared with the mammogram to ascertain that the lesion has been excised. Many times, it is wise to submit the whole excised area for permanent sectioning to improve the reliability of diagnosis. For minimal carcinoma (0.5 cm or less), a total mastectomy with dissection of the level one nodes and with immediate pathological examination is done. If there is no metastasis or if metastasis in the nodes is two millimeters or less, it is probably adequate treatment. If larger metastases are present, a Patey Modified Mastectomy should be done. When the lesion is in the medial half of the breast, radiation to the parasternal area should be given.

The value of breast screening in women less than fifty years of age.

In the four years our Breast Cancer Detection Demonstration Project has been receiving patients, 5,810 women under the age of fifty have been examined. Our findings definitely indicate screening of asymptomatic women by xeromammography is of advantage in this group whose greatest cause of death is cancer of the breast; 71.8% of their cancers were found by xeromammography. Of these 43.8% had in situ cancer and only 12.5% of those cancers found had axillary spread. This group should have a five-year cure rate of 87.1% rather than 63% as is the experience of unscreened women. The absorbed rads averaged 0.4632 to each breast per year. At the end of five years this would cause an estimated increase in risk from 7% to 7.162%. To increase survival rate by 24.1% against a theoretical increased risk of 0.16% is definitely worthwhile.