Proposal of an Appropriate Interval for Screening Mammography Based on Tumor Doubling Time

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  • 腫瘍倍加時間と発見時の病理所見からみた適切な検診間隔への提言

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The minimum size of breast cancer detectable by mammography is theoretically 5mm. If a 5-mm cancer fails to be detected by screening mammography and then grows to 2cm in the next 2 years, the tumor doubling time (DT) is calculated to be 120 days. In 30 patients with breast cancer (21 with mammographically detected tumors and 9 with calcified lesions), the DT was determined by measuring the sizes of the tumors evident on the previous mammograms. If a breast cancer has a DT of less than 120 days, and the screening interval is 2 years, the cancer will have become large and associated with lymph node metastasis. We determined the histopathological type, hormone receptors (HR) and Her2, and studied their relationships with DT. Breast cancers with a DT of less than 120 days were found in 43% of patients with tumors (9/21) and 44% of patients with calcified lesions (4/9). When analyzed according to subtype, 3 cases involving HR (-) and Her 2 (-) tumors showed a very short DT of about 60 days, and 2 of them showed metaplasia pathologically. Cases involving HR (-) and Her2 (+) cancers and those with HR (+) and Her2 (+) cancers showed a DT of 112±10 days and 128±days, respectively. Nineteen cases involving HR (+) Her2 (-) cancers had widely variable DTs of 867±679 days. Among them, 5 (26%) showed a DT less than 120 days, and the pathological types were mucinous cancer in 3 cases and common type of cancer in 2. In conclusion, although a screening interval of 2 years appears to be reasonable for patients with HR (+) and Her2 (-) cancers, a shorter interval is necessary for those with HR (-) and Her2 (-) cancers or Her2 (+) cancers.

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