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Debald M, Jin JP, Linke A, Walgenbach KJ, Rauch P, Zellmer A, Fimmers R, Kuhn W, Hartmann G, Walgenbach-Brünagel G. Calponin-h2: a potential serum marker for the early detection of human breast cancer? Tumour Biol 2014; 35:11121-7. [PMID: 25099617 DOI: 10.1007/s13277-014-2419-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Accepted: 07/29/2014] [Indexed: 01/05/2023] Open
Abstract
Early diagnosis is the key for the successful treatment of breast cancer. A serum marker for the early detection of breast cancer could significantly reduce breast cancer morbidity and mortality by bringing the time of diagnosis at an earlier and therefore still curable stage. So far, no biomarker for the early detection is available for the clinical routine. The aim of the present study was to evaluate the use of calponin-h2 as a blood-based biomarker for the early diagnosis of this disease. Using two monoclonal antibodies against calponin-h2, we developed a sandwich ELISA to analyze the serum levels of calponin-h2. In order to evaluate the diagnostic potential of this biomarker, patients with breast cancer (n = 76), benign diseases of the breast (n = 51) and healthy females (n = 24) were analyzed. Serum levels above 10 ng/ml were only observed in patients with breast cancer (n = 8; 10.5%). Further large-scale studies and preanalytic evaluations are necessary to clarify the definite role of calponin-h2 as a biomarker in breast cancer management.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Biomarkers/analysis
- Biomarkers, Tumor/blood
- Breast/metabolism
- Breast Neoplasms/blood
- Breast Neoplasms/diagnosis
- Calcium-Binding Proteins/blood
- Carcinoma, Ductal, Breast/blood
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/blood
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Lobular/blood
- Carcinoma, Lobular/diagnosis
- Case-Control Studies
- Enzyme-Linked Immunosorbent Assay
- Female
- Fibroadenoma/blood
- Fibroadenoma/diagnosis
- Follow-Up Studies
- Humans
- Lymphatic Metastasis
- Microfilament Proteins/blood
- Middle Aged
- Neoplasm Grading
- Neoplasm Invasiveness
- Neoplasm Staging
- Papilloma/blood
- Papilloma/diagnosis
- Prognosis
- Young Adult
- Calponins
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Affiliation(s)
- Manuel Debald
- Department of Obstetrics and Gynecology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
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Coldman A, Phillips N, Wilson C, Decker K, Chiarelli AM, Brisson J, Zhang B, Payne J, Doyle G, Ahmad R. Pan-Canadian Study of Mammography Screening and Mortality from Breast Cancer. ACTA ACUST UNITED AC 2014; 106:dju261. [DOI: 10.1093/jnci/dju261] [Citation(s) in RCA: 155] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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53
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Differentiation of BIRADS-4 small breast lesions via Multimodal Ultrasound Tomography. Eur Radiol 2014; 25:410-8. [PMID: 25218763 DOI: 10.1007/s00330-014-3415-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 08/20/2014] [Accepted: 08/26/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE To demonstrate the use of a new 3D diagnostic imaging technology, termed Multimodal Ultrasonic Tomography (MUT), for the detection of solid breast lesions < 15 mm in maximum dimension. METHODS AND MATERIALS 3D MUT imaging was performed on 71 volunteers presenting BIRADS-4 nodules, asymmetrical densities, and architectural distortions in X-ray mammograms, who subsequently underwent biopsy. MUT involved D tomographic imaging of the pendulant breast in a water bath using transmission ultrasound and constructed multimodal images corresponding to refractivity and frequency-dependent attenuation (calibrated relative to water). The multimodal images were fused into composite images and a composite index (CI) was calculated and used for diagnostic purposes. The composite images were evaluated against results of histopathology on biopsy specimens. RESULTS Histopathology revealed 22 malignant and 49 benign lesions. The pixels of 22 malignant lesions exhibited high values in both refractivity and attenuation, resulting in CI values > 1. In contrast, 99.9% of benign lesions and normal tissue pixels exhibited lower values of at least one of the attributes measured, corresponding to CI values < 1. CONCLUSIONS MUT imaging appears to differentiate small malignant solid breast lesions as exhibiting CI values >1, while benign lesions or normal breast tissues exhibit CI values <1. KEY POINTS • MUT was able to detect all 22 biopsy-confirmed malignant lesions. • MUT was able to differentiate the malignant from the benign lesions. • Additional MUT detections outside the biopsy area must be evaluated prospectively.
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Beckmann KR, Lynch JW, Hiller JE, Farshid G, Houssami N, Duffy SW, Roder DM. A novel case-control design to estimate the extent of over-diagnosis of breast cancer due to organised population-based mammography screening. Int J Cancer 2014; 136:1411-21. [DOI: 10.1002/ijc.29124] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/14/2014] [Indexed: 11/10/2022]
Affiliation(s)
| | - John W. Lynch
- School of Population Health, University of Adelaide; Australia
| | - Janet E. Hiller
- School of Population Health, University of Adelaide; Australia
- Faculty of Health Sciences, Swinburne University; Australia
| | | | - Nehmat Houssami
- School of Public Health, Sydney Medical School, University of Sydney; Australia
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London; London United Kingdom
| | - David M. Roder
- Population Health, University of South Australia; Australia
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Bonet M, Godoy P, Cambra MJ, Mur E, Algara M, Fernandez L, Dalmau E, Arcusa À, Seguí MÀ, Saigí E, Gonzalez S, Cirera L, Solé JM. Are breast cancer patients treated with radiotherapy younger now than ten years ago? Rep Pract Oncol Radiother 2014; 20:22-6. [PMID: 25535580 DOI: 10.1016/j.rpor.2014.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 05/29/2014] [Indexed: 11/30/2022] Open
Abstract
AIM The aim of the present study was to analyze the age of breast cancer patients managed with curative approach at the time of treatment with radiotherapy. BACKGROUND Breast cancer is the most frequent neoplasm in women. Little is known with regard to the age of patients at diagnosis, and some authors have suggested that breast cancer is now affecting women who are younger than before. MATERIALS AND METHODS We performed a descriptive study of our series of breast cancer patients from 1998 to 2011. The age of patients, city of residence, year of treatment and uni- or bilateral location were extracted from the administrative database of the Radiation Oncology Department. The demographical and reference populational data were extracted from the Catalan Institute of Statistics. RESULTS 3382 patients were obtained. The mean age was 57.79 years. No statistical differences were observed in the mean age during the period of study (p > 0.05), nor in patients with bilateral neoplasias with regard to unilateral tumours (p > 0.5). Patients aged less than 30, 40, 50 and 65 years were 0.3%, 6.3%, 27.0% and 69.1%, respectively. The proportion of patients aged less, equal or more than 40 and 50 years was not statistically different. CONCLUSIONS Breast cancer patients treated with adjuvant radiotherapy after radical surgery have not experienced significant changes in their mean age at treatment. The subgroups of patients that remain out of the mammographic screening programmes were unchanged as well. The observed differences can be explained by demographical disparities and by a probable increase in the indications for adjuvant radiotherapy.
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Affiliation(s)
- Marta Bonet
- Radiation Oncology, Consorci Sanitari de Terrassa, Institut Oncològic del Vallès (CST-HGC-CSPT), Barcelona, Spain
| | - Pere Godoy
- Unitat d'Epidemiologia, Departament de Salut, IRBLleida, Universitat de Lleida, Lleida, Spain
| | - Maria Jose Cambra
- Radiation Oncology, Hospital General de Catalunya, Institut Oncològic del Vallès (CST-HGC-CSPT), Barcelona, Spain
| | - Encarna Mur
- Radiation Oncology, Consorci Sanitari de Terrassa, Institut Oncològic del Vallès (CST-HGC-CSPT), Barcelona, Spain
| | - Manel Algara
- Institut d'Oncologia Radioteràpica, Parc de salut MAR-Universitat Pompeu Fabra, Barcelona, Spain
| | - Luis Fernandez
- Medical Oncology, Corporació Sanitària Parc Taulí de Sabadell, Institut Oncològic del Vallès, Barcelona, Spain
| | - Elsa Dalmau
- Medical Oncology, Corporació Sanitària Parc Taulí de Sabadell, Institut Oncològic del Vallès, Barcelona, Spain
| | - Àngels Arcusa
- Medical Oncology, Hospital de Terrassa, Terrassa, Consorci Sanitari de Terrassa, Institut Oncològic del Vallès, Barcelona, Spain
| | - Miquel Àngel Seguí
- Medical Oncology, Corporació Sanitària Parc Taulí de Sabadell, Institut Oncològic del Vallès, Barcelona, Spain
| | - Eugeni Saigí
- Medical Oncology, Corporació Sanitària Parc Taulí de Sabadell, Institut Oncològic del Vallès, Barcelona, Spain
| | - Sònia Gonzalez
- Medical Oncology, Hospital Universitari Mutua de Terrasa, Terrasa, Spain
| | - Lluís Cirera
- Medical Oncology, Hospital Universitari Mutua de Terrasa, Terrasa, Spain
| | - Josep Maria Solé
- Radiation Oncology, Consorci Sanitari de Terrassa, Institut Oncològic del Vallès (CST-HGC-CSPT), Barcelona, Spain
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Irvin VL, Kaplan RM. Screening mammography & breast cancer mortality: meta-analysis of quasi-experimental studies. PLoS One 2014; 9:e98105. [PMID: 24887150 PMCID: PMC4041743 DOI: 10.1371/journal.pone.0098105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/28/2014] [Indexed: 02/02/2023] Open
Abstract
Background The magnitude of the benefit associated with screening has been debated. We present a meta-analysis of quasi-experimental studies on the effects of mammography screening. Methods We searched MEDLINE/PubMed and Embase for articles published through January 31, 2013. Studies were included if they reported: 1) a population-wide breast cancer screening program using mammography with 5+ years of data post-implementation; 2) a comparison group with equal access to therapies; and 3) breast cancer mortality. Studies excluded were: RCTs, case-control, or simulation studies. We defined quasi-experimental as studies that compared either geographical, historical or birth cohorts with a screening program to an equivalent cohort without a screening program. Meta-analyses were conducted in Stata using the metan command, random effects. Meta-analyses were conducted separately for ages screened: under 50, 50 to 69 and over 70 and weighted by population and person-years. Results Among 4,903 published papers that were retrieved, 19 studies matched eligibility criteria. Birth cohort studies reported a significant benefit for women screened <age 50, but not for women screened ages 50–69. Significant reductions in breast cancer mortality were observed in historical comparisons. For geographical comparisons, there was a significant 20% reduction in mortality for women <age 50 and a significant 21–22% reduction for women ages 50–69. Studies that tested the interaction of geographical and historical comparisons produced a pooled, significant 13–17% reduction in incident breast cancer mortality for women ages 50–69, but the effects in most individual studies were non-significant. All studies of women ages 70+ were non-significant. Conclusions Mammography screening may have modest effects on cancer mortality between the ages of 50 and 69 and non-significant effects for women older than age 70. Results are consistent with meta-analyses of RCTs. Effects on total mortality could not be assessed because of the limited number of studies.
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Affiliation(s)
- Veronica L. Irvin
- Department of Rehabilitation Medicine, Clinical Research Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Robert M. Kaplan
- Department of Rehabilitation Medicine, Clinical Research Center, National Institutes of Health, Bethesda, Maryland, United States of America
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Commentary: approaches, strengths, and limitations of avoidable mortality. J Public Health Policy 2014; 35:171-84. [PMID: 24621843 DOI: 10.1057/jphp.2014.8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Publication of recent papers such as the one by Schoenbaum and colleagues entitled 'Mortality Amenable to Health Care in the United States: The Roles of Demographics and Health Systems Performance' has stimulated this commentary. We discuss strengths and limitations of amenable and avoidable mortality in health-care systems' performance and their contribution to health inequalities. To illustrate, we present a case study of avoidable and amenable mortality in Spain over 27 years. We conclude that amenable mortality is not a good indicator of health-care systems' performance, or for determining whether it could give rise to health inequalities. To understand health problems and to assess the impact of interventions affecting health requires good, basic, and routine monitoring of health indicators and of socioeconomic determinants of health.
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Lages RB, Oliveira GDP, Simeão Filho VM, Nogueira FM, Teles JBM, Vieira SC. Inequalities associated with lack of mammography in Teresina-Piauí-Brazil, 2010-2011. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 15:737-47. [PMID: 23515770 DOI: 10.1590/s1415-790x2012000400006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 05/23/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Randomized studies have shown that screening for breast cancer with mammography reduces the breast cancer mortality. However there are signs of a great inequality in access to mammography in Brazil. OBJECTIVES To analyze the percentage of women who did not undergo mammography according to socioeconomic and demographic variables in women aged from 40 to 69 years in Teresina, Piauí State, Brazil. METHODS This was a cross-sectional population-based study in women aged 40-69 years in Teresina-Piauí in 2010/2011. The sampling was randomly conducted in five stages. The data were processed by SPSS 19.0 and it was performed univariate and multivariate analysis. RESULTS Among 433 women who answered the questionnaire, 75,3% had a mammography and 17,2% of these women had not a mammography over the last two years. The lack of breast cancer screening was associated with non-white skin color (p = 0,030), never being married (p = 0,041), low levels of education (p = 0,010), low family income (p < 0,001), smoking (p = 0,006), having no private health insurance (p < 0,001). The Unified National Health System (SUS) performed 56,3% of reported mammograms. CONCLUSION About 24.7% of women in the sample never had a mammography. According to the findings, the lack of breast cancer screening is associated with social and racial inequalities.
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Seymour CB, Mothersill C. Breast cancer causes and treatment: where are we going wrong? BREAST CANCER (DOVE MEDICAL PRESS) 2013; 5:111-9. [PMID: 24648764 PMCID: PMC3929331 DOI: 10.2147/bctt.s44399] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This discussion paper seeks to provoke thoughts about cancer research in general, and why breast cancer in particular is not yet "curable". It asks the question - are we looking at the disease in the right way? Should we regard cancer as a progressive state, which is part of aging? Should we tailor treatment to "reset" the system or slow progression rather than try using toxic and aggressive therapy to kill every cancer cell (and sometimes also the patient)? The thesis is presented that we need to revisit our fundamental beliefs about the disease and then ask why we cling to beliefs that clearly are no longer valid. The paper also questions the role of ethics boards in hampering research and discusses the concept that breast cancer is an industry with vested interests involving profiteering by preventive, diagnostic, and therapeutic players. Finally, the paper suggests some ways forward based on emerging concepts in system biology and epigenetics.
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Affiliation(s)
- Colin B Seymour
- Medical Physics and Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Carmel Mothersill
- Medical Physics and Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
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Hackney L, Williams S, Hogg P, Szczepura K. Tissue bulge during stereotactic core biopsy. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2013.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Davidson A, Chia S, Olson R, Nichol A, Speers C, Coldman AJ, Bajdik C, Woods R, Tyldesley S. Stage, treatment and outcomes for patients with breast cancer in British Columbia in 2002: a population-based cohort study. CMAJ Open 2013; 1:E134-41. [PMID: 25077115 PMCID: PMC3985980 DOI: 10.9778/cmajo.20130017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND There are very few long-term Canadian data on breast cancer outcomes by stage. We described the stage, treatment and outcomes of breast cancer at a population level for patients in British Columbia. METHODS This population-based cohort study included almost all patients with incident breast cancer registered in 2002 (about 97.6% registry case completeness). For these patients, information on stage, primary local surgery, radiotherapy, chemotherapy, hormone therapy and survival outcome (based on registry date and cause-of-death data) were available. We calculated Kaplan-Meier curves for breast cancer-specific survival and overall survival by stage and analyzed prognostic and treatment factors with a multivariable Cox model. RESULTS The 2927 incident cases of breast cancer identified in 2002 had the following distribution by stage: stage 0 (in situ), 424 (14%); stage I, 1118 (38%); stage II, 938 (32%); stage III, 233 (8%); stage IV, 123 (4%); unknown, 91 (3%). The distribution of patients' ages was < 40 years, 127 (4%); 40-49, 538 (18%); 50-59, 719 (25%); 60-69, 660 (23%); 70-79, 583 (20%); ≥ 80, 300 (10%). Within the first year after diagnosis, radiotherapy was provided to 1649 patients (56%), chemotherapy to 928 (32%) and hormone therapy to 1664 (57%). Ten-year breast cancer-specific survival rates by stage were > 99% for stage 0, 95% for stage I, 81% for stage II, 55% for stage III and 4% for stage IV. Ten-year overall survival rates were 89% for stage 0, 81% for stage I, 68% for stage II, 43% for stage III and 2% for stage IV. INTERPRETATION This analysis provides a Canadian benchmark for treatment rates and 10-year outcomes by stage for all incident cases of breast cancer in a single province. Outcomes in British Columbia compared well with published rates for the United States and Europe.
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Affiliation(s)
- Ashley Davidson
- Department of Medical Oncology, Fraser Valley Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Stephen Chia
- Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC
- Department of Medical Oncology, Vancouver Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Robert Olson
- Department of Radiation Oncology, Centre for the North, British Columbia Cancer Agency, Vancouver, BC
| | - Alan Nichol
- Department of Radiation Oncology, Vancouver Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Caroline Speers
- Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC
| | - Andy J. Coldman
- Cancer Surveillance and Outcomes, British Columbia Cancer Agency, Vancouver, BC
| | - Chris Bajdik
- British Columbia Research Centre, British Columbia Cancer Agency, Vancouver, BC
| | - Ryan Woods
- Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC
| | - Scott Tyldesley
- Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC
- Department of Radiation Oncology, Vancouver Centre, British Columbia Cancer Agency, Vancouver, BC
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Debald M, Yeghiazaryan K, Cebioglu M, Kuhn W, Schild HH, Golubnitschaja O. 'Suspect molecular signature' in blood as the indicator of undiagnosed breast cancer, cancer risk and targeted prevention. EPMA J 2013; 4:22. [PMID: 24228816 PMCID: PMC3847171 DOI: 10.1186/1878-5085-4-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/29/2013] [Indexed: 02/05/2023]
Abstract
BACKGROUND Breast cancer is a multifactorial disease with the highest incidence rates amongst all cancer types. Further, high levels of circulating tumour cells are a characteristic of breast cancer patients demonstrating a particular predisposition to the development of breast cancer metastatic disease. Actual diagnostic approaches are frequently unable to recognise early stages of tumour development which impairs individual outcomes. In contrast, predictive and preventive risk assessment and early diagnosis may lead to full recovery after surgical resection. Recently, the authors have reported about the construction of diagnostic windows, which could influence the molecular diagnostics of breast cancer. MATERIAL AND METHODS In a previous study, diagnostic windows for breast cancer risk assessment were analysed. Women with non-malignant breast diseases demonstrating molecular profiles similar to those of breast cancer patients were enrolled into this follow-up study. In the interviews, for patients identified as predisposed to cancer, a specialised questionnaire has been set up to characterise individual risk factors and estimate their potential impacts on cancer onset and progression. RESULTS AND CONCLUSIONS By utilising the technological tool of diagnostic windows, 13 individuals have been identified demonstrating molecular profiles typical for patients diagnosed with breast cancer. The current paper summarises the analytical results and makes statements to the application of the pathology-specific molecular profiles recognised as the technological tool for improved diagnostic approach, breast cancer risk assessment and preventive health care management. The necessity to create individual patient profiles and analyse the evolution of the molecular signature is justified for advanced medical services. Expert recommendations are provided to promote further developments in the field of advanced breast cancer management.
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Affiliation(s)
- Manuel Debald
- Department of Obstetrics and Gynaecology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
- Breast Cancer Research Centre, University of Bonn, Bonn, Germany
| | - Kristina Yeghiazaryan
- Breast Cancer Research Centre, University of Bonn, Bonn, Germany
- Department of Radiology, Rheinische Friedrich-Wilhelms-University of Bonn, Sigmund-Freud-Str. 25, Bonn, Germany
| | - Melanie Cebioglu
- Breast Cancer Research Centre, University of Bonn, Bonn, Germany
- Department of Radiology, Rheinische Friedrich-Wilhelms-University of Bonn, Sigmund-Freud-Str. 25, Bonn, Germany
| | - Walther Kuhn
- Department of Obstetrics and Gynaecology, Centre for Integrated Oncology, University of Bonn, Bonn, Germany
- Breast Cancer Research Centre, University of Bonn, Bonn, Germany
| | - Hans H Schild
- Breast Cancer Research Centre, University of Bonn, Bonn, Germany
- Department of Radiology, Rheinische Friedrich-Wilhelms-University of Bonn, Sigmund-Freud-Str. 25, Bonn, Germany
| | - Olga Golubnitschaja
- Breast Cancer Research Centre, University of Bonn, Bonn, Germany
- Department of Radiology, Rheinische Friedrich-Wilhelms-University of Bonn, Sigmund-Freud-Str. 25, Bonn, Germany
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Souza FH, Polanczyk CA. Is Age-targeted full-field digital mammography screening cost-effective in emerging countries? A micro simulation model. SPRINGERPLUS 2013; 2:366. [PMID: 23961428 PMCID: PMC3736082 DOI: 10.1186/2193-1801-2-366] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 07/18/2013] [Indexed: 12/30/2022]
Abstract
OBJECTIVE The present paper estimates the cost-effectiveness of population-based breast cancer (BC) screening strategies in Brazil for women under 50 years from the perspective of the Brazilian public health system. METHODS A Markov model, simulating the natural history of female BC sufferers in Brazil, was developed. This model compares the lifetime effects, costs, and cost-effectiveness of seven BC screening strategies in women between 40 to 49 years: (A) usual care; (B) annual screen-film mammography (SFM); (C) SFM every 2 years; (D) annual full-field digital mammography (FFDM); (E) FFDM every 2 years; and (F and G) age-targeted options, with FFDM annually until 49 years and SFM annually (or biannually) from 50 to 69 years. RESULTS Adopting SFM every 2 years (Strategy C) was found to be slightly more costly but also more effective in terms of quality-adjusted life years (QALYs), yielding an incremental cost-effectiveness ratio (ICER) of R$ 1,509 per QALY gained. Annual SFM (Strategy B) was the next best option at an additional R$ 13,131 per QALY gained. FFDM annual screening (Strategy E) was dominated by Strategy F, the age-targeted option. For younger women, the age-based strategy had an ICER of R$ 30,520 per QALY gained. In the sensitivity analysis, the ICERs ranged from R$ 15,300 to R$ 257,899 in different regions of the country, depending on BC incidence, population age distribution, and mammography coverage. CONCLUSIONS SFM every 2 years for all women starting between the ages of 40 and 49 would be a cost-effective strategy. Taking into account regional specificities, age-targeted FFDM is one option to improve the outcomes of BC patients in an emerging country.
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Affiliation(s)
- Fabiano Hahn Souza
- />Institute for Health Technology Assessment (IATS), Porto Alegre, RS Brazil
- />Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
- />Radiology and Oncology Department of the State of São Paulo Cancer Institute, University of São Paulo, Medical School, São Paulo, SP Brazil
| | - Carísi Anne Polanczyk
- />Institute for Health Technology Assessment (IATS), Porto Alegre, RS Brazil
- />Graduate Studies Program in Epidemiology, School of Medicine, Federal University of Rio Grande do Sul, Porto Alegre, RS Brazil
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Bijker N, Donker M, Wesseling J, den Heeten GJ, Rutgers EJT. Is DCIS breast cancer, and how do I treat it? Curr Treat Options Oncol 2013; 14:75-87. [PMID: 23239193 DOI: 10.1007/s11864-012-0217-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Ductal carcinoma in situ (DCIS) is a pre-invasive stage of breast cancer with a heterogeneous clinical behaviour. Since the introduction of mammographic screening programmes, the incidence of DCIS has shown a dramatic increase. Treatment should focus on the prevention of progression to invasive disease. If progression occurs, poorly differentiated DCIS frequently gives rise to grade III invasive breast cancer, whereas well differentiated DCIS more often recurs as grade I invasive disease. However, at present, validated diagnostic test are lacking to predict progression accurately. The majority of women with DCIS are suitable for breast conserving therapy. Obtaining clear surgical margins is the most important goal of a local excision. Radiotherapy is effective in reducing the risk of local recurrence with about 50 % in all subgroups of patients with DCIS. (Breast cancer specific) survival of women with DCIS is excellent, and radiotherapy does not further improve this. Future research should be directed in enabling to select women who have a high risk of--invasive--recurrence, so in which radiotherapy should be standard part of the breast conserving approach, and those women with a more indolent lesion, in which after surgery a watchful waiting approach can be followed.
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Affiliation(s)
- N Bijker
- Department of Radiation Oncology, Academic Medical Center, P.O. Box 22700, 1100DE, Amsterdam, The Netherlands.
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Ascunce N, Delfrade J, Salas D, Zubizarreta R, Ederra M. Programas de detección precoz de cáncer de mama en España: características y principales resultados. Med Clin (Barc) 2013; 141:13-23. [DOI: 10.1016/j.medcli.2012.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
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Mellado Rodríguez M, Osa Labrador A. Cribado de cáncer de mama. Estado actual. RADIOLOGIA 2013; 55:305-14. [DOI: 10.1016/j.rx.2012.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 11/29/2022]
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Mellado Rodríguez M, Osa Labrador A. Breast cancer screening: Current status. RADIOLOGIA 2013. [DOI: 10.1016/j.rxeng.2012.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer 2013; 108:2205-40. [PMID: 23744281 PMCID: PMC3693450 DOI: 10.1038/bjc.2013.177] [Citation(s) in RCA: 617] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- M G Marmot
- UCL Department of Epidemiology and Public Health, UCL Institute of Health Equity, 1-19 Torrington Place, London WC1E 7HB,
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Saxena N, Hartman M, Bhoo-Pathy N, Lim JNW, Aw TC, Iau P, Taib NA, Lee SC, Yip CH, Verkooijen HM. Breast cancer in South East Asia: comparison of presentation and outcome between a middle income and a high income country. World J Surg 2013; 36:2838-46. [PMID: 22926282 DOI: 10.1007/s00268-012-1746-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are large differences in socio-economic growth within the region of South East Asia, leading to sharp contrasts in health-systems development between countries. This study compares breast cancer presentation and outcome between patients from a high income country (Singapore) and a middle income country (Malaysia) in South East Asia. METHODS Within the Singapore Malaysia Breast Cancer Registry we identified all consecutive patients diagnosed with breast cancer between 1993 and 2007 at the National University Hospital in Singapore (high income country, n=2,141) and the University of Malaya Medical Center in Kuala Lumpur, Malaysia (middle income country, n=3,320). We compared demographics, tumor characteristics, treatment patterns, and survival between patients from both countries. RESULTS In Malaysia, patients were less often diagnosed with in situ breast cancer (adjusted odds ratio [ORadj] 0.2; 95% confidence interval [95% CI] 0.1-0.3), more likely to be diagnosed with late stage (III and IV) disease (ORadj for stage III 1.6; 95% CI 1.3-2.0; ORadj for stage IV 1.2; 95% CI 1.1-1.4) as compared to patients from Singapore. Univariate analysis showed that Malaysian patients were at a 72% increased risk of death as compared to Singaporeans. After adjusting for other prognostic factors, the risk decreased by only 5% (ORadj 1.67, 95% CI 1.44-1.92). CONCLUSIONS Differences in way of presentation (except stage and tumor size) and treatment of breast cancer patients from the two countries are small. The overall survival of breast cancer patients from Malaysia is much lower than that of Singaporean patients.
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Affiliation(s)
- Nakul Saxena
- Saw Swee Hock School of Public Health, National University of Singapore, MD3 16 Medical Drive, Singapore, 117597, Singapore
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Broeders M, Moss S, Nyström L, Njor S, Jonsson H, Paap E, Massat N, Duffy S, Lynge E, Paci E. The impact of mammographic screening on breast cancer mortality in Europe: a review of observational studies. J Med Screen 2013; 19 Suppl 1:14-25. [PMID: 22972807 DOI: 10.1258/jms.2012.012078] [Citation(s) in RCA: 270] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To assess the impact of population-based mammographic screening on breast cancer mortality in Europe, considering different methodologies and limitations of the data. METHODS We conducted a systematic literature review of European trend studies (n = 17), incidence-based mortality (IBM) studies (n = 20) and case-control (CC) studies (n = 8). Estimates of the reduction in breast cancer mortality for women invited versus not invited and/or for women screened versus not screened were obtained. The results of IBM studies and CC studies were each pooled using a random effects meta-analysis. RESULTS Twelve of the 17 trend studies quantified the impact of population-based screening on breast cancer mortality. The estimated breast cancer mortality reductions ranged from 1% to 9% per year in studies reporting an annual percentage change, and from 28% to 36% in those comparing post- and prescreening periods. In the IBM studies, the pooled mortality reduction was 25% (relative risk [RR] 0.75, 95% confidence interval [CI] 0.69-0.81) among invited women and 38% (RR 0.62, 95% CI 0.56-0.69) among those actually screened. The corresponding pooled estimates from the CC studies were 31% (odds ratio [OR] 0.69, 95% CI 0.57-0.83), and 48% (OR 0.52, 95% CI 0.42-0.65) adjusted for self-selection. CONCLUSIONS Valid observational designs are those where sufficient longitudinal individual data are available, directly linking a woman's screening history to her cause of death. From such studies, the best 'European' estimate of breast cancer mortality reduction is 25-31% for women invited for screening, and 38-48% for women actually screened. Much of the current controversy on breast cancer screening is due to the use of inappropriate methodological approaches that are unable to capture the true effect of mammographic screening.
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Affiliation(s)
- Mireille Broeders
- Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre & National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands.
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Parameter estimates for invasive breast cancer progression in the Canadian National Breast Screening Study. Br J Cancer 2013; 108:542-8. [PMID: 23322203 PMCID: PMC3593551 DOI: 10.1038/bjc.2012.596] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: The aim of screening is to detect a cancer in the preclinical state. However, a false-positive or a false-negative test result is a real possibility. Methods: We describe invasive breast cancer progression in the Canadian National Breast Screening Study and construct progression models with and without covariates. The effect of risk factors on transition intensities and false-negative probability is investigated. We estimate the transition rates, the sojourn time and sensitivity of diagnostic tests for women aged 40–49 and 50–59. Results: Although younger women have a slower transition rate from healthy state to preclinical, their screen-detected tumour becomes evident sooner. Women aged 50–59 have a higher mortality rate compared with younger women. The mean sojourn times for women aged 40–49 and 50–59 are 2.5 years (95% CI: 1.7, 3.8) and 3.0 years (95% CI: 2.1, 4.3), respectively. Sensitivity of diagnostic procedures for older women is estimated to be 0.75 (95% CI: 0.55, 0.88), while women aged 40–49 have a lower sensitivity (0.61, 95% CI: 0.42, 0.77). Age is the only factor that affects the false-negative probability. For women aged 40–49, ‘age at entry', ‘history of breast disease' and ‘families with breast cancer' are found to be significant for some of the transition rates. For the age-group 50–59, ‘age at entry', ‘history of breast disease', ‘menstruation length' and ‘number of live births' are found to affect the transition rates. Conclusion: Modelling and estimating the parameters of cancer progression are essential steps towards evaluating the effectiveness of screening policies. The parameters include the transition rates, the preclinical sojourn time, the sensitivity, and the effect of different risk factors on cancer progression.
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Nickson C, Mason KE, English DR, Kavanagh AM. Mammographic screening and breast cancer mortality: a case-control study and meta-analysis. Cancer Epidemiol Biomarkers Prev 2012; 21:1479-88. [PMID: 22956730 DOI: 10.1158/1055-9965.epi-12-0468] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Observational studies are necessary to assess the impact of population screening on breast cancer mortality. While some ecological studies have notably found little or no association, case-control studies consistently show strong inverse associations, but they are sometimes ignored, perhaps due to theoretical biases arising from the study design. We conducted a case-control study of breast cancer deaths in Western Australia to evaluate the effect of participation in the BreastScreen Australia program, paying particular attention to potential sources of bias, and undertook an updated meta-analysis of case-control studies. METHODS Our study included 427 cases (women who died from breast cancer), each matched to up to 10 controls. We estimated the association between screening participation and breast cancer mortality, quantifying the effect of potential sources of bias on our findings, including selection bias, information bias, and confounding. We also conducted a meta-analysis of published case-control studies. RESULTS The OR for participation in the Western Australian BreastScreen program in relation to death from breast cancer was 0.48 [95% confidence interval (CI), 0.38-0.59; P < 0.001]. We were unable to identify biases that could negate this finding: sensitivity analyses generated ORs from 0.45 to 0.52. Our meta-analysis yielded an OR of 0.51 (95% CI, 0.46-0.55). CONCLUSIONS Our findings suggest an average 49% reduction in breast cancer mortality for women who are screened. In practice, theoretical biases have little effect on estimates from case-control studies. IMPACT Case-control studies, such as ours, provide robust and consistent evidence that screening benefits women who choose to be screened.
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Affiliation(s)
- Carolyn Nickson
- Centre for Women's Health, Gender and Society, Melbourne School of Population Health, The University of Melbourne, Melbourne, Victoria, Australia.
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Duport N. Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health, Health Care and Insurance Survey. Rev Epidemiol Sante Publique 2012; 60:421-30. [DOI: 10.1016/j.respe.2012.05.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 02/23/2012] [Accepted: 05/07/2012] [Indexed: 11/28/2022] Open
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Urban LABD, Schaefer MB, Duarte DL, Santos RPD, Maranhão NMDA, Kefalas AL, Canella EDO, Ferreira CAP, Peixoto JE, Chala LF, Costa RP, Francisco JLE, Martinelli SE, Amorim HLED, Pasqualette HA, Pereira PMS, Camargo Junior HSAD, Sondermann VR. Recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para rastreamento do câncer de mama por métodos de imagem. Radiol Bras 2012. [DOI: 10.1590/s0100-39842012000600009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Kelava I, Tomicić K, Kokić M, Corusić A, Planinić P, Kirac I, Murgić J, Kulis T, Znaor A. Breast and gynecological cancers in Croatia, 1988-2008. Croat Med J 2012; 53:100-8. [PMID: 22522987 PMCID: PMC3342654 DOI: 10.3325/cmj.2012.53.100] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aim To analyze and interpret incidence and mortality trends of breast and ovarian cancers and incidence trends of cervical and endometrial cancers in Croatia for the period 1988-2008. Methods Incidence data were obtained from the Croatian National Cancer Registry. The mortality data were obtained from the World Health Organization (WHO) mortality database. Trends of incidence and mortality were analyzed by joinpoint regression analysis. Results Joinpoint analysis showed an increase in the incidence of breast cancer with estimated annual percent of change (EAPC) of 2.6% (95% confidence interval [CI], 1.9 to 3.4). The mortality rate was stable, with the EAPC of 0.3% (95% CI, -0.6 to 0.0). Endometrial cancer showed an increasing incidence trend, with EAPC of 0.8% (95% CI, 0.2 to 1.4), while cervical cancer showed a decreasing incidence trend, with EAPC of -1.0 (95% CI, -1.6 to -0.4). Ovarian cancer incidence showed three trends, but the average annual percent change (AAPC) for the overall period was not significant, with a stable trend of 0.1%. Ovarian cancer mortality was increasing since 1992, with EAPC of 1.2% (95% CI, 0.4 to 1.9), while the trend for overall period was stable with AAPC 0.1%. Conclusion Incidence trends of breast, endometrial, and ovarian cancers in Croatia 1988-2008 are similar to the trends observed in most of the European countries, while the modest decline in cervical cancer incidence and lack of decline in breast cancer mortality suggest suboptimal cancer prevention and control.
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Affiliation(s)
- Iva Kelava
- Croatian National Institute of Public Health, Rockefellerova 7, 10000 Zagreb, Croatia
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Zografos G, Koulocheri D, Liakou P, Sofras M, Hadjiagapis S, Orme M, Marmarelis V. Novel technology of multimodal ultrasound tomography detects breast lesions. Eur Radiol 2012; 23:673-83. [PMID: 22983317 DOI: 10.1007/s00330-012-2659-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Revised: 08/19/2012] [Accepted: 08/22/2012] [Indexed: 11/25/2022]
Affiliation(s)
- G Zografos
- Breast Unit, 1st Department of Propaedeutic Surgery, School of Medicine, University of Athens, Athens, Greece.
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77
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Urban L, Urban C. Role of Mammography versus Magnetic Resonance Imaging for Breast Cancer Screening. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0085-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Early detection of cancer has long been thought to be the first step towards eradicating the mortality associated with the disease. National screening programmes for breast cancer have been implemented in many countries. However, there is controversy regarding the efficacy and optimal methods of screening, which is regularly discussed in articles, at conferences and is apparent in conflicting guidelines. In this article, Nature Reviews Clinical Oncology asks four experts their opinions on some of the pressing questions associated with breast cancer screening.
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Lönnberg S, Anttila A, Luostarinen T, Nieminen P. Age-Specific Effectiveness of the Finnish Cervical Cancer Screening Programme. Cancer Epidemiol Biomarkers Prev 2012; 21:1354-61. [DOI: 10.1158/1055-9965.epi-12-0162] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Youlden DR, Cramb SM, Dunn NAM, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol 2012; 36:237-48. [PMID: 22459198 DOI: 10.1016/j.canep.2012.02.007] [Citation(s) in RCA: 463] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/22/2012] [Accepted: 02/26/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND This paper presents the latest international descriptive epidemiological data for invasive breast cancer amongst women, including incidence, survival and mortality, as well as information on mammographic screening programmes. RESULTS Almost 1.4 million women were diagnosed with breast cancer worldwide in 2008 and approximately 459,000 deaths were recorded. Incidence rates were much higher in more developed countries compared to less developed countries (71.7/100,000 and 29.3/100,000 respectively, adjusted to the World 2000 Standard Population) whereas the corresponding mortality rates were 17.1/100,000 and 11.8/100,000. Five-year relative survival estimates range from 12% in parts of Africa to almost 90% in the United States, Australia and Canada, with the differential linked to a combination of early detection, access to treatment services and cultural barriers. Observed improvements in breast cancer survival in more developed parts of the world over recent decades have been attributed to the introduction of population-based screening using mammography and the systemic use of adjuvant therapies. CONCLUSION The future worldwide breast cancer burden will be strongly influenced by large predicted rises in incidence throughout parts of Asia due to an increasingly "westernised" lifestyle. Efforts are underway to reduce the global disparities in survival for women with breast cancer using cost-effective interventions.
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Affiliation(s)
- Danny R Youlden
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Qld 4004, Australia.
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81
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Kallenberg MGJ, Karssemeijer N. Compression paddle tilt correction in full-field digital mammograms. Phys Med Biol 2012; 57:703-15. [PMID: 22241616 DOI: 10.1088/0031-9155/57/3/703] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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82
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Early diagnostic protein biomarkers for breast cancer: how far have we come? Breast Cancer Res Treat 2011; 134:1-12. [PMID: 22179926 DOI: 10.1007/s10549-011-1907-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 11/29/2011] [Indexed: 12/22/2022]
Abstract
Many studies have used surface-enhanced laser desorption/ionization time-of-flight mass spectrometry or matrix-assisted laser desorption/ionization time-of-flight mass spectrometry to search for blood-based proteins that are related to the presence of breast cancer. We review the biomarkers discovered or targeted measured by these methods and discuss the strengths and weaknesses of these studies. We highlight two proteins that were most often related to breast cancer: C3a des-arginine anaphylatoxin (C3adesArg) (molecular weight: 8,938 Da) and fragments of inter-alpha trypsin inhibitor heavy chain H4 (ITIH4). In addition, we elaborate on three important methodological aspects related to these studies: protein identification, specificity of the markers, and disease heterogeneity. Finally, we propose some points to be addressed in future studies. These include the use of other analytical measurement techniques, need of protein identification, the importance of identical sample handling protocols for cases and controls, and the stratification of the results according to molecular subtypes and stages of breast cancer. Ultimately this may lead to the discovery of new and valid breast cancer specific biomarkers.
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83
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Otto SJ, Fracheboud J, Verbeek ALM, Boer R, Reijerink-Verheij JCIY, Otten JDM, Broeders MJM, de Koning HJ. Mammography Screening and Risk of Breast Cancer Death: A Population-Based Case–Control Study. Cancer Epidemiol Biomarkers Prev 2011; 21:66-73. [PMID: 22147362 DOI: 10.1158/1055-9965.epi-11-0476] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Suzie J Otto
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, Rotterdam 3000 CA, The Netherlands.
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Payne H, Cornford P. Prostate-specific antigen: An evolving role in diagnosis, monitoring, and treatment evaluation in prostate cancer. Urol Oncol 2011; 29:593-601. [DOI: 10.1016/j.urolonc.2009.11.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 10/29/2009] [Accepted: 11/04/2009] [Indexed: 10/20/2022]
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Puigpinós-Riera R, Serral G, Pons-Vigués M, Palència L, Rodríguez-Sanz M, Borrell C. Evolution of Inequalities in Breast and Cervical Cancer Screening in Barcelona: Population Surveys 1992, 2001, and 2006. J Womens Health (Larchmt) 2011; 20:1721-7. [DOI: 10.1089/jwh.2010.2478] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosa Puigpinós-Riera
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Departament de Salut Pública, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Gemma Serral
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Mariona Pons-Vigués
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Breast cancer risk assessment: positive predictive value of family history as a predictor of risk. Menopause 2011; 18:621-4. [PMID: 21343830 DOI: 10.1097/gme.0b013e3182027963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the practical usefulness of family history as a tool for breast cancer risk assessment. METHODS Women from the Raloxifene Use for The Heart trial (N = 10,048), which consisted of postmenopausal women with or at high risk for coronary artery disease, were included in this post hoc analysis. The breast cancer risk score at baseline was calculated using the National Cancer Institute's Breast Cancer Risk Assessment tool. The positive predictive value of family history as a predictor of risk was determined for several risk thresholds. RESULTS Almost all (99.6%) women with a family history of breast cancer are found to be at high risk using the National Cancer Institute's accepted cutoff point of at least 1.66%, and almost 98% of women with a family history of breast cancer belong to the high-risk group when the cutoff point for risk score is 2%. CONCLUSIONS Family history alone as a high-risk predictor is associated with a high positive predictive value at commonly used cutoff points based on the risk estimates from the traditional Gail model. Although more complex models of breast cancer risk should still be used as the standard for assessment, screening using family history seems to be a first step in beginning the discussion with women.
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Debald M, Franken S, Heukamp LC, Linke A, Wolfgarten M, Walgenbach KJ, Braun M, Rudlowski C, Gieselmann V, Kuhn W, Hartmann G, Walgenbach-Brünagel G. Identification of specific nuclear structural protein alterations in human breast cancer. J Cell Biochem 2011; 112:3176-84. [DOI: 10.1002/jcb.23249] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Bucchi L. Should breast cancer survivors be excluded from, or invited to, organised mammography screening programmes? BMC Health Serv Res 2011; 11:249. [PMID: 21970334 PMCID: PMC3203044 DOI: 10.1186/1472-6963-11-249] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2011] [Accepted: 10/04/2011] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The prevalence of breast cancer in developed countries has steadily risen over recent decades. Immediate and long-term health needs of patients, including preventive care and screening services, are receiving increasing attention. A question still unresolved is whether breast cancer survivors should receive mammographic surveillance in the clinical or screening setting and, thus, whether they should be excluded from, or invited to, organised mammography screening programmes. The objective of this article is to discuss the many contradictory aspects of this matter. DISCUSSION Problems with mammographic surveillance of breast cancer survivors include: weak evidence of a reduction in mortality; lack of evidence in favour of one setting or the other; lack of evidence-based guidelines for the frequency and duration of surveillance; disproportionate emphasis placed on the first few years post-treatment, probably dictated by surgical and oncological priorities; a variety of screening policies, as these women are permanently or temporarily or partially excluded from many - but not all - organised screening programmes worldwide; an even greater disparity in follow-up protocols used in the clinical setting; a paucity of data on compliance to mammographic surveillance in both settings; and a difficulty in coordinating the roles of health care providers. In the future, the use of mammography in breast cancer survivors will be influenced by the inclusion of women aged > 69 years in organised screening programmes and the implementation of multidisciplinary breast units, and will probably be investigated by research activities on individual risk assessment and risk-tailored screening. In the interim, current problems can be partially alleviated with some technical solutions in screening data recording, patient flows, and care coordination. SUMMARY Mammographic surveillance of breast cancer survivors is situated at the crossroads of numerous different specialist areas of breast cancer control and management. The solutions for current problems probably lie in some important modifications in the conventional screening procedure that are underway or under study. These developments appear to be directed towards a partial modification of the screening rationale, with an adaptation to meet the diversified breast care needs of women. The complexity of the matter constitutes a call to action for several entities to eliminate the barriers to effective research in this field.
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Affiliation(s)
- Lauro Bucchi
- Romagna Cancer Registry, IRST, 47014 Meldola, Forlì, Italy.
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Houssami N. Is Alice still in the Wonderland of breast cancer screening? Maturitas 2011; 70:313-4. [PMID: 21924569 DOI: 10.1016/j.maturitas.2011.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 11/16/2022]
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Sihto H, Lundin J, Lundin M, Lehtimäki T, Ristimäki A, Holli K, Sailas L, Kataja V, Turpeenniemi-Hujanen T, Isola J, Heikkilä P, Joensuu H. Breast cancer biological subtypes and protein expression predict for the preferential distant metastasis sites: a nationwide cohort study. Breast Cancer Res 2011; 13:R87. [PMID: 21914172 PMCID: PMC3262199 DOI: 10.1186/bcr2944] [Citation(s) in RCA: 171] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/28/2011] [Accepted: 09/13/2011] [Indexed: 01/03/2023] Open
Abstract
Introduction Some molecular subtypes of breast cancer have preferential sites of distant relapse. The protein expression pattern of the primary tumor may influence the first distant metastasis site. Methods We identified from the files of the Finnish Cancer Registry patients diagnosed with breast cancer in five geographical regions Finland in 1991-1992, reviewed the hospital case records, and collected primary tumor tissue. Out of the 2,032 cases identified, 234 developed distant metastases after a median follow-up time of 2.7 years and had the first metastatic site documented (a total of 321 sites). Primary tumor microarray (TMA) cores were analyzed for 17 proteins using immunohistochemistry and for erbB2 using chromogenic in situ hybridization, and their associations with the first metastasis site were examined. The cancers were classified into luminal A, luminal B, HER2+ enriched, basal-like or non-expressor subtypes. Results A total of 3,886 TMA cores were analyzed. Luminal A cancers had a propensity to give rise first to bone metastases, HER2-enriched cancers to liver and lung metastases, and basal type cancers to liver and brain metastases. Primary tumors that gave first rise to bone metastases expressed frequently estrogen receptor (ER) and SNAI1 (SNAIL) and rarely COX2 and HER2, tumors with first metastases in the liver expressed infrequently SNAI1, those with lung metastases expressed frequently the epidermal growth factor receptor (EGFR), cytokeratin-5 (CK5) and HER2, and infrequently progesterone receptor (PgR), tumors with early skin metastases expressed infrequently E-cadherin, and breast tumors with first metastases in the brain expressed nestin, prominin-1 and CK5 and infrequently ER and PgR. Conclusions Breast tumor biological subtypes have a tendency to give rise to first distant metastases at certain body sites. Several primary tumor proteins were associated with homing of breast cancer cells.
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Affiliation(s)
- Harri Sihto
- Laboratory of Molecular Oncology, University of Helsinki, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.
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91
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Ascunce N, Ederra M, Delfrade J, Baroja A, Erdozain N, Zubizarreta R, Salas D, Castells X. Impact of intermediate mammography assessment on the likelihood of false-positive results in breast cancer screening programmes. Eur Radiol 2011; 22:331-40. [DOI: 10.1007/s00330-011-2263-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 08/25/2011] [Accepted: 08/29/2011] [Indexed: 12/01/2022]
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92
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Glasziou P, Houssami N. The evidence base for breast cancer screening. Prev Med 2011; 53:100-2. [PMID: 21658406 DOI: 10.1016/j.ypmed.2011.05.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 05/19/2011] [Accepted: 05/25/2011] [Indexed: 11/16/2022]
Abstract
The history of breast cancer screening is littered with controversy. With 10 trials spanning 4 decades, we have a substantial body of evidence, but with different aims and flaws. Combined analysis of the intention-to-treat results gives an overall relative reduction in breast cancer mortality of 19% (95% CI 12%-26%), which, if adjusted for non-attendance gives an approximate 25% relative reduction for those who attend screening. However, given that 4% of all-cause mortality is due to breast cancer deaths, this translates into a less than 1% reduction in all-cause mortality. An emerging issue in interpretation is the improvements in treatment since these trials recruited women. Modern systemic therapy would have improved survival (models suggest between 12% and 21%) in both screened and non-screened groups, which would result in a lesser difference in absolute risk reduction from screening but probably a similar, or slightly smaller, relative risk reduction. However benefits and harms, particularly over-diagnosis, need to balanced and differ by age-groups. The informed views of recipients of screening are needed to guide current and future policy on screening.
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Affiliation(s)
- Paul Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, 4229 Australia.
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93
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Breast cancer screening for women ages 50 to 69 years a systematic review of observational evidence. Prev Med 2011; 53:108-14. [PMID: 21820465 DOI: 10.1016/j.ypmed.2011.07.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Revised: 07/05/2011] [Accepted: 07/11/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To systematically review the observational evidence concerning the effect of screening on breast cancer mortality in actual populations of women ages 50-69 years. METHODS We searched MEDLINE and multiple reference lists for relevant cohort and ecologic studies. At least 2 authors reviewed abstracts and full texts of studies meeting eligibility criteria. We rated each accepted study on standard quality criteria and developed a Summary Evidence Table. RESULTS Seventeen studies met eligibility criteria. Five studies found no to small effect of screening (0-12% relative risk reduction [RRR] in breast cancer mortality), 4 found a large effect (greater than 33% RRR), and 8 found a moderate effect (13% to 33% reduction). The authors found concerns about quality in all studies. There was insufficient evidence to determine whether the effectiveness of screening is decreasing over time. CONCLUSIONS Current observational evidence shows that breast cancer screening in actual populations of women ages 50 to 69 reduces breast cancer mortality; the magnitude of the effect is probably smaller than predicted in the randomized controlled trials. Because the magnitude may change (either increase or decrease) in the future, further ecologic studies are needed. The methodology and infrastructure for these studies should be improved.
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94
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Yao J, Wang LV. Photoacoustic tomography: fundamentals, advances and prospects. CONTRAST MEDIA & MOLECULAR IMAGING 2011; 6:332-45. [PMID: 22025335 PMCID: PMC3205414 DOI: 10.1002/cmmi.443] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Optical microscopy has been contributing to the development of life science for more than three centuries. However, due to strong optical scattering in tissue, its in vivo imaging ability has been restricted to studies at superficial depths. Advances in photoacoustic tomography (PAT) now allow multiscale imaging at depths from sub-millimeter to several centimeters, with spatial resolutions from sub-micrometer to sub-millimeter. Because of this high scalability and its unique optical absorption contrast, PAT is capable of performing anatomical, functional, molecular and fluid-dynamic imaging at various system levels, and is playing an increasingly important role in fundamental biological research and clinical practice. This review discusses recent technical progress in PAT and presents corresponding applications. It ends with a discussion of several prospects and their technical challenges.
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Affiliation(s)
- Junjie Yao
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Campus Box 1097, One Brookings Drive, St. Louis, MO 63130-4899
| | - Lihong V. Wang
- Optical Imaging Laboratory, Department of Biomedical Engineering, Washington University in St. Louis, Campus Box 1097, One Brookings Drive, St. Louis, MO 63130-4899
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95
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Coldman A, Phillips N. Population studies of the effectiveness of mammographic screening. Prev Med 2011; 53:115-7. [PMID: 21798279 DOI: 10.1016/j.ypmed.2011.07.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 07/05/2011] [Accepted: 07/11/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVE To examine population data to see whether survival from breast cancer has improved differentially in screened and unscreened women and examine published studies on mammographic screening to determine whether there is evidence that screening is no longer effective. METHODS Data was reviewed on trends in breast cancer specific survival among women participating and not participating in the British Columbia Breast Screening Program. Population studies of mammographic screening published between 2000 and 2010 with breast cancer mortality as the outcome were also reviewed. RESULTS Breast cancer specific survival in British Columbia improved more in screening participants than non-participants, HR=0.74 (0.58,0.93) between the periods 1990-4 and 2000-4. Among the published studies of mortality between 2000 and 2010 selected from different jurisdictions all had found a reduction in breast cancer mortality although this was not always statistically different from zero. Studies had used a range of designs and evaluative methods which may have contributed to the magnitude of the effect reported. CONCLUSION No evidence was found in the British Columbia data and the published studies reviewed, that treatment or other changes, had caused mammographic screening to become ineffective.
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Affiliation(s)
- Andrew Coldman
- Surveillance and Outcomes Unit, British Columbia Cancer Agency, #800-686 West Broadway, Vancouver, BC, Canada V5Z 1G1.
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96
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Uhry Z, Hédelin G, Colonna M, Asselain B, Arveux P, Exbrayat C, Guldenfelds C, Soler-Michel P, Molinié F, Trétarre B, Rogel A, Courtial I, Danzon A, Guizard A, Ancelle-Park R, Eilstein D, Duffy S. Modelling the effect of breast cancer screening on related mortality using French data. Cancer Epidemiol 2011; 35:235-42. [DOI: 10.1016/j.canep.2010.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/22/2010] [Accepted: 10/31/2010] [Indexed: 11/29/2022]
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Heywang-Köbrunner SH, Hacker A, Sedlacek S. Advantages and Disadvantages of Mammography Screening. ACTA ACUST UNITED AC 2011; 6:199-207. [PMID: 21779225 DOI: 10.1159/000329005] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Mammography screening is the only method presently considered appropriate for mass screening of asymptomatic women. Its frequent use, however, warrants diligent analysis of potential side effects. Radiation risk is far below the natural yearly risk of breast cancer and should not be used as an argument against screening. False-positive calls lead to additional imaging or histopathological assessment, mainly percutaneous breast biopsy. These measures are tolerated and accepted fairly well. Their number is limited by strict quality assurance and constant training. Interval cancers represent a limitation of breast screening that should prompt further research for optimization. Evaluation of overdiagnosis is a highly debated topic in the literature. According to the probably most realistic available calculations, overdiagnosis is acceptable as it is compensated by the potential mortality reduction. Nonetheless, this potential side effect warrants optimal adjustment of therapy to the patient's individual risk. The mortality reduction seen in randomized studies was confirmed by results from national screening programs. A recent case referent study indicated that improvements in mortality reduction run parallel to improved mammographic techniques. Use of less aggressive therapies is another valuable effect of screening. Awareness of potential problems, strict quality assurance, and further research should help to further develop screening programs.
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98
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Majek O, Danes J, Skovajsova M, Bartonkova H, Buresova L, Klimes D, Brabec P, Kozeny P, Dusek L. Breast cancer screening in the Czech Republic: time trends in performance indicators during the first seven years of the organised programme. BMC Public Health 2011; 11:288. [PMID: 21554747 PMCID: PMC3112123 DOI: 10.1186/1471-2458-11-288] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/10/2011] [Indexed: 12/04/2022] Open
Abstract
Background The Czech Breast Cancer Screening Programme (CBCSP) was initiated in September 2002 by establishing a network of accredited centres. The aim of this article is to describe progress in the programme quality over time after the inception of the organised programme. Methods The CBCSP is monitored using an information system consisting of three principal components: 1) the national cancer registry, 2) a screening registry collecting data on all screening examinations, further assessments and final diagnoses at accredited programme centres, and 3) administrative databases of healthcare payers. Key performance indicators from the European Guidelines have been adopted for continuous monitoring. Results Breast cancer incidence in the Czech Republic has steadily been increasing, however with a growing proportion of less advanced stages. The mortality rate has recently stabilised. The screening registry includes 2,083,285 records on screening episodes between 2002 and 2008. In 2007-2008, 51% of eligible women aged 45-69 were screened. In 2008, the detection rates were 6.1 and 3.7 per 1,000 women in initial and subsequent screening respectively. Corresponding recall rates are 3.9% and 2.2%, however, it is necessary to pay attention to further assessment performed during the screening visits. Benign to malignant open biopsy ratio was 0.1. Of invasive cases detected in screening, 35.6% was less than 10 mm in diameter. Values of early performance indicators, as measured by both crude and standardized estimates, are generally improving and fulfil desirable targets set by European Guidelines. Conclusions Mammography screening in the Czech Republic underwent successful transformation from opportunistic prevention to an organised programme. Values of early indicators confirm continuous improvement in different aspects of process quality. Further stimulation of participation through invitation system is necessary to exploit the full potential of screening mammography at the population level.
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Affiliation(s)
- Ondrej Majek
- Institute of Biostatistics and Analyses, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic
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Paap E, Verbeek A, Puliti D, Paci E, Broeders M. Breast cancer screening case–control study design: impact on breast cancer mortality. Ann Oncol 2011; 22:863-869. [DOI: 10.1093/annonc/mdq447] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Magnus MC, Ping M, Shen MM, Bourgeois J, Magnus JH. Effectiveness of mammography screening in reducing breast cancer mortality in women aged 39-49 years: a meta-analysis. J Womens Health (Larchmt) 2011; 20:845-52. [PMID: 21413892 DOI: 10.1089/jwh.2010.2098] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Mammography screening of women >50 years of age significantly reduces breast cancer mortality in randomized controlled trials (RCTs). We sought to evaluate the effectiveness of mammography screening in women aged 39-49 years in reducing breast cancer mortality and to discuss previously published meta-analyses. METHODS PubMed/MEDLINE, OVID, COCHRANE, and Educational Resources Information Center (ERIC) databases were searched, and extracted references were reviewed. Dissertation abstracts and clinical trials databases available online were assessed to identify unpublished works. All assessments were independently done by two reviewers. All trials included were RCTs, published in English, included data on women aged 39-49, and reported relative risk (RR)/odds ratio (OR) or frequency data. RESULTS Nine studies were identified: the Kopparberg, Ostergotland (The Two-County study), Health Insurance Plan (HIP), Canada, Stockholm, Gothenburg, Edinburgh, Age, and Malmo trials. The individual trials were quality assessed, and the data were extracted using predefined forms. Using the DerSimonian and Laird random effects model, the results from the seven RCTs with the highest quality score were combined, and a significant pooled RR estimate of 0.83 (95% confidence interval [CI] 0.72-0.97) was calculated. Post hoc sensitivity analyses excluding studies with randomization before 1980 caused a loss of statistical significance (RR 0.87, 95% CI: 0.56, 1.13). CONCLUSIONS Mammography screenings are effective and generate a 17% reduction in breast cancer mortality in women 39-49 years of age. The quality of the trials varies, and providers should inform women in this age group about the positive and negative aspects of mammography screenings.
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Affiliation(s)
- Maria C Magnus
- Department of Epidemiology, Tulane School of Public Health and Tropical Medicine, 1440 Canal Street, New Orleans, LA 70112, USA.
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