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Farber R, Marinovich ML, Pinna A, Houssami N, McGeechan K, Barratt A, Bell KJL. Systematic review and meta-analysis of prognostic characteristics for breast cancers in populations with digital vs film mammography indicate the transition may have increased both early detection and overdiagnosis. J Clin Epidemiol 2024; 171:111339. [PMID: 38570078 DOI: 10.1016/j.jclinepi.2024.111339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Film mammography has been replaced by digital mammography in breast screening programs globally. This led to a small increase in the rate of detection, but whether the detection of clinically important cancers increased is uncertain. We aimed to assess the impact on tumor characteristics of screen-detected and interval breast cancers. STUDY DESIGN AND SETTING We searched seven databases from inception to October 08, 2023, for publications comparing film and digital mammography within the same population of asymptomatic women at population (average) risk of breast cancer. We recorded reported tumor characteristics and assessed risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions tool. We synthesized results using meta-analyses of random effects. RESULTS Eighteen studies were included in the analysis from 8 countries, including 11,592,225 screening examinations (8,117,781 film; 3,474,444 digital). There were no differences in tumor size, morphology, grade, node status, receptor status, or stage in the pooled differences for screen-detected and interval invasive cancer tumor characteristics. There were statistically significant increases in screen-detected ductal carcinoma in situ (DCIS) across all grades: 0.05 (0.00-0.11), 0.14 (0.05-0.22), and 0.19 (0.05-0.33) per 1000 screens for low, intermediate, and high-grade DCIS, respectively. There were similar (non-statistically significant) increases in screen-detected invasive cancer across all grades. CONCLUSION The increased detection of all grades of DCIS and invasive cancer may indicate both increased early detection of more aggressive disease and increased overdiagnosis.
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Affiliation(s)
- Rachel Farber
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Michael L Marinovich
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Audrey Pinna
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; Department of medical imaging, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nehmat Houssami
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Alexandra Barratt
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Katy J L Bell
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia.
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Farber R, Houssami N, McGeechan K, Barratt A, Bell KJL. Breast Cancer Stage and Size Detected with Film versus Digital Mammography in New South Wales, Australia: A Population-Based Study Using Routinely Collected Data. Cancer Epidemiol Biomarkers Prev 2024; 33:671-680. [PMID: 38407377 DOI: 10.1158/1055-9965.epi-23-0813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 10/25/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Digital mammography has replaced film mammography in breast-screening programs globally, including Australia. This led to an increase in the rate of detection, but whether there was increased detection of clinically important cancers is uncertain. METHODS In this population-wide retrospective cohort study in New South Wales, Australia spanning 2004 to 2016 and including 4,631,656 screens, there were 22,965 cancers in women screened with film (n = 11,040) or digital mammography (n = 11,925). We examined the change in tumor characteristics overall and how these rates changed over time, accounting for changes in background rates using an interrupted time-series. Comparisons were made with unscreened women (n = 26,326) during this time. RESULTS We found increased detection of in situ cancer (3.36 per 10,000 screens), localized invasive, and smaller-sized breast cancers attributable to the change in mammography technology, whereas screen-detected intermediate-sized and metastatic breast cancers decreased. Rates of early-stage and intermediate-sized interval cancers increased, and late-stage (-1.62 per 10,000 screens) and large interval cancers decreased. In unscreened women, there were small increases in the temporal trends of cancers across all stages. CONCLUSIONS At least some of the increased detection of smaller early-stage cancers may have translated into a reduction in larger and late-stage cancers, indicating beneficial detection of cancers that would have otherwise progressed. However, the increased detection of smaller early-stage and small cancers may also have increased over-diagnosis of lesions that would otherwise have not caused harm. IMPACT Robust evaluation of potential benefits and harms is needed after changes to screening programs. See related In the Spotlight, p. 638.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katy J L Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Fatima GN, Fatma H, Saraf SK. Vaccines in Breast Cancer: Challenges and Breakthroughs. Diagnostics (Basel) 2023; 13:2175. [PMID: 37443570 DOI: 10.3390/diagnostics13132175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 06/09/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
Breast cancer is a problem for women's health globally. Early detection techniques come in a variety of forms ranging from local to systemic and from non-invasive to invasive. The treatment of cancer has always been challenging despite the availability of a wide range of therapeutics. This is either due to the variable behaviour and heterogeneity of the proliferating cells and/or the individual's response towards the treatment applied. However, advancements in cancer biology and scientific technology have changed the course of the cancer treatment approach. This current review briefly encompasses the diagnostics, the latest and most recent breakthrough strategies and challenges, and the limitations in fighting breast cancer, emphasising the development of breast cancer vaccines. It also includes the filed/granted patents referring to the same aspects.
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Affiliation(s)
- Gul Naz Fatima
- Division of Pharmaceutical Chemistry, Faculty of Pharmacy, Babu Banarasi Das Northern India Institute of Technology, Lucknow 226028, Uttar Pradesh, India
| | - Hera Fatma
- Division of Pharmaceutical Chemistry, Faculty of Pharmacy, Babu Banarasi Das Northern India Institute of Technology, Lucknow 226028, Uttar Pradesh, India
| | - Shailendra K Saraf
- Division of Pharmaceutical Chemistry, Faculty of Pharmacy, Babu Banarasi Das Northern India Institute of Technology, Lucknow 226028, Uttar Pradesh, India
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Farber R, Houssami N, Barnes I, McGeechan K, Barratt A, Bell KJL. Considerations for Evaluating the Introduction of New Cancer Screening Technology: Use of Interval Cancers to Assess Potential Benefits and Harms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14647. [PMID: 36429373 PMCID: PMC9691207 DOI: 10.3390/ijerph192214647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
This framework focuses on the importance of the consideration of the downstream intermediate and long-term health outcomes when a change to a screening program is introduced. The authors present a methodology for utilising the relationship between screen-detected and interval cancer rates to infer the benefits and harms associated with a change to the program. A review of the previous use of these measures in the literature is presented. The framework presents other aspects to consider when utilizing this methodology, and builds upon an existing framework that helps researchers, clinicians, and policy makers to consider the impacts of changes to screening programs on health outcomes. It is hoped that this research will inform future evaluative studies to assess the benefits and harms of changes to screening programs.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Isabelle Barnes
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Centre for Women’s Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan 2308, Australia
- Australian Longitudinal Study on Women’s Health, The University of Newcastle, Callaghan 2308, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Katy J. L. Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
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Farber R, Houssami N, Wortley S, Jacklyn G, Marinovich ML, McGeechan K, Barratt A, Bell K. Impact of Full-Field Digital Mammography Versus Film-Screen Mammography in Population Screening: A Meta-Analysis. J Natl Cancer Inst 2021; 113:16-26. [PMID: 32572492 PMCID: PMC7781455 DOI: 10.1093/jnci/djaa080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/02/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast screening programs replaced film mammography with digital mammography, and the effects of this practice shift in population screening on health outcomes can be measured through examination of cancer detection and interval cancer rates. METHODS A systematic review and random effects meta-analysis were undertaken. Seven databases were searched for publications that compared film with digital mammography within the same population of asymptomatic women and reported cancer detection and/or interval cancer rates. RESULTS The analysis included 24 studies with 16 583 743 screening examinations (10 968 843 film and 5 614 900 digital). The pooled difference in the cancer detection rate showed an increase of 0.51 per 1000 screens (95% confidence interval [CI] = 0.19 to 0.83), greater relative increase for ductal carcinoma in situ (25.2%, 95% CI = 17.4% to 33.5%) than invasive (4%, 95% CI = -3% to 13%), and a recall rate increase of 6.95 (95% CI = 3.47 to 10.42) per 1000 screens after the transition from film to digital mammography. Seven studies (80.8% of screens) reported interval cancers: the pooled difference showed no change in the interval cancer rate with -0.02 per 1000 screens (95% CI = -0.06 to 0.03). Restricting analysis to studies at low risk of bias resulted in findings consistent with the overall pooled results for all outcomes. CONCLUSIONS The increase in cancer detection following the practice shift to digital mammography did not translate into a reduction in the interval cancer rate. Recall rates were increased. These results suggest the transition from film to digital mammography did not result in health benefits for screened women. This analysis reinforces the need to carefully evaluate effects of future changes in technology, such as tomosynthesis, to ensure new technology leads to improved health outcomes and beyond technical gains.
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Affiliation(s)
- Rachel Farber
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Sally Wortley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Gemma Jacklyn
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Michael L Marinovich
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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Song SY, Hong S, Jun JK. Digital Mammography as a Screening Tool in Korea. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2021; 82:2-11. [PMID: 36237465 PMCID: PMC9432404 DOI: 10.3348/jksr.2021.0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 12/09/2022]
Abstract
국가암검진사업에서 매년 400만 명 이상의 여성이 유방촬영술을 이용한 유방암 검진을 받고 있다. 2000년 디지털 유방촬영술의 도입 이후, 선행 연구들에 의하면 디지털 유방촬영술은 치밀유방을 가진 여성에서 제한적으로 기존의 필름 방식 또는 computed radiography (이하 CR)보다 높은 진단 정확도를 보고하였다. 최근 국가암검진사업에서 수행된 자료를 분석한 결과에 따르면 디지털 유방촬영술의 진단 정확도가 필름 또는 CR 방식에 비해서 치밀유방을 가진 여성뿐만 아니라 모든 연령대의 여성에서 검진 횟수와 상관없이 보다 정확하였다. 우리나라는 OECD 국가 중에서도 높은 유방촬영기기 보급률에도 불구하고 현재 디지털 유방촬영기기의 보급은 전체 유방촬영기기 중, 35% 정도 수준으로 더디기만 하다. 디지털 유방촬영기기로의 신속한 전환을 위하여 수가제도의 개선, 유방 영상 판독 교육 지원 등 관련법과 제도의 정비가 필요할 것이다. 아울러 국가암검진사업에서 보다 많은 여성이 디지털 유방촬영기기를 이용한 유방암 검진을 받을 수 있도록 장비 보급의 지역 간 격차 해소를 위해 노력해야 할 것이다.
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Affiliation(s)
- Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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Luiten JD, Voogd AC, Luiten EJT, Broeders MJM, Roes KCB, Tjan-Heijnen VCG, Duijm LEM. Recall and Outcome of Screen-detected Microcalcifications during 2 Decades of Mammography Screening in the Netherlands National Breast Screening Program. Radiology 2020; 294:528-537. [PMID: 31990268 DOI: 10.1148/radiol.2020191266] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Trends in the detection of suspicious microcalcifications at mammography screening and the yield of these lesions after recall are unknown. Purpose To determine trends in recall and outcome of screen-detected microcalcifications during 20 years of mammography screening. Materials and Methods The authors performed a retrospective analysis of a consecutive series of 817 656 screening examinations (January 1997 to January 2017) in a national breast screening program. In 2009-2010 (transition period), screen-film mammography (SFM) was gradually replaced by full-field digital mammography (FFDM). The recalls of suspicious microcalcifications from all radiology reports and pathologic outcome of recalled women with 2-year follow-up were analyzed. Screening outcome in the era of SFM (1997-2008), the transition period (2009-2010), and the era of FFDM (2011-2016) were compared. Trends over time and variations between the SFM and FFDM periods were expressed by using proportions with 95% confidence intervals (CIs). In cases where the analysis based on the CI confirmed clear periods (eg, before and after introduction of FFDM), pre- and postchange outcomes were compared by using χ2 tests. Results A total of 18 592 women (median age, 59 years; interquartile range, 14 years) were recalled at mammography screening, 3556 of whom had suspicious microcalcifications. The recall rate for microcalcifications increased from 0.1% in 1997-1998 to 0.5% in 2015-2016 (P < .001). This was temporally associated with the change from SFM to FFDM. The recalls yielding ductal carcinoma in situ (DCIS) increased from 0.3 per 1000 screening examinations with SFM to 1.1 per 1000 screening examinations with FFDM (P < .001), resulting in a decrease in the positive predictive value for recall for suspicious microcalcifications from 51% to 33% (P < .001). More than half of all DCIS lesions were high grade (52.6%; 393 of 747). The distribution of DCIS grades was stable during the 20-year screening period (P = .36). Conclusion The recall rate for suspicious microcalcifications at mammographic screening increased during the past 2 decades, whereas the ductal carcinoma in situ detection rate increased less rapidly, resulting in a lower positive predictive value for recall. © RSNA, 2020.
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Affiliation(s)
- Jacky D Luiten
- From the Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands (J.D.L.); School for Oncology and Developmental Biology, GROW Research Institute (J.D.L., V.C.G.T.), and Department of Epidemiology (A.C.V.), Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands (A.C.V.); Department of Breast Surgery, Amphia Hospital, Breda, the Netherlands (E.J.T.L.); Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, the Netherlands (M.J.M.B., K.C.B.R.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., L.E.M.D.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, the Netherlands (V.C.G.T.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Adri C Voogd
- From the Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands (J.D.L.); School for Oncology and Developmental Biology, GROW Research Institute (J.D.L., V.C.G.T.), and Department of Epidemiology (A.C.V.), Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands (A.C.V.); Department of Breast Surgery, Amphia Hospital, Breda, the Netherlands (E.J.T.L.); Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, the Netherlands (M.J.M.B., K.C.B.R.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., L.E.M.D.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, the Netherlands (V.C.G.T.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Ernest J T Luiten
- From the Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands (J.D.L.); School for Oncology and Developmental Biology, GROW Research Institute (J.D.L., V.C.G.T.), and Department of Epidemiology (A.C.V.), Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands (A.C.V.); Department of Breast Surgery, Amphia Hospital, Breda, the Netherlands (E.J.T.L.); Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, the Netherlands (M.J.M.B., K.C.B.R.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., L.E.M.D.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, the Netherlands (V.C.G.T.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Mireille J M Broeders
- From the Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands (J.D.L.); School for Oncology and Developmental Biology, GROW Research Institute (J.D.L., V.C.G.T.), and Department of Epidemiology (A.C.V.), Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands (A.C.V.); Department of Breast Surgery, Amphia Hospital, Breda, the Netherlands (E.J.T.L.); Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, the Netherlands (M.J.M.B., K.C.B.R.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., L.E.M.D.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, the Netherlands (V.C.G.T.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Kit C B Roes
- From the Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands (J.D.L.); School for Oncology and Developmental Biology, GROW Research Institute (J.D.L., V.C.G.T.), and Department of Epidemiology (A.C.V.), Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands (A.C.V.); Department of Breast Surgery, Amphia Hospital, Breda, the Netherlands (E.J.T.L.); Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, the Netherlands (M.J.M.B., K.C.B.R.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., L.E.M.D.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, the Netherlands (V.C.G.T.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Vivianne C G Tjan-Heijnen
- From the Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands (J.D.L.); School for Oncology and Developmental Biology, GROW Research Institute (J.D.L., V.C.G.T.), and Department of Epidemiology (A.C.V.), Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands (A.C.V.); Department of Breast Surgery, Amphia Hospital, Breda, the Netherlands (E.J.T.L.); Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, the Netherlands (M.J.M.B., K.C.B.R.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., L.E.M.D.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, the Netherlands (V.C.G.T.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
| | - Lucien E M Duijm
- From the Department of Surgery, Elisabeth-Tweesteden Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, the Netherlands (J.D.L.); School for Oncology and Developmental Biology, GROW Research Institute (J.D.L., V.C.G.T.), and Department of Epidemiology (A.C.V.), Maastricht University, Maastricht, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organization, Utrecht, the Netherlands (A.C.V.); Department of Breast Surgery, Amphia Hospital, Breda, the Netherlands (E.J.T.L.); Department of Health Evidence, Biostatistics Section, Radboud University Medical Centre, Nijmegen, the Netherlands (M.J.M.B., K.C.B.R.); Dutch Expert Centre for Screening, Nijmegen, the Netherlands (M.J.M.B., L.E.M.D.); Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, Maastricht, the Netherlands (V.C.G.T.); and Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands (L.E.M.D.)
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Yuan Y, Vu K, Shen Y, Dickinson J, Winget M. Importance of quality in breast cancer screening practice - a natural experiment in Alberta, Canada. BMJ Open 2020; 10:e028766. [PMID: 31911508 PMCID: PMC6955468 DOI: 10.1136/bmjopen-2018-028766] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 10/21/2019] [Accepted: 12/11/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Regular breast cancer screening is a widely used cancer prevention strategy. Important quality indicators of screening include cancer detection rate, false positive rate, benign biopsy rate and post-screen invasive cancer rate. We compared quality indicators of community radiology clinics to those of 'Screen Test', which feature centralised batch reading and quality control processes. Both types of providers operated under a single provincial Breast Cancer Screening Programme. SETTING Community radiology clinics are operated by independent fee-for-service radiologists serving large and small communities throughout the Canadian province of Alberta. Launched by the provincial cancer agency, the Screen Test operates two physical clinics serving metropolises and mobile units serving remote regions. Eligible women may self-refer to any provider for screening mammography. PARTICIPANTS Women aged 50 to 69 years who had at least one screening mammogram between July 2006 and June 2010 in Alberta were included. Women with missing health region information or prior breast cancer diagnosis were excluded. RESULTS A total of 389 788 screening mammograms were analysed, of which 12.7% were performed by Screen Test. Compared with Screen Test during 2006 to 2008, community radiology clinics had a lower cancer detection rate (3.6 vs 4.6 per 1000 screens, risk ratio (RR): 0.81, 95% CI: 0.67 to 0.98) and a much higher false positive rate (9.4% vs 3.4%, RR: 2.72, 95% CI: 2.55 to 2.90). Most other performance indicators were also better in Screen Test overall and across all health regions. These performance indicators were similar during 2008 to 2010, showing no improvement with time. CONCLUSIONS Screen Test has a quality assurance process in place and performed significantly better. This provides empirical evidence of the effectiveness of a quality assurance process and may explain some of the large differences in breast cancer screening indicators between provinces and countries with formal programmes and those without.
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Affiliation(s)
- Yan Yuan
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Khanh Vu
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Ye Shen
- School of Public Health, University of Alberta, Edmonton, Canada
| | - James Dickinson
- University of Calgary Cumming School of Medicine, Calgary, Canada
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Hong S, Song SY, Park B, Suh M, Choi KS, Jung SE, Kim MJ, Lee EH, Lee CW, Jun JK. Effect of Digital Mammography for Breast Cancer Screening: A Comparative Study of More than 8 Million Korean Women. Radiology 2019; 294:247-255. [PMID: 31793847 DOI: 10.1148/radiol.2019190951] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Full-field digital mammography (FFDM) has been accepted as a superior modality for breast cancer screening compared with conventional screen-film mammography (SFM), especially in women younger than 50 years or with dense breasts. Purpose To evaluate the accuracy of FFDM for breast cancer screening. Materials and Methods Data from January 1, 2011 to December 31, 2013 in the database from a nationwide breast cancer screening program linked with the national cancer registry were retrospectively analyzed. The study included Korean women aged 40-79 years who had undergone screening mammography with SFM, computed radiography (CR), or FFDM. The sensitivity, specificity, positive predictive value (PPV), and absolute and relative differences among these modalities were calculated, followed by pairwise comparison tests with multiple testing corrections. The areas under the receiver operating characteristic curve (AUCs) were also estimated and compared by using the DeLong method with Bonferroni correction. Results Among the 8 482 803 women included (mean age, 55 years ± 10), 34.4% (2 920 279 of 8 482 803), 51.7% (4 385 807 of 8 482 803), and 13.9% (1 176 717 of 8 482 803) underwent SFM, CR, and FFDM, respectively. The sensitivity and PPV were higher for FFDM than for SFM (adjusted odds ratio, 1.77 [95% confidence interval {CI}: 1.62, 1.95] for sensitivity and 1.36 [95% CI: 1.29, 1.43] for PPV) and CR (adjusted odds ratio, 1.70 [95% CI: 1.56, 1.85] for sensitivity and 1.26 [95% CI: 1.20, 1.32] for PPV), whereas specificity was lower with FFDM. The overall AUC for FFDM was 0.80 (95% CI: 0.80, 0.81), which was higher than that for SFM (0.75 [95% CI: 0.75, 0.76]) and CR (0.76 [95% CI: 0.75, 0.76]). P < .05 was found for differences in sensitivity, PPV, and AUC among modalities overall and in most of the subgroups of age, breast density, and screening round. Conclusion Full-field digital mammography allows better discrimination or prediction of breast cancer in the general female population than screen-film mammography or computed radiography, regardless of age, breast density, or screening round. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Seri Hong
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Soo Yeon Song
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Boyoung Park
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Mina Suh
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Kui Son Choi
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Seung Eun Jung
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Min Jung Kim
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Eun Hye Lee
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Chan Wha Lee
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Jae Kwan Jun
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
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Scimeca M, Urbano N, Bonfiglio R, Duggento A, Toschi N, Schillaci O, Bonanno E. Novel insights into breast cancer progression and metastasis: A multidisciplinary opportunity to transition from biology to clinical oncology. Biochim Biophys Acta Rev Cancer 2019; 1872:138-148. [PMID: 31348975 DOI: 10.1016/j.bbcan.2019.07.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/25/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022]
Abstract
According to the most recent epidemiological studies, breast cancer shows the highest incidence and the second leading cause of death in women. Cancer progression and metastasis are the main events related to poor survival of breast cancer patients. This can be explained by the presence of highly resistant to chemo- and radiotherapy stem cells in many breast tumor tissues. In this context, numerous studies highlighted the possible involvement of epithelial to mesenchymal transition phenomenon as biological program to generate cancer stem cells, and thus participate to both metastatic and drug resistance process. Therefore, the comprehension of mechanisms (both cellular and molecular) involved in breast cancer occurrence and progression can lay the foundation for the development of new diagnostic and therapeutical protocols. In this review, we reported the most important findings in the field of breast cancer highlighting the most recent data concerning breast tumor biology, diagnosis and therapy.
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Affiliation(s)
- Manuel Scimeca
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy; San Raffaele University, Via di Val Cannuta 247, 00166 Rome, Italy; Fondazione Umberto Veronesi (FUV), Piazza Velasca 5, 20122 Milano (Mi), Italy.
| | | | - Rita Bonfiglio
- Department of Experimental Medicine, University "Tor Vergata", Via Montpellier 1, Rome 00133, Italy
| | - Andrea Duggento
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy
| | - Nicola Toschi
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy; Department of Radiology, Athinoula A. Martinos Center for Biomedical Imaging and Harvard Medical School, Massachusetts General Hospital, Boston, MA, United States
| | - Orazio Schillaci
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Via Montpellier 1, Rome 00133, Italy; IRCCS Neuromed, Pozzilli, Italy
| | - Elena Bonanno
- Department of Experimental Medicine, University "Tor Vergata", Via Montpellier 1, Rome 00133, Italy; Neuromed Group, "Diagnostica Medica" and "Villa dei Platani", Avellino, Italy
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11
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Song SY, Park B, Hong S, Kim MJ, Lee EH, Jun JK. Comparison of Digital and Screen-Film Mammography for Breast-Cancer Screening: A Systematic Review and Meta-Analysis. J Breast Cancer 2019; 22:311-325. [PMID: 31281732 PMCID: PMC6597401 DOI: 10.4048/jbc.2019.22.e24] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 04/19/2019] [Indexed: 11/30/2022] Open
Abstract
Purpose Digital mammography (DM) has replaced screen-film mammography (SFM). However, findings of comparisons between the performance indicators of DM and SFM for breast-cancer screening have been inconsistent. Moreover, the summarized results from studies comparing the performance of screening mammography according to device type vary over time. Therefore, this study aimed to compare the performance of DM and SFM using recently published data. Methods The MEDLINE, Embase, and Cochrane Library databases were searched for paired studies, cohorts, and randomized controlled trials published through 2018 that compared the performance of DM and SFM. All studies comparing the diagnostic accuracy of DM and SFM in asymptomatic, average-risk women aged 40 years and older were included. Two reviewers independently assessed the study quality and extracted the data. Results Thirteen studies were included in the meta-analysis. The pooled sensitivity (DM, 0.76 [95% confidence interval {CI}, 0.70–0.81]; SFM, 0.76 [95% CI, 0.70–0.81]), specificity (DM, 0.96 [95% CI, 0.94–0.97]; SFM, 0.97 [95% CI, 0.94–0.98]), and area under the receiver-operating characteristic curve (DM, 0.94 [95% CI, 0.92–0.96]; SFM, 0.92 [95% CI, 0.89–0.94]) were similar for both DM and SFM. The pooled screening performance indicators reinforced superior accuracy of full-field DM, which is a more advanced type of mammography, than SFM. The advantage of DM appeared greater among women aged 50 years or older. There was high heterogeneity among studies in the pooled sensitivity, specificity, and overall diagnostic accuracy estimates. Stratifying by study design (prospective or retrospective) and removing studies with a 2-year or greater follow-up period resulted in homogeneous overall diagnostic accuracy estimates. Conclusion The breast-cancer screening performance of DM is similar to that of SFM. The diagnostic performance of DM depends on the study design, and, in terms of performance, full-field DM is superior to SFM, unlike computed radiography systems.
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Affiliation(s)
- Soo Yeon Song
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Medicine, Hanyang University College of Medicine, Seoul, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Seri Hong
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Min Jung Kim
- Department of Radiology, Severance Hospital, Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Hye Lee
- Department of Radiology, Soonchunhyang University Hospital Bucheon, Soonchunhyang University College of Medicine, Bucheon, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
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12
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Aromaa-Häyhä A, Auvinen P, Sarkeala T, Heinävaara S, Lamminmäki A, Malila N, Kataja V. Improved diagnostics and change of tumour characteristics in breast cancer: a retrospective study over two decades. Acta Oncol 2018; 57:1331-1338. [PMID: 29882462 DOI: 10.1080/0284186x.2018.1479073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Generally, screen-detected cancers have more favourable tumour characteristics than clinically detected or symptomatic cancers. Less is known, whether the tumour characteristics of breast cancer have changed over time into more favourable in general and whether the changes have been similar in all ages. MATERIAL AND METHODS The aim of this study was to explore the change of breast cancer characteristics in parallel to the implementation of modern diagnostic methods in three age groups over four 5-year time periods between 1992 and 2011. The data from 942 primary breast cancers in one university hospital district in Finland were combined with data from the Finnish Cancer Registry and the Mass Screening Registry. The association of favourable tumour characteristics with time period, age group and diagnostic methods was explored. RESULTS The most discernible secular change was the increase in oestrogen (ER)-positive cancers in every consecutive time period. The risk for ER positivity in the second, third and fourth period was 2- to 2.71-fold compared to the first period. An increase in small tumours and node-negative tumours was detected during the most recent years of data collection. The secular changes were observed in all age groups; however, overall ER positivity was most frequent among women beyond screening age and small tumours among screening-aged women. The increase in small and node-negative tumours could partly be explained by the implementation of new radiological methods. CONCLUSIONS This study detected a secular change of tumour characteristics into more favourable irrespective of age group. If the trend continues, it seems that we are going to have a breast cancer population of mainly small ER-positive breast cancers in the future forcing to rethink the therapeutic approach.
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Affiliation(s)
| | - Päivi Auvinen
- Centre of Oncology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | | | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Vesa Kataja
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Jyväskylä Central Hospital, Central Finland Health Care District, Jyväskylä, Finland
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13
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Muller P, Walters S, Coleman MP, Woods L. Which indicators of early cancer diagnosis from population-based data sources are associated with short-term mortality and survival? Cancer Epidemiol 2018; 56:161-170. [PMID: 30056051 PMCID: PMC6189520 DOI: 10.1016/j.canep.2018.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 06/20/2018] [Accepted: 07/16/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND A key component of recent English cancer policy is the monitoring of trends in early diagnosis of cancer. Early diagnosis can be defined by the disease stage at diagnosis or by other indicators derived from electronic health records. We evaluate the association between different early diagnosis indicators and survival, and discuss the implementation of the indicators in surveillance of early diagnosis. METHODS We searched the PubMed database and grey literature to identify early diagnosis indicators and evaluate their association with survival. We analysed cancer registrations for 355,502 cancer patients diagnosed in England during the period 2009-2013, and quantified the association between each early diagnosis indicator and 30-day mortality and five-year net survival. RESULTS Each incremental difference in stage (I-IV) predicts lower 5-year survival, so prognostic information is lost in comparisons which use binary stage indicators. Patients without a recorded stage have high risk of death shortly following diagnosis and lower 5-year survival. Emergency presentation is independently associated with lower five-year survival. Shorter intervals between first symptoms and diagnosis are not consistently associated with improved survival, potentially due to confounding from tumour characteristics. INTERPRETATION Contrary to current practice, we recommend that all the stage information should be used in surveillance. Patients missing stage should also be included to minimise bias. Combined data on stage and emergency presentation could be used to create summary prognostic measures. More work is needed to create statistics based on the diagnostic interval that will be useful for surveillance.
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Affiliation(s)
- Patrick Muller
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
| | - Sarah Walters
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Michel P Coleman
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
| | - Laura Woods
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK
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Autier P, Boniol M, Koechlin A, Pizot C, Boniol M. Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. BMJ 2017; 359:j5224. [PMID: 29208760 PMCID: PMC5712859 DOI: 10.1136/bmj.j5224] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammography screening programme, the Netherlands.Participants Dutch women of all ages, 1989 to 2012.Main outcome measures Stage specific age adjusted incidence of breast cancer from 1989 to 2012. The extra numbers of in situ and stage 1 breast tumours associated with screening were estimated by comparing rates in women aged 50-74 with those in age groups not invited to screening. Overdiagnosis was estimated after subtraction of the lead time cancers. Breast cancer mortality reductions and overdiagnosis during 2010-12 were computed without (scenario 1) and with (scenario 2) a cohort effect on mortality secular trends.Results The incidence of stage 2-4 breast cancers in women aged 50 or more was 168 per 100 000 in 1989 and 166 per 100 000 in 2012. Screening would be associated with a 5% mortality reduction in scenario 1 and with no influence on mortality in scenario 2. In both scenarios, improved treatments would be associated with 28% reductions in mortality. Overdiagnosis has steadily increased over time with the extension of screening to women aged 70-75 and with the introduction of digital mammography. After deduction of clinical lead time cancers, 33% of cancers found in women invited to screening in 2010-12 and 59% of screen detected cancers would be overdiagnosed.Conclusions The Dutch mammography screening programme seems to have little impact on the burden of advanced breast cancers, which suggests a marginal effect on breast cancer mortality. About half of screen detected breast cancers would represent overdiagnosis.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
| | - Magali Boniol
- International Prevention Research Institute, Lyon, France
| | - Alice Koechlin
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
| | - Cécile Pizot
- International Prevention Research Institute, Lyon, France
| | - Mathieu Boniol
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
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Le MT, Mothersill CE, Seymour CB, McNeill FE. Is the false-positive rate in mammography in North America too high? Br J Radiol 2016; 89:20160045. [PMID: 27187600 PMCID: PMC5124917 DOI: 10.1259/bjr.20160045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/04/2016] [Accepted: 05/16/2016] [Indexed: 01/23/2023] Open
Abstract
The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.
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Affiliation(s)
- Michelle T Le
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Carmel E Mothersill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Colin B Seymour
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Fiona E McNeill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
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Domingo L, Hofvind S, Hubbard RA, Román M, Benkeser D, Sala M, Castells X. Cross-national comparison of screening mammography accuracy measures in U.S., Norway, and Spain. Eur Radiol 2016; 26:2520-8. [PMID: 26560729 PMCID: PMC4927608 DOI: 10.1007/s00330-015-4074-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/19/2015] [Accepted: 10/15/2015] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To compare accuracy measures for mammographic screening in Norway, Spain, and the US. METHODS Information from women aged 50-69 years who underwent mammographic screening 1996-2009 in the US (898,418 women), Norway (527,464), and Spain (517,317) was included. Screen-detected cancer, interval cancer, and the false-positive rates, sensitivity, specificity, positive predictive value (PPV) for recalls (PPV-1), PPV for biopsies (PPV-2), 1/PPV-1 and 1/PPV-2 were computed for each country. Analyses were stratified by age, screening history, time since last screening, calendar year, and mammography modality. RESULTS The rate of screen-detected cancers was 4.5, 5.5, and 4.0 per 1000 screening exams in the US, Norway, and Spain respectively. The highest sensitivity and lowest specificity were reported in the US (83.1 % and 91.3 %, respectively), followed by Spain (79.0 % and 96.2 %) and Norway (75.5 % and 97.1 %). In Norway, Spain and the US, PPV-1 was 16.4 %, 9.8 %, and 4.9 %, and PPV-2 was 39.4 %, 38.9 %, and 25.9 %, respectively. The number of women needed to recall to detect one cancer was 20.3, 6.1, and 10.2 in the US, Norway, and Spain, respectively. CONCLUSIONS Differences were found across countries, suggesting that opportunistic screening may translate into higher sensitivity at the cost of lower specificity and PPV. KEY POINTS • Positive predictive value is higher in population-based screening programmes in Spain and Norway. • Opportunistic mammography screening in the US has lower positive predictive value. • Screening settings in the US translate into higher sensitivity and lower specificity. • The clinical burden may be higher for women screened opportunistically.
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Affiliation(s)
- Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg Marítim 25-29, 08003, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Solveig Hofvind
- Department of Screening, Cancer Registry of Norway, P.O. 5313, Majorstua, 0304, Oslo, Norway
- Faculty of Health Science, Oslo and Akershus University College of Applied Sciences, P.O. 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 604 Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Marta Román
- Department of Screening, Cancer Registry of Norway, P.O. 5313, Majorstua, 0304, Oslo, Norway
- National Advisory Unit for Women's Health, Oslo University Hospital, Rikshospitalet, P.O. 4950, Nydalen, 0424, Oslo, Norway
| | - David Benkeser
- Department of Biostatistics, School of Public Health, University of Washington, F-600, Health Sciences Building, Seattle, WA, 98195, USA
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg Marítim 25-29, 08003, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg Marítim 25-29, 08003, Barcelona, Spain.
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.
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Théberge I, Vandal N, Langlois A, Pelletier É, Brisson J. Detection Rate, Recall Rate, and Positive Predictive Value of Digital Compared to Screen-Film Mammography in the Quebec Population-Based Breast Cancer Screening Program. Can Assoc Radiol J 2016; 67:330-338. [PMID: 27451910 DOI: 10.1016/j.carj.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/21/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The study sought to compare performance indicators of computed radiography (CR) using different plate readers, digital direct radiography (DR), and screen-film mammography (SFM) in a population-based screening program. METHODS This analysis involved women 50-69 years of age who participated in the breast screening program of Quebec (Canada) and who had screening mammogram between January 1, 2007, and September 30, 2012. The detection rate, recall rate, and positive predictive value of CR (n = 672,125 mammograms) and DR (n = 60,023) were compared to SFM (n = 782,894) using mixed-effect logistic regression, adjusting for potential confounders. No institutional review board approval was required. RESULTS CR was not associated with change in cancer detection rate (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.88-1.03), but with a small increase in recall rate (OR: 1.03; 95% CI: 1.01-1.06) compared to SFM. The association of CR with recall rate varies with the CR plate reader manufacturer (P < .0001). DR was not associated with change in detection rate (OR: 1.06; 95% CI: 0.89-1.25), but with an increase in the recall rate (OR: 1.25; 95% CI: 1.19-1.30) compared to SFM. CONCLUSIONS In our screening program, digital mammograms gave detection rates equivalent to those of SFM, but with an increase of recall rate, particularly for DR. If this situation persists, the adoption of DR may increase the adverse effects of screening with little or no benefit for women.
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Affiliation(s)
- Isabelle Théberge
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada.
| | - Nathalie Vandal
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - André Langlois
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Éric Pelletier
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Jacques Brisson
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec City, Québec, Canada
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Gossner J. Digital Mammography in Young Women: Is a Single View Sufficient? J Clin Diagn Res 2016; 10:TC10-2. [PMID: 27134963 DOI: 10.7860/jcdr/2016/17342.7502] [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: 10/15/2015] [Accepted: 01/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Single view mammography may be a less time consuming, more comfortable and radiation reduced alternative for young women, but there are no studies examining this approach after the implementation of digital mammography into clinical practice. MATERIALS AND METHODS Retrospective analysis of all mammographies performed in women younger than 40 years during a 24 month period. The sample consisted of 109 women with 212 examined breasts. All patients initially received standard two- view mammography. In the study setting the MLO- views were read by a single viewer and compared to a composite reference standard. RESULTS In this sample 7 malignant findings were present and the review of the MLO-view detected 6 of them (85%). In patients with dense breasts 4 out of 5 malignant findings were found on the single-view (sensitivity 80%) and all 2 malignant findings were detected in patients with low breast density (sensitivity 100%). There were 7 false positive findings (3.3%). i.e. in total 8 out of 212 examined breasts were therefore misinterpreted (3.8%). CONCLUSION Single view digital mammography detects the vast majority of malignant findings, especially in low density breast tissue and the rate of false-positive findings is within acceptable limits. Therefore this approach may be used in different scenarios (for example in increasing patient throughout in resource poor settings, reducing radiation burden in the young or in combination with ultrasound to use the strengths of both methods). More research on this topic is needed to establish its potential role in breast imaging.
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Affiliation(s)
- Johannes Gossner
- Faculty, Department of Clinical Radiology, Evangelisches Krankenhaus Göttingen- Weende , An der Lutter 24, 37024 Göttingen, Germany
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Posso MC, Puig T, Quintana MJ, Solà-Roca J, Bonfill X. Double versus single reading of mammograms in a breast cancer screening programme: a cost-consequence analysis. Eur Radiol 2016; 26:3262-71. [PMID: 26747264 DOI: 10.1007/s00330-015-4175-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 11/30/2015] [Accepted: 12/15/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVES To assess the costs and health-related outcomes of double versus single reading of digital mammograms in a breast cancer screening programme. METHODS Based on data from 57,157 digital screening mammograms from women aged 50-69 years, we compared costs, false-positive results, positive predictive value and cancer detection rate using four reading strategies: double reading with and without consensus and arbitration, and single reading with first reader only and second reader only. Four highly trained radiologists read the mammograms. RESULTS Double reading with consensus and arbitration was 15 % (Euro 334,341) more expensive than single reading with first reader only. False-positive results were more frequent at double reading with consensus and arbitration than at single reading with first reader only (4.5 % and 4.2 %, respectively; p < 0.001). The positive predictive value (9.3 % and 9.1 %; p = 0.812) and cancer detection rate were similar for both reading strategies (4.6 and 4.2 per 1000 screens; p = 0.283). CONCLUSIONS Our results suggest that changing to single reading of mammograms could produce savings in breast cancer screening. Single reading could reduce the frequency of false-positive results without changing the cancer detection rate. These results are not conclusive and cannot be generalized to other contexts with less trained radiologists. KEY POINTS • Double reading of digital mammograms is more expensive than single reading. • Compared to single reading, double reading yields a higher proportion of false-positive results. • The cancer detection rate was similar for double and single readings. • Single reading may be a cost-effective strategy in breast cancer screening programmes.
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Affiliation(s)
- Margarita C Posso
- Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain. .,Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, C/ Sant Antoni Maria Claret, 167. Pavelló 18, planta 0, CP: 08025, Barcelona, Spain.
| | - Teresa Puig
- Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Ma Jesus Quintana
- Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Judit Solà-Roca
- Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Xavier Bonfill
- Epidemiology Department, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain.,Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
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