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Bhan AD, Jayaram J. Screening, Self-Examination and Awareness in Breast Cancer. Breast Cancer 2022. [DOI: 10.1007/978-981-16-4546-4_29] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ozkan Gurdal S, Ozaydın AN, Aribal E, Ozcinar B, Cabioglu N, Sahin C, Ozmen V. Bahcesehir long-term population-based screening compared to National Breast Cancer Registry Data: effectiveness of screening in an emerging country. ACTA ACUST UNITED AC 2021; 27:157-163. [PMID: 33599208 DOI: 10.5152/dir.2021.20486] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE We aimed to show the effects of long-term screening on clinical, pathologic, and survival outcomes in patients with screen-detected breast cancer and compare these findings with breast cancer patients registered in the National Breast Cancer Registry Data (NBCRD). METHODS Women aged 40-69 years, living in Bahcesehir county, Istanbul, Turkey, were screened every 2 years using bilateral mammography. The Bahcesehir National Breast Cancer Registry Data (BMSP) data were collected during a 10-year screening period (five rounds of screening). BMSP data were compared with the NBCRD regarding age, cancer stage, types of surgery, tumor size, lymph node status, molecular subtypes, and survival rates. RESULTS During the 10-year screening period, 8758 women were screened with 22621 mammograms. Breast cancer was detected in 130 patients; 51 (39.2%) were aged 40-49 years. The comparison of breast cancer patients in the two programs revealed that BMSP patients had earlier stages, higher breast-conserving surgery rates, smaller tumor size, more frequent negative axillary nodal status, lower histologic grade, and higher ductal carcinoma in situ rates than NBCRD patients (p = 0.001, for all). CONCLUSION These results indicate the feasibility of successful population-based screening in middle-income countries.
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Affiliation(s)
- Sibel Ozkan Gurdal
- Department of General Surgery, Namik Kemal University, School of Medicine, Tekirdag, Turkey
| | - Ayse Nilufer Ozaydın
- Department of Public Health, Marmara University School of Medicine, Istanbul, Turkey
| | - Erkin Aribal
- Department of Radiology, Acıbadem Mehmet Ali Aydınlar. University, School of Medicine, Istanbul, Turkey
| | - Beyza Ozcinar
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Neslihan Cabioglu
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Cennet Sahin
- Department of Radiology University of Health Sciences, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey
| | - Vahit Ozmen
- Department of General Surgery, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
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Wanis ML, Wong JA, Rodriguez S, Wong JM, Jabo B, Ashok A, Lum SSJ, Solomon NL, Reeves ME, Garberoglio CA, Senthil M. Rate of Re-excision after Breast-conserving Surgery for Invasive Lobular Carcinoma. Am Surg 2020. [DOI: 10.1177/000313481307901034] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Invasive lobular carcinoma (ILC) accounts for approximately 5 to 20 per cent of all breast cancers and is often multicentric. Despite pre- and intraoperative assessments to achieve negative margins, ILC is reported to be associated with higher rates of positive margin. This cross-sectional study examined patients with breast cancer treated at our institution from 2000 to 2010. The objective was to investigate the rate of re-excision resulting from positive or close margin (1 mm or less) in patients who underwent breast-conserving surgery (BCS) for ILC compared with invasive ductal carcinoma (IDC) and ductal carcinoma in situ (DCIS). Of the 836 patients treated, 416 patients underwent BCS. The rate of re-excision after BCS for ILC was 35.1 versus 17.7 per cent for IDC and 20.0 per cent for DCIS ( P = 0.04). Re-excisions were more often performed for positive margin in patients with ILC (11 of 37 [29.7%]) versus IDC (36 of 334 [10.8%]) and DCIS (five of 45 [11.1%];( P = 0.004). In this single-institution review, BCS for ILC had significantly higher rates of re-excision as a result of positive margins when compared with IDC and DCIS. Tumor size greater than 2 cm and lymph node involvement were identified as factors associated with positive surgical margin in ILC. The higher possibility of positive margins and the need for additional procedures should be discussed with patients undergoing BCS for ILC.
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Affiliation(s)
- Morcos L. Wanis
- From Loma Linda University Medical Center, Loma Linda, California
| | - Jennifer A. Wong
- From Loma Linda University Medical Center, Loma Linda, California
| | - Samuel Rodriguez
- From Loma Linda University Medical Center, Loma Linda, California
| | - Jasmine M. Wong
- From Loma Linda University Medical Center, Loma Linda, California
| | - Brice Jabo
- From Loma Linda University Medical Center, Loma Linda, California
| | - Arjun Ashok
- From Loma Linda University Medical Center, Loma Linda, California
| | - Sharon S. J. Lum
- From Loma Linda University Medical Center, Loma Linda, California
| | | | - Mark E. Reeves
- From Loma Linda University Medical Center, Loma Linda, California
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Duffy SW, Tabár L, Yen AMF, Dean PB, Smith RA, Jonsson H, Törnberg S, Chen SLS, Chiu SYH, Fann JCY, Ku MMS, Wu WYY, Hsu CY, Chen YC, Svane G, Azavedo E, Grundström H, Sundén P, Leifland K, Frodis E, Ramos J, Epstein B, Åkerlund A, Sundbom A, Bordás P, Wallin H, Starck L, Björkgren A, Carlson S, Fredriksson I, Ahlgren J, Öhman D, Holmberg L, Chen THH. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer 2020; 126:2971-2979. [PMID: 32390151 PMCID: PMC7318598 DOI: 10.1002/cncr.32859] [Citation(s) in RCA: 166] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/18/2020] [Accepted: 02/20/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND It is of paramount importance to evaluate the impact of participation in organized mammography service screening independently from changes in breast cancer treatment. This can be done by measuring the incidence of fatal breast cancer, which is based on the date of diagnosis and not on the date of death. METHODS Among 549,091 women, covering approximately 30% of the Swedish screening-eligible population, the authors calculated the incidence rates of 2473 breast cancers that were fatal within 10 years after diagnosis and the incidence rates of 9737 advanced breast cancers. Data regarding each breast cancer diagnosis and the cause and date of death of each breast cancer case were gathered from national Swedish registries. Tumor characteristics were collected from regional cancer centers. Aggregated data concerning invitation and participation were provided by Sectra Medical Systems AB. Incidence rates were analyzed using Poisson regression. RESULTS Women who participated in mammography screening had a statistically significant 41% reduction in their risk of dying of breast cancer within 10 years (relative risk, 0.59; 95% CI, 0.51-0.68 [P < .001]) and a 25% reduction in the rate of advanced breast cancers (relative risk, 0.75; 95% CI, 0.66-0.84 [P < .001]). CONCLUSIONS Substantial reductions in the incidence rate of breast cancers that were fatal within 10 years after diagnosis and in the advanced breast cancer rate were found in this contemporaneous comparison of women participating versus those not participating in screening. These benefits appeared to be independent of recent changes in treatment regimens.
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Affiliation(s)
- Stephen W Duffy
- Centre for Cancer Prevention, Department of Epidemiology, Mathematics and Statistics, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - László Tabár
- Department of Mammography, Falun Central Hospital, Falun, Sweden
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Peter B Dean
- Diagnostic Radiology, University of Turku, Turku, Finland
| | - Robert A Smith
- Cancer Control Sciences, American Cancer Society, Atlanta, Georgia
| | - Håkan Jonsson
- Regional Cancer Center, Umeå University, Umeå, Sweden
| | - Sven Törnberg
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Division of Biostatistics, Institute of Preventive Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jean Ching-Yuan Fann
- Department of Nutrition and Health Sciences, Kainan University, Taoyuan City, Taiwan
| | - May Mei-Sheng Ku
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | | | - Chen-Yang Hsu
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | | | - Gunilla Svane
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Edward Azavedo
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Ewa Frodis
- Västerås Central Hospital, Västerås, Sweden
| | | | | | | | | | | | | | | | | | | | - Irma Fredriksson
- Karolinska Institute, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Ahlgren
- Regional Cancer Center, Uppsala University Hospital, Uppsala, Sweden
| | - Daniel Öhman
- Regional Cancer Center, Stockholm-Gotland, Stockholm, Sweden
| | | | - Tony Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei City, Taiwan
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Mandrik O, Zielonke N, Meheus F, Severens J(H, Guha N, Herrero Acosta R, Murillo R. Systematic reviews as a 'lens of evidence': Determinants of benefits and harms of breast cancer screening. Int J Cancer 2019; 145:994-1006. [PMID: 30762235 PMCID: PMC6619055 DOI: 10.1002/ijc.32211] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 01/17/2019] [Accepted: 01/29/2019] [Indexed: 12/14/2022]
Abstract
This systematic review, stimulated by inconsistency in secondary evidence, reports the benefits and harms of breast cancer (BC) screening and their determinants according to systematic reviews. A systematic search, which identified 9,976 abstracts, led to the inclusion of 58 reviews. BC mortality reduction with screening mammography was 15-25% in trials and 28-56% in observational studies in all age groups, and the risk of stage III+ cancers was reduced for women older than 49 years. Overdiagnosis due to mammography was 1-60% in trials and 1-12% in studies with a low risk of bias, and cumulative false-positive rates were lower with biennial than annual screening (3-17% vs 0.01-41%). There is no consistency in the reviews' conclusions about the magnitude of BC mortality reduction among women younger than 50 years or older than 69 years, or determinants of benefits and harms of mammography, including the type of mammography (digital vs screen-film), the number of views and the screening interval. Similarly, there was no solid evidence on determinants of benefits and harms or BC mortality reduction with screening by ultrasonography or clinical breast examination (sensitivity ranges, 54-84% and 47-69%, respectively), and strong evidence of unfavourable benefit-to-harm ratio with breast self-examination. The reviews' conclusions were not dependent on the quality of the reviews or publication date. Systematic reviews on mammography screening, mainly from high-income countries, systematically disagree on the interpretation of the benefit-to-harm ratio. Future reviews are unlikely to clarify the discrepancies unless new original studies are published.
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Affiliation(s)
- Olena Mandrik
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
- Erasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
- Health Economic and Decision Science (HEDS), School of Health and Related Research (ScHARR)The University of SheffieldSheffieldUnited Kingdom
| | - Nadine Zielonke
- Department of Public Health, Erasmus MCUniversity Medical Center RotterdamRotterdamThe Netherlands
| | - Filip Meheus
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
| | - J.L. (Hans) Severens
- Erasmus School of Health Policy & Management, Erasmus University RotterdamRotterdamThe Netherlands
- Institute for Medical Technology Assessment (iMTA)Erasmus University RotterdamRotterdamThe Netherlands
| | - Neela Guha
- Section of Evidence Synthesis and ClassificationInternational Agency for Research on CancerLyonFrance
| | - Rolando Herrero Acosta
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
| | - Raul Murillo
- Section of Early Detection and Prevention, International Agency for Research on CancerLyonFrance
- Centro Javeriano de Oncología – Hospital Universitario San IgnacioBogotáColombia
- Faculty of Medicine – Pontificia Universidad JaverianaBogotáColombia
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Broeders MJM, Allgood P, Duffy SW, Hofvind S, Nagtegaal ID, Paci E, Moss SM, Bucchi L. The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review. BMC Cancer 2018; 18:860. [PMID: 30176813 PMCID: PMC6122725 DOI: 10.1186/s12885-018-4666-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 07/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Observational studies have reported conflicting results on the impact of mammography service screening programmes on the advanced breast cancer rate (ABCR), a correlation that was firmly established in randomized controlled trials. We reviewed and summarized studies of the effect of service screening programmes in the European Union on ABCR and discussed their limitations. Methods The PubMed database was searched for English language studies published between 01-01-2000 and 01–06-2018. After inspection of titles and abstracts, 220 of the 8644 potentially eligible papers were considered relevant. Their abstracts were reviewed by groups of two authors using predefined criteria. Fifty studies were selected for full paper review, and 22 of these were eligible. A theoretical framework for their review was developed. Review was performed using a ten-point checklist of the methodological caveats in the analysis of studies of ABCR and a standardised assessment form designed to extract quantitative and qualitative information. Results Most of the evaluable studies support a reduction in ABCR following the introduction of screening. However, all studies were challenged by issues of design and analysis which could at least potentially cause bias, and showed considerable variation in the estimated effect. Problems were observed in duration of follow-up time, availability of reliable reference ABCR, definition of advanced stage, temporal variation in the proportion of unknown-stage cancers, and statistical approach. Conclusions We conclude that much of the current controversy on the impact of service screening programmes on ABCR is due to observational data that were gathered and/or analysed with methodological approaches which could not capture stage effects in full. Future research on this important early indicator of screening effectiveness should focus on establishing consensus in the correct methodology. Electronic supplementary material The online version of this article (10.1186/s12885-018-4666-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J M Broeders
- Radboud Institute for Health Sciences, Radboud university medical center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands. .,Dutch Expert Centre for Screening, Nijmegen, The Netherlands.
| | - P Allgood
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - S W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - S Hofvind
- Cancer Registry of Norway, Oslo, Norway
| | - I D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Paci
- Retired, Clinical and Descriptive Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - S M Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - L Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forli, Italy
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Moothathu NS, Philpotts LE, Busch SH, Gross CP, Staib LH, Hooley RJ. Knowledge of Density and Screening Ultrasound. Breast J 2016; 23:323-332. [DOI: 10.1111/tbj.12734] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Nitya S. Moothathu
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven Connecticut
| | - Liane E. Philpotts
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven Connecticut
| | - Susan H. Busch
- Department of Health Policy and Management; Yale School of Public Health; New Haven Connecticut
| | - Cary P. Gross
- General Internal Medicine and the Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center; Yale School of Medicine; New Haven Connecticut
| | - Lawrence H. Staib
- Departments of Radiology and Biomedical Imaging, Biomedical Engineering, and Electrical Engineering; Yale School of Medicine; New Haven Connecticut
| | - Regina J. Hooley
- Department of Radiology and Biomedical Imaging; Yale School of Medicine; New Haven Connecticut
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Flippo-Morton T, Walsh K, Chambers K, Amacker-North L, White B, Sarantou T, Boselli DM, White RL. Surgical Decision Making in the BRCA-Positive Population: Institutional Experience and Comparison with Recent Literature. Breast J 2015; 22:35-44. [DOI: 10.1111/tbj.12521] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Teresa Flippo-Morton
- Division of Surgical Oncology; Department of Surgery; Levine Cancer Institute; Carolinas Medical Center; Charlotte North Carolina
| | - Kendall Walsh
- Division of Surgical Oncology; Department of Surgery; Levine Cancer Institute; Carolinas Medical Center; Charlotte North Carolina
| | - Karinn Chambers
- Department of Surgery; Cornerstone Breast Care; High Point North Carolina
| | - Lisa Amacker-North
- Clinical Genetics Program; Levine Cancer Institute; Carolinas Medical Center; Charlotte North Carolina
| | - Brook White
- Clinical Genetics Program; Levine Cancer Institute; Carolinas Medical Center; Charlotte North Carolina
| | - Terry Sarantou
- Division of Surgical Oncology; Department of Surgery; Levine Cancer Institute; Carolinas Medical Center; Charlotte North Carolina
| | - Danielle M. Boselli
- Department of Cancer Biostatistics; Levine Cancer Institute; Carolinas HealthCare System; Charlotte North Carolina
| | - Richard L. White
- Division of Surgical Oncology; Department of Surgery; Levine Cancer Institute; Carolinas Medical Center; Charlotte North Carolina
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Tvedskov TF, Jensen MB, Balslev E, Garne JP, Vejborg I, Christiansen P, Ejlertsen B, Kroman N. Risk of non-sentinel node metastases in patients with symptomatic cancers compared to screen-detected breast cancers. Acta Oncol 2015; 55:455-9. [PMID: 26452696 DOI: 10.3109/0284186x.2015.1094186] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Symptomatic breast cancers may be more aggressive as compared to screen-detected breast cancers. This could favor axillary lymph node dissection (ALND) in patients with symptomatic breast cancer and positive sentinel nodes. METHOD We identified 955 patients registered in the Danish Breast Cancer Cooperative Group (DBCG) Database in 2008 - 2010 with micrometastases (773) or isolated tumor cells (ITC) (182) in the sentinel node. Patients were cross-checked in the Danish Quality Database of Mammography Screening and 481 patients were identified as screen-detected cancers. The remaining 474 patients were considered as having symptomatic cancers. Multivariate analyses of the risk of non-sentinel node metastases were performed including known risk factors for non-sentinel node metastases as well as method of detection. RESULTS 18% of the patients had metastases in non-sentinel nodes. This was evenly distributed between patients with symptomatic and screen-detected cancers; 18.5% vs 17.5% (OR 1.07; 95% CI 0.77-1.49; p = 0.69). In patients with micrometastases 21% had non-sentinel node metastases in the group with symptomatic cancers compared to 19% of patients with screen-detected cancers. This difference was not significant (OR 1.16; 95% CI 0.81-1.65, p = 0.43). Neither the multivariate analysis showed an increased risk of non-sentinel node metastases in patients with symptomatic cancers compared to screen-detected cancers (OR 1.12, CI 0.77-1.62, p = 0.55). In patients with ITCs 8% of patients with symptomatic cancers had non-sentinel node metastases compared to 13% of patients with screen-detected cancers. This difference was not significant (OR 0.58; 95% CI 0.22-1.54, p = 0.27). In the multivariate analysis, the risk of non-sentinel node metastases was still not significantly increased in patients with symptomatic cancers compared to screen-detected cancers (OR 0.45; 95% CI 0.16-1.27, p = 0.13). CONCLUSION We did not find any clinically relevant difference in the risk of non-sentinel node metastases between patients with symptomatic and screen-detected cancers with micrometastases or ITC in the sentinel node.
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Affiliation(s)
- Tove F. Tvedskov
- Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Maj-Britt Jensen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark
| | - Eva Balslev
- Department of Pathology, Herlev Hospital, Copenhagen, Denmark
| | - Jens P. Garne
- Department of Breast Surgery, Ringsted Hospital, Ringsted, Denmark
| | - Ilse Vejborg
- Department of Radiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peer Christiansen
- Department of Surgery, Breast Surgery Unit, Aarhus University Hospital/Randers Regional Hospital, Aarhus, Denmark, and
| | - Bent Ejlertsen
- Danish Breast Cancer Cooperative Group, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Oncology, Copenhagen University Hospital, Copenhagen, Denmark
| | - N. Kroman
- Department of Breast Surgery, Copenhagen University Hospital, Copenhagen, Denmark
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Performance indicators evaluation of the population-based breast cancer screening programme in Northern Portugal using the European Guidelines. Cancer Epidemiol 2015; 39:783-9. [PMID: 26315486 DOI: 10.1016/j.canep.2015.08.004] [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: 04/26/2015] [Revised: 08/08/2015] [Accepted: 08/12/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the first 10 years of operation of the population-based breast cancer screening programme implemented in the Northern Region of Portugal, using selected recommended standard performance indicators. METHODS Data from women aged 50-69 screened with two-view mammography, biennially, in the period 2000-2009, were included. Main performance indicators were compared with the recommended levels of the European Guidelines. RESULTS A total of 202,039 screening examinations were performed, 71,731 (35.5%) in the initial screening and 130,308 (64.5%) in the subsequent screening. Coverage rate by examination reached 74.3% of the target population, in the last period evaluated. Recall rates were 8.1% and 2.4% and cancer detection rates were 4.4/1000 and 2.9/1000 respectively, for initial and subsequent screenings. The breast cancer detection rate, expressed as a multiple of the background expected incidence was 3.1 in initial screen and 2.2 in subsequent screen. The incidence of invasive interval cancers met the desirable recommended levels both the first and second years since last screening examination, in the initial and subsequent screenings. Invasive tumours <15mm were 50.4% and 53.8% of the invasive cancers detected in initial and subsequent screenings. Less favourable size, grading and biomarkers expression were found in interval cancers compared to screen-detected cancers. CONCLUSIONS Breast cancer screening programme in the Northern Region of Portugal was well accepted by the population. Most of the performance indicators were consistent with the desirable levels of the European Guidelines, which indicate an effective screening programme. Future research should verify the consistency of some of these results by using updated information from a larger population.
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All-Cause Mortality Is Decreased in Women Undergoing Annual Mammography Before Breast Cancer Diagnosis. AJR Am J Roentgenol 2015; 204:898-902. [DOI: 10.2214/ajr.14.12666] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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12
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Complexities and challenges in the pathologic assessment of size (T) of invasive breast carcinoma. Adv Anat Pathol 2014; 21:420-32. [PMID: 25299311 DOI: 10.1097/pap.0000000000000040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Size (the "T" in the TNM System) of invasive breast carcinoma is a proven independent prognostic factor; however, its accurate determination can be challenging. The purpose of this review is to discuss the complexities inherent in determining "T"-including those encountered in the clinical measurement ("cT", ie, physical and radiologic assessment) as well as pathologic determination (pT) of invasive breast carcinomas. Pathologic estimation of tumor size, macroscopic, as well as microscopic, can be problematic due to the complexity of multiple situations, seeming confusion regarding staging guidelines, and interobserver variation in interpretation. Additional problematic scenarios in determination of "T" include those incurred in excisions performed after the performance of needle core biopsies, and in cases wherein there are multiple foci of invasive carcinoma, as well as in carcinomas status post-neoadjuvant chemotherapy. It can also be difficult to determine "T" in certain types of invasive carcinoma, particularly those of the lobular type. In this communication, some of the complexities and challenges in determing "T" are discussed, and modest suggestions are offered to assist in optimizing such assessments.
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Cedolini C, Bertozzi S, Londero AP, Bernardi S, Seriau L, Concina S, Cattin F, Risaliti A. Type of breast cancer diagnosis, screening, and survival. Clin Breast Cancer 2014; 14:235-40. [PMID: 24703317 DOI: 10.1016/j.clbc.2014.02.004] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Revised: 01/23/2014] [Accepted: 02/12/2014] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence of breast cancers detected through screening, before and after introduction of an organized screening, and we evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected breast cancer or those with palpable breast cancers. MATERIALS AND METHODS We collected data about all women who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and recurrences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. RESULTS Among the 2070 cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A), 843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extrascreening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively, 99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference between the first 2 groups and the third (P < .05) and a trend between groups A and B (P = .081). CONCLUSION The diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the diagnosis, but a longer follow-up is necessary to confirm this data.
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Affiliation(s)
| | | | | | - Sergio Bernardi
- Department of Surgery, Ospedale Civile di Latisana, Udine, Italy; Department of Surgery, AOU "Santa Maria della Misericordia," Udine, Italy
| | - Luca Seriau
- Clinic of Surgery, University of Udine, Udine, Italy
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Walker MJ, Mirea L, Cooper K, Nabavi M, Glendon G, Andrulis IL, Knight JA, O'Malley FP, Chiarelli AM. Impact of familial risk and mammography screening on prognostic indicators of breast disease among women from the Ontario site of the Breast Cancer Family Registry. Fam Cancer 2013; 13:163-72. [PMID: 24097051 DOI: 10.1007/s10689-013-9689-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Although several studies have found screen-detected cancers in women with familial breast cancer risk have favorable prognostic features compared with symptomatic cancers, the impact of level of familial risk is unknown. A cohort of 899 first-degree female relatives of cases of breast cancer from the Ontario site of the Breast Cancer Family Registry was followed for 2 years. Logistic regression analyses compared diagnoses of breast cancer or benign breast disease (BBD) between women at high (n = 258, 28.7 %) versus low/moderate (n = 641, 71.3 %) familial risk. Similar analyses compared prognostic features of invasive cancers and BBD by level of familial risk and mammography screening status. Among 899 women, 44 (4.9 %) were diagnosed with invasive breast cancer and/or ductal carcinoma in situ, and 56 (6.2 %) with BBD. Women with high familial risk were significantly more likely to be diagnosed with breast cancer [odds ratio (OR) = 2.84, 95 % confidence interval (CI) 1.50-5.38] than low/moderate risk women, particularly if diagnosed at age ≥50 (OR = 2.99, 95 % CI 1.37-6.56) or screened with mammography (OR = 3.33, 95 % CI 1.54-7.18). High risk women were more likely to be diagnosed with BBD (OR = 1.94, 95 % CI 1.03-3.66). Level of familial risk was not associated with prognostic features. Cancers among unscreened women were larger (OR = 9.72, 95 % CI 1.01-93.61) and diagnosed at stage II or above (OR = 7.80, 95 % CI 1.18-51.50) compared with screen-detected cancers. Screening mammography may be effective for women with a first-degree family history of breast cancer, irrespective of level of familial risk.
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Affiliation(s)
- Meghan J Walker
- Division of Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON, M5G 2L7, Canada,
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