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Shao SH, Allen B, Clement J, Chung G, Gao J, Hubbell E, Liu MC, Swanton C, Tang WW, Yimer H, Tummala M. Multi-cancer early detection test sensitivity for cancers with and without current population-level screening options. TUMORI JOURNAL 2023; 109:335-341. [PMID: 36316952 PMCID: PMC10248281 DOI: 10.1177/03008916221133136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 09/23/2022] [Accepted: 09/26/2022] [Indexed: 11/18/2022]
Abstract
There are four solid tumors with common screening options in the average-risk population aged 21 to 75 years (breast, cervical, colorectal, and, based on personalized risk assessment, prostate), but many cancers lack recommended population screening and are often detected at advanced stages when mortality is high. Blood-based multi-cancer early detection tests have the potential to improve cancer mortality through additional population screening. Reported here is a post-hoc analysis from the third Circulating Cell-free Genome Atlas substudy to examine multi-cancer early detection test performance in solid tumors with and without population screening recommendations and in hematologic malignancies. Participants with cancer in the third Circulating Cell-free Genome Atlas substudy analysis were split into three subgroups: solid screened tumors (breast, cervical, colorectal, prostate), solid unscreened tumors, and hematologic malignancies. In this post hoc analysis, sensitivity is reported for each subgroup across all ages and those aged ⩾50 years overall, by cancer, and by clinical cancer stage. Aggregate sensitivity in the solid screened, solid unscreened, and hematologic malignancy subgroups was 34%, 66%, and 55% across all cancer stages, respectively; restricting to participants aged ⩾50 years showed similar aggregate sensitivity. Aggregate sensitivity was 27%, 53%, and 60% across stages I to III, respectively. Within the solid unscreened subgroup, aggregate sensitivity was >75% in 8/18 cancers (44%) and >50% in 13/18 (72%). This multi-cancer early detection test detected cancer signals at high (>75%) sensitivity for multiple cancers without existing population screening recommendations, suggesting its potential to complement recommended screening programs.Clinical trial identifier: NCT02889978.
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Affiliation(s)
| | - Brian Allen
- GRAIL, LLC, a subsidiary of Illumina Inc.,
Menlo Park, CA, USA†
| | | | - Gina Chung
- The Christ Hospital Health Network,
Cincinnati, OH, USA
| | - Jingjing Gao
- GRAIL, LLC, a subsidiary of Illumina Inc.,
Menlo Park, CA, USA†
| | - Earl Hubbell
- GRAIL, LLC, a subsidiary of Illumina Inc.,
Menlo Park, CA, USA†
| | | | - Charles Swanton
- The Francis Crick Institute, London, UK
- University College London Cancer Institute,
London, UK
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2
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Park GE, Kang BJ, Kim SH, Lee J. Retrospective Review of Missed Cancer Detection and Its Mammography Findings with Artificial-Intelligence-Based, Computer-Aided Diagnosis. Diagnostics (Basel) 2022; 12:diagnostics12020387. [PMID: 35204478 PMCID: PMC8871484 DOI: 10.3390/diagnostics12020387] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 11/24/2022] Open
Abstract
To investigate whether artificial-intelligence-based, computer-aided diagnosis (AI-CAD) could facilitate the detection of missed cancer on digital mammography, a total of 204 women diagnosed with breast cancer with diagnostic (present) and prior mammograms between 2018 and 2020 were included in this study. Two breast radiologists reviewed the mammographic features and classified them into true negative, minimal sign or missed cancer. They analyzed the AI-CAD results with an abnormality score and assessed whether the AI-CAD correctly localized the known cancer sites. Of the 204 cases, 137 were classified as true negative, 33 as minimal signs, and 34 as missed cancer. The sensitivity, specificity and diagnostic accuracy of AI-CAD were 84.7%, 91.5% and 86.3% on diagnostic mammogram and 67.2%, 91.2% and 83.38% on prior mammogram, respectively. The AI-CAD correctly localized 27 cases from 34 missed cancers on prior mammograms. The findings in the preceding mammography of AI-CAD-detected missed cancer were common in the order of calcifications, focal asymmetry and asymmetry. Asymmetry was the most common finding among the seven cases, which could not be detected by AI-CAD in the missed cases (5/7). The assistance of AI-CAD can be helpful in the early detection of breast cancer in mammography screenings.
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Zhang F, de Haan-Du J, Sidorenkov G, Landman GWD, Jalving M, Zhang Q, de Bock GH. Type 2 Diabetes Mellitus and Clinicopathological Tumor Characteristics in Women Diagnosed with Breast Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13194992. [PMID: 34638475 PMCID: PMC8508341 DOI: 10.3390/cancers13194992] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/17/2021] [Accepted: 09/29/2021] [Indexed: 02/05/2023] Open
Abstract
Poor prognosis caused by type 2 diabetes mellitus (T2DM) in women with breast cancer is conferred, while the association between T2DM and breast tumor aggressiveness is still a matter of debate. This study aimed to clarify the differences in breast cancer characteristics, including stage, size, lymph node status, grade, estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor (Her2), between patients with and without pre-existing T2DM. PubMed, Embase, and Web of Science were searched for studies from 1 January 2010 to 2 July 2021. Adjusted odds ratios (ORs) with 95% confidence intervals (CIs) were pooled by using a random effects model. T2DM was significantly associated with tumor stages III/IV versus cancers in situ and stages I/II (pooled ORs (pOR), 95% CI: 1.19; 1.04-1.36, p = 0.012), tumor size >20 versus ≤20 mm (pOR, 95% CI: 1.18; 1.04-1.35, p = 0.013), and lymph node invasion versus no involvement (pOR, 95% CI: 1.26; 1.05-1.51, p = 0.013). These findings suggest that women with T2DM are at a higher risk of late-stage tumors, large tumor sizes, and invasive lymph nodes at breast cancer diagnosis.
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Affiliation(s)
- Fan Zhang
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.Z.); (J.d.H.-D.); (G.H.d.B.)
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China;
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
| | - Jing de Haan-Du
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.Z.); (J.d.H.-D.); (G.H.d.B.)
| | - Grigory Sidorenkov
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.Z.); (J.d.H.-D.); (G.H.d.B.)
- Correspondence:
| | - Gijs W. D. Landman
- Department of Internal Medicine, Gelre Hospital, 7334 DZ Apeldoorn, The Netherlands;
| | - Mathilde Jalving
- Department of Oncology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands;
| | - Qingying Zhang
- Department of Preventive Medicine, Shantou University Medical College, Shantou 515041, China;
- Guangdong Provincial Key Laboratory for Breast Cancer Diagnosis and Treatment, Cancer Hospital of Shantou University Medical College, Shantou 515041, China
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (F.Z.); (J.d.H.-D.); (G.H.d.B.)
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Bar Y, Bar K, Itzhak I, Niselbaum CS, Dershowitz N, Shachar E, Weiss-Meilik A, Golan O, Wolf I, Menes T, Sonnenblick A. The impact of tumor detection method on genomic and clinical risk and chemotherapy recommendation in early hormone receptor positive breast cancer. Breast 2021; 60:78-85. [PMID: 34509707 PMCID: PMC8437822 DOI: 10.1016/j.breast.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/16/2021] [Accepted: 09/03/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Symptomatic breast cancers share aggressive clinico-pathological characteristics compared to screen-detected breast cancers. We assessed the association between the method of cancer detection and genomic and clinical risk, and its effect on adjuvant chemotherapy recommendations. PATIENTS AND METHODS Patients with early hormone receptor positive (HR+) HER2neu-negative (HER2-) breast cancer, and known OncotypeDX Breast Recurrence Score test were included. A natural language processing (NLP) algorithm was used to identify the method of cancer detection. The clinical and genomic risks of symptomatic and screen-detected tumors were compared. RESULTS The NLP algorithm identified the method of detection of 401 patients, with 216 (54%) diagnosed by routine screening, and the remainder secondary to symptoms. The distribution of OncotypeDX recurrence score (RS) varied between the groups. In the symptomatic group there were lower proportions of low RS (13% vs 23%) and higher proportions of high RS (24% vs. 13%) compared to the screen-detected group. Symptomatic tumors were significantly more likely to have a high clinical risk (59% vs 40%). Based on genomic and clinical risk and current guidelines, we found that women aged 50 and under, with a symptomatic cancer, had an increased probability of receiving adjuvant chemotherapy recommendation compared to women with screen-detected cancers (60% vs. 37%). CONCLUSIONS We demonstrated an association between the method of cancer detection and both genomic and clinical risk. Symptomatic breast cancer, especially in young women, remains a poor prognostic factor that should be taken into account when evaluating patient prognosis and determining adjuvant treatment plans.
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Affiliation(s)
- Yael Bar
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kfir Bar
- School of Computer Science, The College of Management, Rishon LeZion, Israel; School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Itay Itzhak
- School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eliya Shachar
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Orit Golan
- Radiology Department, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah Menes
- Department of Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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The Role of Screening Mammography in Addressing Disparities in Breast Cancer Diagnosis, Treatment, and Outcomes. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Alanko J, Tanner M, Vanninen R, Auvinen A, Isola J. Triple-negative and HER2-positive breast cancers found by mammography screening show excellent prognosis. Breast Cancer Res Treat 2021; 187:267-274. [PMID: 33420595 PMCID: PMC8062374 DOI: 10.1007/s10549-020-06060-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/15/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Our purpose was to explore the prognosis of aggressive breast cancers of the HER2 oncogene amplification (HER2 +) and triple-negative (TN) subtypes detected by screening, as well as the prognosis of interval cancers (clinically due to symptoms between screening rounds) and cancers in screening nonparticipants. METHODS The study population comprised of 823 breast cancers in women aged 50-69 years from 2006-2014. Of these, 572 were found by screening mammography (69%), 170 were diagnosed between the screening rounds (21%), and 81 were diagnosed in women who did not participate in the screening program (10%). RESULTS The majority of all HER2 + (59%) and TN cancers (57%) in this age group were detected by screening. Screen-detected HER2 + tumors were small (median 12 mm), and node-negative (84%). During a median follow-up of eight years, the distant disease-free survival of screen-detected HER2 + and TN cancers was better than that of interval and nonparticipant cancers (age-adjusted HR = 0.16, 95% CI 0.03-0.81 and HR = 0.09, 95% CI 0.01-0.79, respectively). In nonparticipants, the distant disease-free survival of these cancers was worse than in participants (age-adjusted HR = 2.52, 95% CI 0.63-10.11 and HR = 5.30, 95% 1.16-24.29, respectively). CONCLUSION In the 50-69 age group, the majority of HER2 + and TN cancers can be found by a quality assured population-based mammography screening. Despite their generally aggressive behavior, after a median follow-up of 8 years, distant disease-free survival was over 90% of these cancers detected by screening. The worst prognosis of these cancers was in women who did not participate in screening.
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Affiliation(s)
- Johanna Alanko
- Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Screening Clinic of Terveystalo, Tampere University, Tampere, Finland.
| | - Minna Tanner
- Department of Oncology, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, School of Medicine, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - Jorma Isola
- Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Jilab Inc., Tampere University, Tampere, Finland
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Dave RV, Cheung S, Sibbering M, Kearins O, Jenkins J, Gandhi A. Residual lymph node tumour burden following removal of a single axillary sentinel lymph with macrometastatic disease in women with screen-detected invasive breast cancer. BJS Open 2020; 5:6024956. [PMID: 33688940 PMCID: PMC7944503 DOI: 10.1093/bjsopen/zraa022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 09/11/2020] [Indexed: 01/28/2023] Open
Abstract
Background Women with screen-detected invasive breast cancer who have macrometastatic disease on axillary sentinel lymph node biopsy (SLNB) are usually offered either surgical axillary node clearance (ANC) or axillary radiotherapy. These treatments can lead to significant complications for patients. The aim of this study was to identify a group of patients who may not require completion ANC. Methods Data from the NHS Breast Screening Programme between 1 April 2012 and 31 March 2017 were interrogated to identify women with invasive breast carcinoma and a single sentinel lymph node (SLN) with macrometastatic disease who subsequently proceeded to completion ANC. Univariable and multivariable analyses were performed to identify patients with a single positive SLN who had no further lymph node metastasis on ANC. Results Of the 2401 women included in the cohort, the presence of non-sentinel node disease was significantly affected by: the number of nodes obtained at SLNB (odds ratio (OR) 0.49 for retrieval of more than 1 node), invasive size of tumour (OR 1.63 for size greater than 20 mm), surgical treatment (OR 1.34 for mastectomy), human epidermal growth factor receptor (HER) 2 status (OR 0.71 for HER2 positivity), and patient age (OR 1.10 for age less than 50 years; OR 1.46 for age greater than 70 years). Patients aged less than 70 years, with tumour size smaller than 2 cm, more than one node retrieved on SLNB, and who had breast-conserving surgery had a lower chance of positive non-sentinel nodes on completion ANC compared with other patients. Conclusion This study, of a purely screen-detected breast cancer cohort, identified a subset of patients who may be spared completion ANC in the event of a single axillary SLN with macrometastasis.
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Affiliation(s)
- R V Dave
- The Nightingale Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - S Cheung
- National Health Service Breast Screening Programme, Public Health England, Birmingham, UK
| | - M Sibbering
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - O Kearins
- National Health Service Breast Screening Programme, Public Health England, Birmingham, UK
| | - J Jenkins
- National Health Service Breast Screening Programme, Public Health England, Birmingham, UK
| | - A Gandhi
- The Nightingale Centre, Wythenshawe Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK.,Manchester Academic Health Sciences Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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López-García MÁ, Carretero-Barrio I, Pérez-Míes B, Chiva M, Castilla C, Vieites B, Palacios J. Low Prevalence of HER2-Positive Breast Carcinomas among Screening Detected Breast Cancers. Cancers (Basel) 2020; 12:cancers12061578. [PMID: 32549380 PMCID: PMC7352518 DOI: 10.3390/cancers12061578] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022] Open
Abstract
Conflicting results have been reported regarding the prevalence of screen-detected human epidermal growth factor receptor 2 (HER2)-positive breast carcinomas and non-screen detected HER2-positive breast carcinomas. To address this issue, we evaluated the prevalence of HER2-positive breast carcinomas in two independent regional screening programs in Spain. The clinicopathologic and immunohistochemical characteristics of 479 (306 and 173) screen-detected breast carcinomas and 819 (479 and 340) non-screen-detected breast carcinomas diagnosed in women between 50 and 69-year-olds were compared. The prevalence of HER2-positive breast carcinomas was 8.8% and 6.4% in the two series of screen-detected tumors, compared with 16.4% and 13% in non-screen-detected carcinomas. These differences were statistically significant. This lower prevalence of HER2-positive in-screen-detected breast carcinomas was observed in both hormone receptor positive (luminal HER2) and hormone-receptor-negative (HER2 enriched) tumors. In addition, a lower prevalence of triple-negative and a higher prevalence of luminal-A breast carcinomas was observed in screen-detected tumors. Moreover, a literature review pointed out important differences in subrogate molecular types in screen-detected breast carcinomas among reported series, mainly due to study design, technical issues and racial differences.
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Affiliation(s)
- M. Ángeles López-García
- Unidad de Anatomía Patológica, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (M.Á.L.-G.); (B.V.)
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
| | | | - Belén Pérez-Míes
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Pathology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
- Universidad de Alcalá de Henares, 28801 Madrid, Spain
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
- IRyCIS, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Miguel Chiva
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
- Radiology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
| | - Carolina Castilla
- Nodo Biobanco Hospital Universitario Virgen del Rocío—Instituto de Biomedicina de Sevilla, Biobanco del SSPA, Unidad de Anatomía Patológica, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain;
| | - Begoña Vieites
- Unidad de Anatomía Patológica, Hospital Universitario Virgen del Rocío, 41013 Sevilla, Spain; (M.Á.L.-G.); (B.V.)
| | - José Palacios
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Instituto de Salud Carlos III, 28029 Madrid, Spain;
- Pathology Department, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
- Universidad de Alcalá de Henares, 28801 Madrid, Spain
- Breast Pathology Unit, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain;
- IRyCIS, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
- Correspondence: ; Tel.: +34-91-336-8337
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Szukis HA, Qin B, Xing CY, Doose M, Xu B, Tsui J, Lin Y, Hirshfield KM, Ambrosone CB, Demissie K, Hong CC, Bandera EV, Llanos AAM. Factors Associated with Initial Mode of Breast Cancer Detection among Black Women in the Women's Circle of Health Study. JOURNAL OF ONCOLOGY 2019; 2019:3529651. [PMID: 31354818 PMCID: PMC6637674 DOI: 10.1155/2019/3529651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/07/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
Mammogram-detected breast cancers have a better prognosis than those identified through clinical breast exam (CBE) or through self-detection, primarily because tumors detected by mammography are more likely to be smaller and do not involve regional nodes. In a sample of 1,322 Black women, aged 40-75 years, diagnosed with breast cancer between 2002 and 2016, we evaluated factors associated with CBE and self-detection versus screening mammogram as the initial mode of breast cancer detection, using multivariable logistic regression models. Compared with screening mammogram, history of routine screening mammogram (OR 0.20, 95% CI: 0.07, 0.54) and performance of breast self-examination (BSE) (OR 0.31, 95% CI: 0.13, 0.74) before diagnosis were associated with lower odds of CBE as the initial mode of detection, while performance of CBEs before diagnosis (OR 11.04, 95% CI: 2.24, 54.55) was positively associated. Lower body mass index (<25.0 kg/m2 vs. ≥35.0 kg/m2: OR 2.46, 95% CI: 1.52, 3.98), performance of BSEs before diagnosis (less than once per month: OR 4.08, 95% CI: 2.45, 6.78; at least monthly: OR 4.99, 95% CI: 3.13, 7.97), and larger tumor size (1.0-2.0 cm vs. <1.0 cm: OR 2.92, 95% CI: 1.84, 4.64; >2.0 cm vs. <1.0 cm: OR 6.41, 95% CI: 3.30, 12.46) were associated with increased odds of self-detection relative to screening mammogram. The odds of CBE and self-detection as initial modes of breast cancer detection among Black women are independently associated with breast care and breast cancer screening services before diagnosis and with larger tumors at diagnosis.
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Affiliation(s)
- Holly A. Szukis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Bo Qin
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
| | - Cathleen Y. Xing
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Michelle Doose
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Baichen Xu
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
| | - Jennifer Tsui
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Yong Lin
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
- Biometrics Division, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
| | - Kim M. Hirshfield
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christine B. Ambrosone
- Division of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kitaw Demissie
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Chi-Chen Hong
- Division of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Elisa V. Bandera
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
| | - Adana A. M. Llanos
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
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Özmen V, Özmen T, Doğru V. Breast Cancer in Turkey; An Analysis of 20.000 Patients with Breast Cancer. Eur J Breast Health 2019; 15:141-146. [PMID: 31312788 DOI: 10.5152/ejbh.2019.4890] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/08/2019] [Indexed: 01/22/2023]
Abstract
Objective Breast cancer is the most common type of cancer and the leading cause of cancer-related deaths in women in Turkey. This study presents the characteristics of patients registered in National Breast Cancer Registry Program of Turkish Federation of Breast Diseases Societies. Materials and Methods The registry contains 242 variables under 10 categories and 699 questions. Patients were recorded (online and offline) from nationwide breast centers around Turkey. Results Twenty-thousand patients were registered between May 2005 and April 2017 at 36 centers. After data cleaning, 19,503 women were included in the study. The median age at diagnosis was 51 [14-97]; 17.2% were younger than 40 and 37.2% were premenopausal; 13.6% were nulliparous. Breast conserving surgery rate was 39.3%. Histopathology was invasive ductal cancer in 77%. Majority of patients had stage II cancer (48.3%). Estrogen, progesterone and HER-2 receptor positivity rates in invasive breast cancer were 72.5%, 62.5% and 21.8%, respectively. The mean tumor diameter was 2.5±1.7 cm. During the mean 51.6 months of follow-up, the local/regional and systemic recurrence rates were 3.7% and 5.2%, respectively; five and 10-year overall survival rates were 86% and 76%. Conclusion Despite increasing number of screening centers and free-of-charge mammography (ages 40 to 69) and mobile screening systems in recent years, a significant portion of patients were diagnosed at advanced stage due to lack of breast cancer awareness. In contrast with the study published 5 years ago, there was a decrease in the rate of pre-menopausal women and an increase in the breast conserving surgery.
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Affiliation(s)
- Vahit Özmen
- Department of Surgery, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
| | - Tolga Özmen
- Department of Surgery, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Florida, USA
| | - Volkan Doğru
- Department of Surgery, Akdeniz University School of Medicine, Antalya, Turkey
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11
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Lawrenson R, Lao C, Jacobson G, Seneviratne S, Scott N, Sarfati D, Elwood M, Campbell I. Outcomes in different ethnic groups of New Zealand patients with screen-detected vs. non-screen-detected breast cancer. J Med Screen 2019; 26:197-203. [PMID: 31068074 DOI: 10.1177/0969141319844801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To compare characteristics and survival of New Zealand European, Māori, and Pacific women with screen-detected vs. non-screen-detected breast cancer. Methods Women aged 45–69 diagnosed with invasive breast cancer between January 2005 and May 2013 were identified from the Waikato and Auckland Breast Cancer Registries. Patient demographics and tumour characteristics were described by detection mode and ethnicity. Kaplan–Meier method was used to estimate the five-year breast cancer-specific survival of women with stage I–III breast cancer by ethnicity and detection mode. Results Women with screen-detected cancers were older, had smaller tumours, fewer stage IV (0.8% vs. 7.6%), fewer high grade (16.8% vs. 39.0%), and fewer lymph node positive diseases (26.3% vs. 51.5%) than women with non-screen-detected cancers. There were more Luminal A (70.0% vs. 54.0%), fewer human epidermal growth factor receptor 2 positive non-Luminal (4.4% vs. 8.8%), and fewer triple negative cases (7.0% vs. 13.8%) in screen-detected than non-screen-detected cancers. If not screen detected, 22.7% of breast cancers in Pacific women were stage IV compared with 2.4% if screen detected. If not screen detected, the five-year breast cancer-specific survival was 91.1% for New Zealand European women, 84.2% for Māori women, and 80.2% for Pacific women (p-value <0.001). For screen-detected breast cancer, survival between different ethnic groups was similar. Conclusions Breast cancers detected through screening are diagnosed at an earlier stage and have a greater proportion of subtypes, with better outcome. Variations in survival for Māori and Pacific women are only found in women with non-screen-detected breast cancer.
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Affiliation(s)
- Ross Lawrenson
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Chunhuan Lao
- Waikato Medical Research Centre, The University of Waikato, Hamilton, New Zealand
| | - Gregory Jacobson
- Department of Biological Science, The University of Waikato, Hamilton, New Zealand
| | | | - Nina Scott
- Waikato District Health Board, Hamilton, New Zealand
| | - Diana Sarfati
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Mark Elwood
- School of Population Health, The University of Auckland, Auckland, New Zealand
| | - Ian Campbell
- School of Medicine, The University of Auckland, Auckland, New Zealand
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12
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Screening status, tumour subtype, and breast cancer survival: a national population-based analysis. Breast Cancer Res Treat 2018; 172:133-142. [PMID: 30006795 DOI: 10.1007/s10549-018-4877-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 05/31/2018] [Indexed: 01/27/2023]
Abstract
PURPOSE We examined whether demographic and tumour characteristics (including subtype) were different for women with breast cancer diagnosed via mammography screening compared with women with interval breast cancers, lapsed attenders of the screening programme and non-participants of the screening programme. In addition, we explored whether there were survival differences between the groups, taking into account lead time bias. METHODS We used linked data from National Cancer Registry Ireland and the national breast screening programme BreastCheck. Multinomial logistic regression was used to test the association of covariates with screening status. For survival analysis, we corrected the survival time for screen-detected cases for lead time bias, examined Kaplan-Meier curves and then used Cox regression to investigate differences in survival by screening status. RESULTS Subtype (HER2 over-expressing, triple negative), stage (III/IV), grade (poor), having co-morbidities, area of deprivation, smoking status and age were associated with having interval cancer or being a non-participant of the screening programme in the multivariable model. After correcting for lead time bias, and adjusting for variables associated with screening status, there was no evidence that risk of breast-cancer death for women with screen-detected cancer was different from women with interval cancer (HR = 0.76, 95% CI 0.56-1.03), non-participants (HR = 1.07, 95% CI 0.84-1.37) and lapsed attenders (HR = 0.97, 95% CI 0.65-1.45). CONCLUSIONS Screening status was strongly associated with subtype and this association persisted after adjustment for covariates including tumour stage and grade. After correcting for lead-time bias and adjusting for stage, subtype, grade and socio-demographic variables, no significant survival difference was demonstrated for women with screen-detected cancer in the 5-year period post-diagnosis. Since we are adjusting for stage, subtype and other variables, the lack of difference between these groups would be expected but has not been demonstrated in studies which do not correct for lead time bias.
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13
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Holloway CMB, Jiang L, Whitehead M, Racz JM, Groome PA. Organized screening detects breast cancer at earlier stage regardless of molecular phenotype. J Cancer Res Clin Oncol 2018; 144:1769-1775. [PMID: 29909564 DOI: 10.1007/s00432-018-2687-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 06/12/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE Mortality reduction attributable to organized breast screening is modest. Screening may be less effective at detecting more aggressive cancers at an earlier stage. This study was conducted to determine the relative efficacy of screening mammography to detect cancers at an earlier stage by molecular phenotype. METHODS We identified 2882 women with primary invasive breast cancer diagnosed between January 1, 2008 and December 31, 2012 and who had a mammogram through the Ontario Breast Screening Program in the 28 months before diagnosis. Five tumor phenotypes were defined by expression of estrogen (ER) and progesterone (PR) receptors and HER2/neu oncogene. We conducted univariable and multivariable analyses to describe the predictors of detection as an interval cancer. Additional analyses identified predictors of detection at stages II, III, or IV compared with stage I, by phenotype. Analyses were adjusted for the effects of age, grade, and breast density. RESULTS ER negative and HER2 positive tumors were over-represented among interval cancers, and triple negative cancers were more likely than ER +/HER2 - cancers to be detected as interval cancers OR 2.5 (95% CI 2.0-3.2, p < 0.0001). Method of detection (interval vs. screen) and molecular phenotype were independently associated with stage at diagnosis (p < 0.0001), but there was no interaction between method of detection and phenotype (p = 0.44). CONCLUSION In a screened population, triple negative and HER2 + breast cancers are diagnosed at a higher stage but this appears to be due to higher growth rates of these tumors rather than a relative inability of screening to detect them.
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Affiliation(s)
- Claire M B Holloway
- Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Sunnybrook Health Sciences Centre, T2-109 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada.
| | - Li Jiang
- Critical Care Services Ontario, University Health Network, Toronto, Canada
| | - Marlo Whitehead
- Institute for Clinical Evaluative Sciences, Queen's University, Kingston, ON, Canada
| | - Jennifer M Racz
- Division of Breast, Endocrine, Metabolic and Gastrointestinal Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Patti A Groome
- Institute for Clinical Evaluative Sciences and Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen's University, Kingston, ON, Canada
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14
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Puvanesarajah S, Nyante SJ, Kuzmiak CM, Chen M, Tse CK, Sun X, Allott EH, Kirk EL, Carey LA, Perou CM, Olshan AF, Henderson LM, Troester MA. PAM50 and Risk of Recurrence Scores for Interval Breast Cancers. Cancer Prev Res (Phila) 2018; 11:327-336. [PMID: 29622545 PMCID: PMC5984721 DOI: 10.1158/1940-6207.capr-17-0368] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/01/2018] [Accepted: 03/28/2018] [Indexed: 12/20/2022]
Abstract
Breast cancers detected after a negative breast screening examination and prior to the next screening are referred to as interval cancers. These cancers generally have poor clinical characteristics compared with screen-detected cancers, but associations between interval cancer and genomic cancer characteristics are not well understood. Mammographically screened women diagnosed with primary invasive breast cancer from 1993 to 2013 (n = 370) were identified by linking the Carolina Breast Cancer Study and the Carolina Mammography Registry. Among women with a registry-identified screening mammogram 0 to 24 months before diagnosis, cancers were classified as screen-detected (N = 165) or interval-detected (N = 205). Using logistic regression, we examined the association of mode of detection with cancer characteristics (clinical, IHC, and genomic), overall, and in analyses stratified on mammographic density and race. Interval cancer was associated with large tumors [>2 cm; OR, 2.3; 95% confidence interval (CI), 1.5-3.7], positive nodal status (OR, 1.8; 95% CI, 1.1-2.8), and triple-negative subtype (OR, 2.5; 95% CI, 1.1-5.5). Interval cancers were more likely to have non-Luminal A subtype (OR, 2.9; 95% CI, 1.5-5.7), whereas screen-detected cancers tended to be more indolent (96% had low risk of recurrence genomic scores; 71% were PAM50 Luminal A). When stratifying by mammographic density and race, associations between interval detection and poor prognostic features were similar by race and density status. Strong associations between interval cancers and poor-prognosis genomic features (non-Luminal A subtype and high risk of recurrence score) suggest that aggressive tumor biology is an important contributor to interval cancer rates. Cancer Prev Res; 11(6); 327-36. ©2018 AACR.
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Affiliation(s)
| | - Sarah J Nyante
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Cherie M Kuzmiak
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Mengjie Chen
- Section of Genetic Medicine, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Chiu-Kit Tse
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Xuezheng Sun
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Emma H Allott
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Erin L Kirk
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Lisa A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Andrew F Olshan
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Radiology, School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - Melissa A Troester
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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15
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Zhang Q, Ding L, Liang X, Wang Y, Jiao J, Lu W, Guo X. Comparison of pathological characteristics between self-detected and screen-detected invasive breast cancers in Chinese women: a retrospective study. PeerJ 2018; 6:e4567. [PMID: 29713563 PMCID: PMC5924684 DOI: 10.7717/peerj.4567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 03/13/2018] [Indexed: 11/20/2022] Open
Abstract
Background In China, there is insufficient evidence to support that screening programs can detect breast cancer earlier and improve outcomes compared with patient self-reporting. Therefore, we compared the pathological characteristics at diagnosis between self-detected and screen-detected cases of invasive breast cancer at our institution and determined whether these characteristics were different after the program's introduction (vs. prior to). Methods Three databases were selected (breast cancer diagnosed in 1995-2000, 2010, and 2015), which provided a total of 3,014 female patients with invasive breast cancer. The cases were divided into self-detected and screen-detected groups. The pathological characteristics were compared between the two groups and multiple imputation and complete randomized imputation were used to deal with missing data. Results Compared with patient self-reporting, screening was associated with the following factors: a higher percentage of stage T1 tumors (75.0% vs 17.1%, P = 0.109 in 1995-2000; 66.7% vs 40.4%, P < 0.001 in 2010; 67.8% vs 35.7%, P < 0.001 in 2015); a higher percentage of tumors with stage N0 lymph node status (67.3% vs. 48.4%, P = 0.007 in 2010); and a higher percentage of histologic grade I tumors (22.9% vs 13.9%, P = 0.017 in 2010). Conclusion Screen-detected breast cancer was associated with a greater number of favorable pathological characteristics. However, although screening had a beneficial role in early detection in China, we found fewer patients were detected by screening in this study compared with those in Western and Asian developed countries.
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Affiliation(s)
- Qi Zhang
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lanjun Ding
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Xuan Liang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Jiao Jiao
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, Tianjin Medical University, Tianjin, China.,Collaborative Innovation Center of Chronic Disease Prevention and Control, Tianjin Medical University, Tianjin, China
| | - Xiaojing Guo
- Department of Breast Pathology and Lab, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
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16
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Pan B, Yao R, Zhou YD, Zhu QL, Shi J, Xu QQ, Wang CJ, You SS, Mao F, Lin Y, Shen SJ, Liang ZY, Jiang YX, Sun Q. Tumor biology, clinicopathological characteristics and prognosis of screen detected T1 invasive non-palpable breast cancer in asymptomatic Chinese women (2001-2014). Oncotarget 2018; 8:26221-26230. [PMID: 28412736 PMCID: PMC5432251 DOI: 10.18632/oncotarget.15431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Accepted: 02/06/2017] [Indexed: 01/24/2023] Open
Abstract
Background Mammography screening usually detects low-risk breast cancer in the western world. However, little is known about the ultrasound and mammography screen-detected T1 invasive non-palpable breast cancer (NPBC) in asymptomatic Chinese women. Results With the increase of tumor size (T1a, b, c), lymph node positivity (8.7%, 18.3%, 26.0%, p = 0.018), pN (p = 0.028) and TNM stage (p = 0.035) increased accordingly. Tumor size (T1a, b, c) was correlated with high Ki-67 index (defined as ≥ 14%, 37.9%, 45.8%, 56.2%, p = 0.017), chemotherapy (20.4%, 35.2%, 57.3%, p < 0.001) and targeted therapy (2.9%, 9.9%, 15.1%, p = 0.008). T1a disease had higher chance of being luminal A and accompanied with ductal carcinoma in situ (DCIS), while T1c tumor being triple-negative and without DCIS. The 5-year disease free survival (DFS) of T1a, b, c NPBC were 99.0%, 96.9% and 92.9%, whereas the 5-year overall survival (OS) were 100.0%, 100.0% and 97.9% respectively. There was no significant difference in 5-year DFS or OS among the T1 NPBC subgroups or subtypes/immunophenotypes. Patients and methods From 2001 to 2014, 4,574 screening positive women received biopsies in Peking Union Medical College (PUMC) Hospital, and 729 NPBC including 437 T1 unilateral invasive NPBC were diagnosed. With a median follow-up time of 32 months (6–163 months), the clinicopathological characteristics, treatment choice, 5-year DFS and OS were compared between T1a, T1b and T1c NPBC. The DFS and OS prognostic factors were identified. Conclusion Screen-detected T1 invasive NPBC could be regarded as low-risk cancer in Chinese women. TNM stage and LN metastasis instead of molecular subtype was identified as the DFS prognostic factors while radiotherapy as the OS predictor.
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Affiliation(s)
- Bo Pan
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Ru Yao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Yi-Dong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Qing-Li Zhu
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Jie Shi
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Qian-Qian Xu
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Chang-Jun Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Shan-Shan You
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Song-Jie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Zhi-Yong Liang
- Department of Pathology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Yu-Xin Jiang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, P. R. China
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17
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Shen SC, Ueng SH, Yang CK, Yu CC, Lo YF, Chang HK, Lin YC, Chen SC. Impact of Detection Method and Accompanying Ductal Carcinoma in Situ on Prognosis of T1a,bN0 Breast Cancer. J Cancer 2017; 8:2328-2335. [PMID: 28819437 PMCID: PMC5560152 DOI: 10.7150/jca.19293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Accepted: 04/01/2017] [Indexed: 11/05/2022] Open
Abstract
Background: T1a,bN0 breast cancer is not easily detected. Before mammography became widespread, most cases were discovered only after the development of symptoms. The presence of ductal carcinoma in situ (DCIS) affects the detectability of associated invasive cancer; however, the prognostic value of concomitant DCIS is controversial. This study compared the characteristics of screening-detected and symptom-detected T1a,bN0 breast cancer, and investigated the impact of accompanying DCIS on detection and prognosis. Patients and Methods: Data were collected from a single hospital between 2000 and 2009. Of 5,690 primary breast cancers patients, 438 met the criteria for T1a,bN0M0. Logistic regression models were used to identify prognostic indicators and their association with the detection method. Survival analyses were performed to estimate distant relapse-free survival (DRFS) and breast cancer-specific survival (BCSS). Results: Tumors in 79 and 359 patients were detected by screening and development of symptoms, respectively. Symptomatic cancer patients were younger, more likely to receive a mastectomy, and had larger accompanying DCIS lesions; their 10-year DRFS rates were worse than those of patients with screening-detected tumors (91.1% vs. 100% respectively, p=0.049). Patients with large accompanying DCIS (≥2 cm) had markedly worse 10-year DRFS (77.1% vs. 97.4%, p<0.001) and BCSS (94.3% vs. 98.9%, p<0.001). Conclusion: T1a,bN0 breast cancers detected owing to symptoms are more likely to have larger accompanying DCIS. T1a,bN0 patients with large accompanying DCIS have worse DRFS and BCSS. It is important to consider associated DCIS size when evaluating prognosis in T1a,bN0 breast cancer patients.
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Affiliation(s)
- Shih-Che Shen
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Chan-Keng Yang
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Hsien-Kun Chang
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
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18
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Kobayashi N, Hikichi M, Ushimado K, Sugioka A, Kiriyama Y, Kuroda M, Utsumi T. Differences in subtype distribution between screen-detected and symptomatic invasive breast cancer and their impact on survival. Clin Transl Oncol 2017; 19:1232-1240. [PMID: 28409323 DOI: 10.1007/s12094-017-1660-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Accepted: 04/04/2017] [Indexed: 01/15/2023]
Abstract
PURPOSE Stage shift is considered a major reason for more favorable outcomes in patients with screen-detected breast cancer. However, even after adjusting for clinical stage, unresolved issues concerning the reasons for a survival benefit associated with screening programs remain. This study aims to evaluate differences in subtype distribution and outcomes among patients with screen-detected and symptomatic invasive breast cancer and assess whether variations in subtype distribution could explain differences in prognosis. METHODS Survival analysis was performed to estimate the likelihood of distant recurrence and death in 1132 patients. Subtypes were defined as luminal A [estrogen receptor (ER)+ and/or progesterone receptor (PR)+, human epidermal growth factor receptor 2 (HER2)-, and Ki67 low], luminal B (HER2-) (ER+ and/or PR+, HER2-, and Ki67 high), luminal B (HER2+) (ER+ and/or PR+ and HER2+), HER2 overexpressing (ER-, PR-, and HER2+), and triple negative (ER-, PR-, and HER2-). RESULTS Screen-detected cancers had favorable clinicopathological characteristics, such as smaller tumor size and a lower frequency of lymph node involvement. Women with screen-detected cancers had a survival advantage. Subtype distribution differed significantly among women with screen-detected and symptomatic cancer. Screen-detected cancers were more likely to be luminal A and less likely to be HER2 overexpressing or triple negative cancer compared with symptomatic cancers (luminal A 61.3 vs. 44.2%, HER2 overexpressing 4.0 vs. 8.0%, triple negative 8.0 vs. 15.9%). Node status, mode of detection, and subtype were independent prognostic factors in the multivariate analysis. CONCLUSIONS Differences in subtype distribution between screen-detected and symptomatic cancer could partially explain differences in outcomes.
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Affiliation(s)
- N Kobayashi
- Department of Breast Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - M Hikichi
- Department of Breast Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - K Ushimado
- Department of Breast Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - A Sugioka
- Department of Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - Y Kiriyama
- Department of Diagnostic Pathology, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - M Kuroda
- Department of Diagnostic Pathology, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan
| | - T Utsumi
- Department of Breast Surgery, School of Medicine, Fujita Health University, Toyoake, Aichi, 470-1192, Japan.
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19
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Inari H, Shimizu S, Suganuma N, Yoshida T, Nakayama H, Yamanaka T, Yamanaka A, Rino Y, Masuda M. A comparison of clinicopathological characteristics and long-term survival outcomes between symptomatic and screen-detected breast cancer in Japanese women. Breast Cancer 2016; 24:98-103. [PMID: 26868519 DOI: 10.1007/s12282-016-0678-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2015] [Accepted: 01/28/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Several studies from other countries have reported that patients with screen-detected breast cancer have better survival than those with symptomatic breast cancer. However, no such comparison has been performed in Japan. Therefore, we aimed to compare the clinicopathological characteristics and survival rates between symptomatic and screen-detected breast cancer in Japanese women. METHODS From January 2000 to December 2004, 977 and 182 women with symptomatic or screen-detected breast cancer, respectively, underwent surgery at a single Japanese hospital. We retrospectively reviewed these patients' clinicopathological data. Likelihood of death was estimated using the Kaplan-Meier method and the log-rank test. Multivariate analysis including mode of detection, tumor size, lymph node status, hormone receptor status, and adjuvant therapy administration was performed using the Cox proportional hazards model. RESULTS Screen-detected breast cancer was associated with increased rate of breast-conserving surgery, non-invasive carcinoma, smaller tumor size, decreased lymph node involvement, increased hormone receptor positivity, and decreased adjuvant chemotherapy administration. Compared to women with symptomatic tumors, those with screen-detected tumors had improved overall and breast cancer-specific survival rates. Factors associated with survival in univariate analysis were screen detection, tumor size, lymph node status, progesterone receptor status, and adjuvant chemotherapy administration. CONCLUSIONS Breast cancer screening in Japanese women has led to increases in the rates of breast-conserving surgery, hormone receptor positivity, and survival rates along with reductions in axillary lymph node dissection and adjuvant chemotherapy administration.
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Affiliation(s)
- Hitoshi Inari
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 232 Nakao, Asahi-ku, Yokohama, Japan.
| | - Satoru Shimizu
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 232 Nakao, Asahi-ku, Yokohama, Japan
| | - Nobuyasu Suganuma
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 232 Nakao, Asahi-ku, Yokohama, Japan
| | - Tatsuya Yoshida
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 232 Nakao, Asahi-ku, Yokohama, Japan
| | - Hirotaka Nakayama
- Department of Surgery, Yokohama City University, 39 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Takashi Yamanaka
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, 232 Nakao, Asahi-ku, Yokohama, Japan
| | - Ayumi Yamanaka
- Department of Surgery, Yokohama City University, 39 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Yasushi Rino
- Department of Surgery, Yokohama City University, 39 Fukuura, Kanazawa-ku, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, 39 Fukuura, Kanazawa-ku, Yokohama, Japan
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Falck AK, Röme A, Fernö M, Olsson H, Chebil G, Bendahl PO, Rydén L. St Gallen molecular subtypes in screening-detected and symptomatic breast cancer in a prospective cohort with long-term follow-up. Br J Surg 2016; 103:513-23. [PMID: 26856820 PMCID: PMC5067683 DOI: 10.1002/bjs.10070] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/03/2015] [Accepted: 10/29/2015] [Indexed: 12/14/2022]
Abstract
Background Diagnosis by screening mammography is considered an independent positive prognostic factor, although the data are not fully in agreement. The aim of the study was to explore whether the mode of detection (screening‐detected versus symptomatic) adds prognostic information to the St Gallen molecular subtypes of primary breast cancer, in terms of 10‐year cumulative breast cancer mortality (BCM). Methods A prospective cohort of patients with primary breast cancer, who had regularly been invited to screening mammography, were included. Tissue microarrays were constructed from primary tumours and lymph node metastases, and evaluated by two independent pathologists. Primary tumours and lymph node metastases were classified into St Gallen molecular subtypes. Cause of death was retrieved from the Central Statistics Office. Results A total of 434 patients with primary breast cancer were included in the study. Some 370 primary tumours and 111 lymph node metastases were classified into St Gallen molecular subtypes. The luminal A‐like subtype was more common among the screening‐detected primary tumours (P = 0·035) and corresponding lymph node metastases (P = 0·114) than among symptomatic cancers. Patients with screening‐detected tumours had a lower BCM (P = 0·017), and for those diagnosed with luminal A‐like tumours the 10‐year cumulative BCM was 3 per cent. For patients with luminal A‐like lymph node metastases, there was no BCM. In a stepwise multivariable analysis, the prognostic information yielded by screening detection was hampered by stage and tumour biology. Conclusion The prognosis was excellent for patients within the screening programme who were diagnosed with a luminal A‐like primary tumour and/or lymph node metastases. Stage, molecular pathology and mode of detection help to define patients at low risk of death from breast cancer. Low‐risk group identified
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Affiliation(s)
- A K Falck
- Departments of Surgery, Clinical Sciences Lund, Lund, Sweden.,Department of Surgery, Hospital of Helsingborg, Helsingborg, Sweden
| | - A Röme
- Department of Surgery, Clinical Sciences Malmö, Lund University, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
| | - M Fernö
- Departments of Oncology and Pathology, Clinical Sciences Lund, Lund, Sweden
| | - H Olsson
- Molecular and Immunological Pathology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - G Chebil
- Unilabs Pathology Unit, Helsingborg, Sweden
| | - P O Bendahl
- Departments of Oncology and Pathology, Clinical Sciences Lund, Lund, Sweden
| | - L Rydén
- Departments of Surgery, Clinical Sciences Lund, Lund, Sweden.,Department of Surgery, Skåne University Hospital, Lund, Sweden
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21
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Hofvind S, Holen Å, Román M, Sebuødegård S, Puig-Vives M, Akslen L. Mode of detection: an independent prognostic factor for women with breast cancer. J Med Screen 2015; 23:89-97. [PMID: 26582492 DOI: 10.1177/0969141315604006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/24/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate breast cancer survival and risk of breast cancer death by detection mode (screen-detected, interval, and detected outside the screening programme), adjusting for prognostic and predictive tumour characteristics. METHODS Information about detection mode, prognostic (age, tumour size, histologic grade, lymph node status) and predictive factors (molecular subtypes based on immunohistochemical analyses of hormone receptor status (estrogen and progesterone) and Her2 status) were available for 8344 women in Norway aged 50-69 at diagnosis of breast cancer, 2005-2011. A total of 255 breast cancer deaths were registered by the end of 2011. Kaplan-Meier method was used to estimate six years breast cancer specific survival and Cox proportional hazard model to estimate hazard ratio (HR) for breast cancer death by detection mode, adjusting for prognostic and predictive factors. RESULTS Women with screen-detected cancer had favourable prognostic and predictive tumour characteristics compared with interval cancers and those detected outside the screening programme. The favourable characteristics were present for screen-detected cancers, also within the subtypes. Adjusted HR of dying from breast cancer was two times higher for women with symptomatic breast cancer (interval or outside the screening), using screen-detected tumours as the reference. CONCLUSIONS Detection mode is an independent prognostic factor for women diagnosed with breast cancer. Information on detection mode might be relevant for patient management to avoid overtreatment.
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Affiliation(s)
- Solveig Hofvind
- Department of Screening - Cancer Registry of Norway, Oslo Oslo and Akershus University College of Applied Sciences - Department of Radiography
| | - Åsne Holen
- Department of Screening - Cancer Registry of Norway, Oslo
| | - Marta Román
- Department of Screening - Cancer Registry of Norway, Oslo National Advisory Unit for Women's Health - Oslo University Hospital
| | | | - Montse Puig-Vives
- Epidemiology Unit and Girona Cancer Registry (UERCG)/University of Girona, Economics Campus Montilivi, Spain
| | - Lars Akslen
- University of Bergen Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, Norway/Haukeland University Hospital, Department of Pathology, Bergen, Norway
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22
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Associations between sociodemographic and clinicopathological factors and breast cancer subtypes in a population-based study. Cancer Causes Control 2015; 26:1737-50. [PMID: 26376894 DOI: 10.1007/s10552-015-0667-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 09/05/2015] [Indexed: 02/01/2023]
Abstract
PURPOSE This study examines the factors distinguishing breast cancer (BC) subtypes. METHODS We examined subtypes in 629 women with invasive BC, diagnosed from 2006 to 2012, and enrolled in an epidemiological study in New Jersey. Using molecular characteristics from pathology reports, BCs were categorized as luminal A, luminal B, non-luminal HER2-expressing, or triple-negative breast cancer (TNBC) subtypes. Multinomial logistic models (luminal A as referent) were used to describe BC subtype associations. RESULTS Women with luminal B tumors were more likely to be younger at diagnosis [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.0-3.4] and to have higher-grade (OR 2.6, 95% CI 1.5-4.7), larger (OR 1.9, 95% CI 1.0-3.6), and Ki67-positive tumors (OR 2.1, 95% CI 1.1-4.0). Women with non-luminal HER2-expressing BCs were more likely to have higher-grade tumors (OR 14.5, 95% CI 5.3-39.7). Women with TNBCs were more likely to be African-American (OR 1.9, 95% CI 1.0-3.4) and to have higher-grade (OR 9.7, 95% CI 5.1-18.4), larger (OR 2.2, 95% CI 1.0-4.8), and Ki67-positive (OR 2.9, 95% CI 1.6-5.2) tumors. Notably, compared to the luminal A subtype, luminal B, non-luminal HER2-expressing, and triple-negative subtypes were more frequently self-detected; however, these associations were attenuated in multivariable models. CONCLUSIONS These findings suggest that some BC subtypes were associated with features denoting more aggressive phenotypes, namely higher grade, larger size, and Ki67 positivity, and possibly patient self-detection among some women. These findings highlight a need for enhanced screening, particularly among younger women, racial/ethnic minorities, and lower socioeconomic subgroups.
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23
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Cutuli B, Dalenc F, Cottu PH, Gligorov J, Guastalla JP, Petit T, Amrate A. Impact of screening on clinicopathological features and treatment for invasive breast cancer: results of two national surveys. Cancer Radiother 2015; 19:295-302. [PMID: 26188735 DOI: 10.1016/j.canrad.2015.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 02/22/2015] [Accepted: 02/25/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Several studies showed a breast cancer downstaging due to screening. A first national survey was conducted in France in 2001-2002 to evaluate in the current clinical practice the clinicopathological features and treatments of 1049 firstly operated breast cancers. In order to assess the impact of the national screening program implemented in all regions in France in 2004, a new survey was performed in 2007-2008. MATERIAL The new survey included 1433 firstly operated breast cancers prospectively collected. These new data were compared to the results of the first national survey. RESULTS According to TN classification, we found in the second survey T0: 27.6%, T1: 48.6%, T2: 21.3%, T3T4: 3.8% and Tx: 0.7%. Infiltrating ductal and lobular carcinomas represented 80% and 13% of tumours. Hormone receptors were positive in 85.3% and Her-2 overexpressed in 12.4% of tumours (83.9% and 20.6% in the first survey); 68.2% and 32% were pN0 and pN1-3. Lumpectomy and mastectomy were performed in 77% and 23% of the cases. Axillary dissection, sentinel node biopsy or both were performed in 42.6%, 41% and 16.4% of the cases, respectively. Radiotherapy, chemotherapy, hormonotherapy and trastuzumab were given to 93%, 51%, 83% and 9.3% of the patients. Compared with the results from the first survey, we found an increase of infraclinical lesions (T0 from 8.4 to 27.6%) and a wide decrease of pN+ rate (from 44% to 32%). The mastectomy rate was constant (23%), as well as radiotherapy use, whereas chemotherapy use decreased from 62.8 to 55.6%. CONCLUSION A complete national screening coverage clearly provides a favourable modification of breast cancer clinicopathological features. Both locoregional and adjuvant treatments were greatly downscaled.
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Affiliation(s)
- B Cutuli
- Department of Oncology and Radiotherapy, institut du cancer Courlancy, 38, rue de Courlancy, 51100 Reims, France.
| | - F Dalenc
- Institut Claudius-Regaud, 33000 Toulouse, France
| | | | | | | | - T Petit
- Centre Paul-Strauss, 67000 Strasbourg, France
| | - A Amrate
- AstraZeneca, 92500 Rueil-Malmaison, France
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Meshkat B, Prichard RS, Al-Hilli Z, Bass GA, Quinn C, O'Doherty A, Rothwell J, Geraghty J, Evoy D, McDermott EW. A comparison of clinical-pathological characteristics between symptomatic and interval breast cancer. Breast 2015; 24:278-82. [PMID: 25771080 DOI: 10.1016/j.breast.2015.02.032] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND An association between interval breast cancers (cancer detected after a normal mammogram and before the next scheduled mammogram) and tumour aggressiveness has been postulated which may reflect their relatively poor overall prognosis. The aim of this study was to evaluate known prognostic features of screen detected breast cancers compared to interval breast cancers. METHODS Patients diagnosed with breast cancer between January 2010 and 2013 at a single unit of the National Breast Screening Program (NBSP) in Ireland and those between the ages of 50 and 65 diagnosed at a symptomatic breast clinic were included in the study. Patients who had not had a screening mammogram within the proceeding two years or had a previous history of breast cancer were excluded. Data were retrospectively collected on patient demographics, tumour type, grade, hormone receptor status and stage of disease at presentation. RESULTS There were 915 patients included in the study, with 92% (n = 844) diagnosed through the NBSP. Ductal carcinoma in-situ accounted for 19% (n = 160) of screen-detected breast cancers but only 2.8% of interval cancers (p < 0.05). The most common type of invasive cancer was invasive ductal carcinoma. Tumour grade was significantly higher in interval breast cancers (p < 0.05). Interval cancers were identified at a significantly higher stage (Stage 1 versus 2; p < 0.001) than screen-detected cancers. Interval breast cancers were less likely to be ER positive (76% versus 81%; p < 0.05) and significantly more likely to over-express HER2 (20% vs 10%, p < 0.05) than screen-detected cancers. CONCLUSION This study highlights the fact that interval cancers appear to have a number of adverse prognostic markers for overall breast cancer survival when compared to women with screen-detected breast cancers. Interval cancers were more likely to be invasive, of a higher grade and stage and with a greater predominance of HER2 and triple negative molecular subtypes. Therefore this heterogeneous group of tumours may be biologically more aggressive and account disproportionately to overall breast cancer mortality.
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Affiliation(s)
- B Meshkat
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland.
| | - R S Prichard
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - Z Al-Hilli
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - G A Bass
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - C Quinn
- Department of Histopathology, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - A O'Doherty
- Department of Radiology, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - J Rothwell
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - J Geraghty
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - D Evoy
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
| | - E W McDermott
- Department of Breast Surgery, St Vincent's Healthcare Group, Elm Park, Dublin 4, Ireland
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Socioeconomic disparity in survival after breast cancer in ireland: observational study. PLoS One 2014; 9:e111729. [PMID: 25372837 PMCID: PMC4221110 DOI: 10.1371/journal.pone.0111729] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 10/06/2014] [Indexed: 11/19/2022] Open
Abstract
We evaluated the relationship between breast cancer survival and deprivation using data from the Irish National Cancer Registry. Cause-specific survival was compared between five area-based socioeconomic deprivation strata using Cox regression. Patient and tumour characteristics and treatment were compared using modified Poisson regression with robust variance estimation. Based on 21356 patients diagnosed 1999-2008, age-standardized five-year survival averaged 80% in the least deprived and 75% in the most deprived stratum. Age-adjusted mortality risk was 33% higher in the most deprived group (hazard ratio 1.33, 95% CI 1.21-1.45, P<0.001). The most deprived groups were more likely to present with advanced stage, high grade or hormone receptor-negative cancer, symptomatically, or with significant comorbidity, and to be smokers or unmarried, and less likely to have breast-conserving surgery. Cox modelling suggested that the available data on patient, tumour and treatment factors could account for only about half of the survival disparity (adjusted hazard ratio 1.18, 95% CI 0.97-1.43, P = 0.093). Survival disparity did not diminish over time, compared with the period 1994-1998. Persistent survival disparities among Irish breast cancer patients suggest unequal use of or access to services and highlight the need for further research to understand and remove the behavioural or other barriers involved.
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26
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Chuang SL, Chen SLS, Yu CP, Chang KJ, Yen AMF, Chiu SYH, Fann JCY, Tabár L, Stephen DW, Smith RA, Chen HH. Using tumor phenotype, histological tumor distribution, and mammographic appearance to explain the survival differences between screen-detected and clinically detected breast cancers. APMIS 2014; 122:699-707. [PMID: 25046200 DOI: 10.1111/apm.12294] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/08/2014] [Indexed: 11/28/2022]
Abstract
In the era of mass screening for breast cancer with mammography, it has been noted that conventional tumor attributes and mammographic appearance are insufficient to account for the better prognosis of screen-detected tumors. Such prognostication may require additional updated pathological information regarding tumor phenotype (e.g., basal status) and histological tumor distribution (focality). We investigated this hypothesis using a Bayesian approach to analyze breast cancer data from Dalarna County, Sweden. We used data for tumors diagnosed in the Swedish Two-County Trial and early service screening period, 1977-1995, and from the mature service screening period, 1996-1998. In the early period of mammographic screening (1977-1995), the crude hazard ratio (HR) of breast cancer death for screen-detected cases compared with symptomatic ones was 0.22 (95% CI: 0.17-0.29) compared with 0.53 (95% CI: 0.34-0.76) when adjusted for conventional tumor attributes only. Using the data from the mature service screening period, 1996-1998, the HR was 0.23 (95% CI: 0.08-0.44) unadjusted and 0.71 (95% CI: 0.26-1.47) after adjustment for tumor phenotype, mammographic appearance, histological tumor distribution, and conventional tumor attributes. The area under the ROC curve (AUC) for the prediction of breast cancer deaths using these variables without the detection mode was 0.82, only slightly less than that observed when additionally including the detection mode (AUC=0.83). Using Freedman statistics, conventional tumor attributes and mammographic appearances explained 58% (95% CI: 57.5-58.6%) of the difference of breast cancer survival between the screen-detected and the clinically detected breast cancers, whereas the corresponding figure was increased to 77% (95% CI: 75.6-77.6%) when adding the two information on tumor phenotype and histological tumor distribution. The results indicated that conventional tumor attributes and mammographic appearance are not sufficient to be interim markers for explaining the survival difference between screen-detected and clinically detected cancers in the era marked by the widespread use of mammography. Additional information on tumor phenotype and histological distribution may be added as effective interim markers for explaining the benefit of the early detection of breast cancer with mammography.
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Affiliation(s)
- Shu-Lin Chuang
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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Singh D, Malila N, Pokhrel A, Anttila A. Association of symptoms and breast cancer in population-based mammography screening in Finland. Int J Cancer 2014; 136:E630-7. [PMID: 25160029 PMCID: PMC4312922 DOI: 10.1002/ijc.29170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
The study purpose was to assess association of symptoms at screening visits with detection of breast cancer among women aged 50–69 years during the period 2006–2010. Altogether 1.2 million screening visits were made and symptoms (lump, retraction, secretion etc.) were reported either by women or radiographer. Breast cancer risk was calculated for each symptom separately using logistic regression [odds ratio (OR)] and 95% confidence intervals (CIs). Of the 1,198,410 screening visits symptoms were reported in 298,220 (25%) visits. Breast cancer detection rate for women with and without symptoms was 7.8 per 1,000 and 4.7 per 1,000 screening visits, respectively, whereas lump detected 32 cancers per 1,000 screens. Women with lump or retraction had an increased risk of breast cancer, OR = 6.47, 95% CI 5.89−7.09 and OR = 2.19, 95% CI 1.92–2.49, respectively. The sensitivity of symptoms in detecting breast carcinoma was 35.5% overall. Individual symptoms sensitivity and specificity ranged from, 0.66 to 14.8% and 87.4 to 99.7%, respectively. Of 5,541 invasive breast cancers, 1,993 (36%) reported symptoms at screen. Breast cancer risk among women with lump or retraction was higher in large size tumors (OR = 9.20, 95% CI 8.08–10.5) with poorly differentiated grades (OR = 5.91, 95% CI 5.03–6.94) and regional lymph nodes involvement (OR = 6.47, 95% CI 5.67–7.38). This study was done in a setting where breast tumors size is generally small, and symptoms sensitivity and specificity in diagnosing breast tumors were limited. Importance of breast cancer symptoms in the cancer prevention and control strategy needs to be evaluated also in other settings.
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Affiliation(s)
- Deependra Singh
- School of Health Sciences, University of Tampere, Tampere, Finland
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28
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Mathews M, Ryan D, Gadag V, West R. Use of screening tests, diagnosis wait times, and wait-related satisfaction in breast and prostate cancer. ACTA ACUST UNITED AC 2014; 21:e441-8. [PMID: 24940104 DOI: 10.3747/co.21.1843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Understanding factors relating to the perception of wait time by patients is key to improving the patient experience. METHODS We surveyed 122 breast and 90 prostate cancer patients presenting at clinics or listed on the cancer registry in Newfoundland and Labrador and reviewed their charts. We compared the wait time (first visit to diagnosis) and the wait-related satisfaction for breast and prostate cancer patients who received regular screening tests and whose cancer was screening test-detected ("screen/screen"); who received regular screening tests and whose cancer was symptomatic ("screen/symptomatic"); who did not receive regular screening tests and whose cancer was screen test-detected ("no screen/screen"); and who did not receive regular screening tests and whose cancer was symptomatic ("no screen/symptomatic"). RESULTS Although there were no group differences with respect to having a long wait (greater than the median of 47.5 days) for breast cancer patients (47.8% screen/screen, 54.7% screen/symptomatic, 50.0% no screen/ screen, 40.0% no screen/symptomatic; p = 0.814), a smaller proportion of the screen/symptomatic patients were satisfied with their wait (72.5% screen/ screen, 56.4% screen/symptomatic, 100% no screen/ screen, 90.9% no screen/symptomatic; p = 0.048). A larger proportion of screen/symptomatic prostate cancer patients had long waits (>104.5 days: 41.3% screen/screen, 92.0% screen/symptomatic, 46.0% no screen/screen, 40.0% no screen/symptomatic; p = 0.011) and a smaller proportion of screen/ symptomatic patients were satisfied with their wait (71.2% screen/screen, 30.8% screen/symptomatic, 76.9% no screen/screen, 90.9% no screen/symptomatic; p = 0.008). CONCLUSIONS Diagnosis-related wait times and satisfaction were poorest among patients who received regular screening tests but whose cancer was not detected by those tests.
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Affiliation(s)
- M Mathews
- Division of Community Health and Humanities, Memorial University, St. John's, NL
| | - D Ryan
- Division of Community Health and Humanities, Memorial University, St. John's, NL
| | - V Gadag
- Division of Community Health and Humanities, Memorial University, St. John's, NL
| | - R West
- Division of Community Health and Humanities, Memorial University, St. John's, NL
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Crispo A, Barba M, D’Aiuto G, De Laurentiis M, Grimaldi M, Rinaldo M, Caolo G, D’Aiuto M, Capasso I, Esposito E, Amore A, Di Bonito M, Botti G, Montella M. Molecular profiles of screen detected vs. symptomatic breast cancer and their impact on survival: results from a clinical series. BMC Cancer 2013; 13:15. [PMID: 23305429 PMCID: PMC3598199 DOI: 10.1186/1471-2407-13-15] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 10/30/2012] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Stage shift is widely considered a major determinant of the survival benefit conferred by breast cancer screening. However, factors and mechanisms underlying such a prognostic advantage need further clarification. We sought to compare the molecular characteristics of screen detected vs. symptomatic breast cancers and assess whether differences in tumour biology might translate into survival benefit. METHODS In a clinical series of 448 women with operable breast cancer, the Kaplan-Meier method and the log-rank test were used to estimate the likelihood of cancer recurrence and death. The Cox proportional hazard model was used for the multivariate analyses including mode of detection, age at diagnosis, tumour size, and lymph node status. These same models were applied to subgroups defined by molecular subtypes. RESULTS Screen detected breast cancers tended to show more favourable clinicopathological features and survival outcomes compared to symptomatic cancers. The luminal A subtype was more common in women with mammography detected tumours than in symptomatic patients (68.5 vs. 59.0%, p=0.04). Data analysis across categories of molecular subtypes revealed significantly longer disease free and overall survival for screen detected cancers with a luminal A subtype only (p=0.01 and 0.02, respectively). For women with a luminal A subtype, the independent prognostic role of mode of detection on recurrence was confirmed in Cox proportional hazard models (p=0.03). An independent role of modality of detection on survival was also suggested (p=0.05). CONCLUSIONS Molecular subtypes did not substantially explain the differences in survival outcomes between screened and symptomatic patients. However, our results suggest that molecular profiles might play a role in interpreting such differences at least partially.Further studies are warranted to reinterpret the efficacy of screening programmes in the light of tumour biology.
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Affiliation(s)
- Anna Crispo
- Epidemiology Unit, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, Naples 80131, Italy
| | - Maddalena Barba
- Scientific Direction-Division of Medical Oncology B, Regina Elena National Cancer Institute, Via Elio Chianesi 53, Rome 00144, Italy
| | - Giuseppe D’Aiuto
- Breast Unit, National Cancer Institute G. Pascale Foudation, Via Mariano Semmola, Naples 80131, Italy
| | - Michelino De Laurentiis
- Medical Oncology, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, Naples 80131, Italy
| | - Maria Grimaldi
- Epidemiology Unit, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, Naples 80131, Italy
| | - Massimo Rinaldo
- Breast Unit, National Cancer Institute G. Pascale Foudation, Via Mariano Semmola, Naples 80131, Italy
| | - Giuseppina Caolo
- Epidemiology Unit, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, Naples 80131, Italy
| | - Massimiliano D’Aiuto
- Breast Unit, National Cancer Institute G. Pascale Foudation, Via Mariano Semmola, Naples 80131, Italy
| | - Immacolata Capasso
- Breast Unit, National Cancer Institute G. Pascale Foudation, Via Mariano Semmola, Naples 80131, Italy
| | - Emanuela Esposito
- Breast Unit, National Cancer Institute G. Pascale Foudation, Via Mariano Semmola, Naples 80131, Italy
| | - Alfonso Amore
- Epidemiology Unit, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, Naples 80131, Italy
| | - Maurizio Di Bonito
- Pathology Unit, National Cancer Institute G Pascale Foundation, Via Mariano Semmola, Naples 80131, Italy
| | - Gerardo Botti
- Pathology Unit, National Cancer Institute G Pascale Foundation, Via Mariano Semmola, Naples 80131, Italy
| | - Maurizio Montella
- Epidemiology Unit, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, Naples 80131, Italy
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Ermiah E, Abdalla F, Buhmeida A, Larbesh E, Pyrhönen S, Collan Y. Diagnosis delay in Libyan female breast cancer. BMC Res Notes 2012; 5:452. [PMID: 22909280 PMCID: PMC3542159 DOI: 10.1186/1756-0500-5-452] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2012] [Accepted: 08/10/2012] [Indexed: 02/07/2023] Open
Abstract
AIMS To study the diagnosis delay and its impact on stage of disease among women with breast cancer on Libya. METHODS 200 women, aged 22 to 75 years with breast cancer diagnosed during 2008-2009 were interviewed about the period from the first symptoms to the final histological diagnosis of breast cancer. This period (diagnosis time) was categorized into 3 periods: <3 months, 3-6 months, and >6 months. If diagnosis time was longer than 3 months, the diagnosis was considered delayed (diagnosis delay). Consultation time was the time taken to visit the general practitioner after the first symptoms. Retrospective preclinical and clinical data were collected on a form (questionnaire) during an interview with each patient and from medical records. RESULTS The median of diagnosis time was 7.5 months. Only 30.0% of patients were diagnosed within 3 months after symptoms. 14% of patients were diagnosed within 3-6 months and 56% within a period longer than 6 months. A number of factors predicted diagnosis delay: Symptoms were not considered serious in 27% of patients. Alternative therapy (therapy not associated with cancer) was applied in 13.0% of the patients. Fear and shame prevented the visit to the doctor in 10% and 4.5% of patients, respectively. Inappropriate reassurance that the lump was benign was an important reason for prolongation of the diagnosis time. Diagnosis delay was associated with initial breast symptom(s) that did not include a lump (p < 0.0001), with women who did not report monthly self examination (p < 0.0001), with old age (p = 0.004), with illiteracy (p = 0.009), with history of benign fibrocystic disease (p = 0.029) and with women who had used oral contraceptive pills longer than 5 years (p = 0.043). At the time of diagnosis, the clinical stage distribution was as follows: 9.0% stage I, 25.5% stage II, 54.0% stage III and 11.5% stage IV.Diagnosis delay was associated with bigger tumour size (p <0.0001), with positive lymph nodes (N2, N3; p < 0.0001), with high incidence of late clinical stages (p < 0.0001), and with metastatic disease (p < 0.0001). CONCLUSIONS Diagnosis delay is very serious problem in Libya. Diagnosis delay was associated with complex interactions between several factors and with advanced stages. There is a need for improving breast cancer awareness and training of general practitioners to reduce breast cancer mortality by promoting early detection. The treatment guidelines should pay more attention to the early phases of breast cancer. Especially, guidelines for good practices in managing detectable of tumors are necessary.
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Affiliation(s)
- Eramah Ermiah
- Department of Oncology, University of Turku, Turku, Finland.
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