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Bennett DL, Winter AM, Billadello L, Lowdermilk MC, Doherty CM, Kazmi S, Laster S, Al-Hammadi N, Hardy A, Kopans DB, Moy L. Breast cancer outcomes based on method of detection in community-based breast cancer registry. Breast Cancer Res Treat 2024; 203:215-224. [PMID: 37878149 DOI: 10.1007/s10549-023-07092-x] [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: 05/03/2023] [Accepted: 08/11/2023] [Indexed: 10/26/2023]
Abstract
PURPOSE The impact of opportunistic screening mammography in the United States is difficult to quantify, partially due to lack of inclusion regarding method of detection (MOD) in national registries. This study sought to determine the feasibility of MOD collection in a multicenter community registry and to compare outcomes and characteristics of breast cancer based on MOD. METHODS We conducted a retrospective study of breast cancer patients from a multicenter tumor registry in Missouri from January 2004 - December 2018. Registry data were extracted by certified tumor registrars and included MOD, clinicopathologic information, and treatment. MOD was assigned as screen-detected or clinically detected. Data were analyzed at the patient level. Chi-squared tests were used for categorical variable comparison and Mann-Whitney-U test was used for numerical variable comparison. RESULTS 5351 women (median age, 63 years; interquartile range, 53-73 years) were included. Screen-detected cancers were smaller than clinically detected cancers (median size 12 mm vs. 25 mm; P < .001) and more likely node-negative (81% vs. 54%; P < .001), lower grade (P < .001), and lower stage (P < .001). Screen-detected cancers were more likely treated with lumpectomy vs. mastectomy (73% vs. 41%; P < .001) and less likely to require chemotherapy (24% vs. 52%; P < .001). Overall survival for patients with invasive breast cancer was higher for screen-detected cancers (89% vs. 74%, P < .0001). CONCLUSION MOD can be routinely collected and linked to breast cancer outcomes through tumor registries, with demonstration of significant differences in outcome and characteristics of breast cancers based on MOD. Routine inclusion of MOD in US tumor registries would help quantify the impact of opportunistic screening mammography in the US.
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Affiliation(s)
- Debbie Lee Bennett
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA.
| | | | | | | | - Christina Michelle Doherty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Sakina Kazmi
- Department of Radiology, University of Michigan, Ann Arbor, MI, USA
| | | | - Noor Al-Hammadi
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Anna Hardy
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Saint Louis University School of Medicine, St. Louis, USA
| | - Daniel B Kopans
- Department of Radiology, Harvard Medical School, Boston, MA, USA
| | - Linda Moy
- Department of Radiology, NYU Langone Health, NYU School of Medicine, New York, NY, USA
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Hill H, Kearns B, Pashayan N, Roadevin C, Sasieni P, Offman J, Duffy S. The cost-effectiveness of risk-stratified breast cancer screening in the UK. Br J Cancer 2023; 129:1801-1809. [PMID: 37848734 PMCID: PMC10667489 DOI: 10.1038/s41416-023-02461-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 09/09/2023] [Accepted: 10/04/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND There has been growing interest in the UK and internationally of risk-stratified breast screening whereby individualised risk assessment may inform screening frequency, starting age, screening instrument used, or even decisions not to screen. This study evaluates the cost-effectiveness of eight proposals for risk-stratified screening regimens compared to both the current UK screening programme and no national screening. METHODS A person-level microsimulation model was developed to estimate health-related quality of life, cancer survival and NHS costs over the lifetime of the female population eligible for screening in the UK. RESULTS Compared with both the current screening programme and no screening, risk-stratified regimens generated additional costs and QALYs, and had a larger net health benefit. The likelihood of the current screening programme being the optimal scenario was less than 1%. No screening amongst the lowest risk group, and triannual, biennial and annual screening amongst the three higher risk groups was the optimal screening strategy from those evaluated. CONCLUSIONS We found that risk-stratified breast cancer screening has the potential to be beneficial for women at the population level, but the net health benefit will depend on the particular risk-based strategy.
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Affiliation(s)
- Harry Hill
- School of Medicine and Population Health, University of Sheffield, Sheffield, England.
| | - Ben Kearns
- School of Medicine and Population Health, University of Sheffield, Sheffield, England
- Lumanity Inc, Sheffield, England
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, England
| | - Cristina Roadevin
- Nottingham Clinical Trials Unit, University of Nottingham, Nottingham, England
| | - Peter Sasieni
- Life Sciences & Medicine, King's College London, London, England
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Judith Offman
- Life Sciences & Medicine, King's College London, London, England
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
| | - Stephen Duffy
- Wolfson Institute of Population Health, Queen Mary University of London, London, England
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3
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Deng Z, Jones MR, Wolff AC, Visvanathan K. Evaluation of Predict, a prognostic risk tool, after diagnosis of a second breast cancer. JNCI Cancer Spectr 2023; 7:pkad081. [PMID: 37773987 PMCID: PMC10660126 DOI: 10.1093/jncics/pkad081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The UK National Health Service's Predict is a clinical tool widely used to estimate the prognosis of early-stage breast cancer. The performance of Predict for a second primary breast cancer is unknown. METHODS Women 18 years of age or older diagnosed with a first or second invasive breast cancer between 2000 and 2013 and followed for at least 5 years were identified from the US Surveillance, Epidemiology, and End Results (SEER) database. Model calibration of Predict was evaluated by comparing predicted and observed 5-year breast cancer-specific mortality separately by estrogen receptor status for first vs second breast cancer. Receiver operating characteristic curves and areas under the curve were used to assess model discrimination. Model performance was also evaluated for various races and ethnicities. RESULTS The study population included 6729 women diagnosed with a second breast cancer and 357 204 women with a first breast cancer. Overall, Predict demonstrated good discrimination for first and second breast cancers (areas under the curve ranging from 0.73 to 0.82). Predict statistically significantly underestimated 5-year breast cancer mortality for second estrogen receptor-positive breast cancers (predicted-observed = ‒6.24%, 95% CI = ‒6.96% to ‒5.49%). Among women with a first estrogen receptor-positive cancer, model calibration was good (predicted-observed = ‒0.22%, 95% CI = ‒0.29% to ‒0.15%), except in non-Hispanic Black women (predicted-observed = ‒2.33%, 95% CI = ‒2.65% to ‒2.01%) and women 80 years of age or older (predicted-observed = ‒3.75%, 95% CI = ‒4.12% to ‒3.41%). Predict performed well for second estrogen receptor-negative cancers overall (predicted-observed = ‒1.69%, 95% CI = ‒3.99% to 0.16%) but underestimated mortality among those who had previously received chemotherapy or had a first cancer with more aggressive tumor characteristics. In contrast, Predict overestimated mortality for first estrogen receptor-negative cancers (predicted-observed = 4.54%, 95% CI = 4.27% to 4.86%). CONCLUSION The Predict tool underestimated 5-year mortality after a second estrogen receptor-positive breast cancer and in certain subgroups of women with a second estrogen receptor-negative breast cancer.
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Affiliation(s)
| | - Miranda R Jones
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Antonio C Wolff
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Kala Visvanathan
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- Department of Oncology, Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Basappa SN, Finney Rutten LJ, Hruska CB, Olson JE, Jacobson DJ, Rhodes DJ. Breast Cancer Mode of Detection in a Population-Based Cohort. Mayo Clin Proc 2023; 98:278-289. [PMID: 36737116 PMCID: PMC9907001 DOI: 10.1016/j.mayocp.2022.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 09/01/2022] [Accepted: 10/07/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To evaluate how breast cancers come to clinical attention (mode of detection [MOD]) in a population-based cohort, determine the relative frequency of different MODs, and characterize patient and tumor characteristics associated with MOD. PATIENTS AND METHODS We used the Rochester Epidemiology Project to identify women ages 40 to 75 years with a first-time diagnosis of breast cancer from May 9, 2017, to May 9, 2019 (n=500) in a 9-county region in Minnesota. We conducted a retrospective medical record review to ascertain the relative frequency of MODs, evaluating differences between screening mammography vs all other MODs by breast density and cancer characteristics. Multiple logistic regression was conducted to examine the likelihood of MOD for breast density and stage of disease. RESULTS In our population-based cohort, 162 of 500 breast cancers (32.4%) were detected by MODs other than screening mammography, including 124 (24.8%) self-detected cancers. Compared with women with mammography-detected cancers, those with MODs other than screening mammography were more frequently younger than 50 years of age (P=.004) and had higher-grade tumors (P=.007), higher number of positive lymph nodes (P<.001), and larger tumor size (P<.001). Relative to women with mammography-detected cancers, those with MODs other than screening mammography were more likely to have dense breasts (odds ratio, 1.87; 95% CI, 1.20 to 2.92; P=.006) and advanced cancer at diagnosis (odds ratio, 3.58; 95% CI, 2.29 to 5.58; P<.001). CONCLUSION One-third of all breast cancers in this population were detected by MODs other than screening mammography. Increased likelihood of nonmammographic MODs was observed among women with dense breasts and advanced cancer.
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Affiliation(s)
- Susanna N Basappa
- Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Carrie B Hruska
- Division of Medical Physics, Department of Radiology, Mayo Clinic, Rochester, MN
| | - Janet E Olson
- Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Debra J Jacobson
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Deborah J Rhodes
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Department of Internal Medicine, Yale New Haven Health, New Haven, CT.
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Trapp EK, Fasching PA, Fehm T, Schneeweiss A, Mueller V, Harbeck N, Lorenz R, Schumacher C, Heinrich G, Schochter F, de Gregorio A, Tzschaschel M, Rack B, Janni W, Friedl TWP. Does the Presence of Circulating Tumor Cells in High-Risk Early Breast Cancer Patients Predict the Site of First Metastasis—Results from the Adjuvant SUCCESS A Trial. Cancers (Basel) 2022; 14:cancers14163949. [PMID: 36010945 PMCID: PMC9406108 DOI: 10.3390/cancers14163949] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/03/2022] [Accepted: 08/09/2022] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Due to recent advances in breast cancer detection and treatment strategies, the number of breast cancer survivors has increased over the past decades. However, breast cancer follow-up guidelines have not changed for years. The presence of CTCs detected during follow-up has been shown to indicate poor prognosis in high-risk breast cancer patients. Here, we evaluated if the presence of CTCs also indicates the site of metastatic disease by analyzing CTC status and metastatic location in 206 patients with distant recurrence from the large adjuvant breast cancer trial SUCCESS A. Patients who were CTC-positive both before and after chemotherapy were more likely to show bone-only first distant disease (37.5% vs. 21.0%) and first distant disease at multiple sites (31.3% vs. 12.6%) than patients without CTCs. These data indicate that CTCs might serve as a liquid biopsy surveillance-marker enabling risk-stratification for deciding on further adjuvant add-on-treatment. Abstract The prognostic relevance of circulating tumor cells (CTCs) in breast cancer is well established. However, little is known about the association of CTCs and site of first metastasis. In the SUCCESS A trial, 373 out of 3754 randomized high-risk breast cancer patients developed metastatic disease. CTC status was assessed by the FDA-approved CellSearch®-System (Menarini Silicon Biosystems, Bologna, Italy) in 206 of these patients before chemotherapy and additionally in 159 patients after chemotherapy. CTCs were detected in 70 (34.0%) of 206 patients before (median 2 CTCs, 1–827) and in 44 (27.7%) of 159 patients after chemotherapy (median 1 CTC, 1–124); 16 (10.1%) of 159 patients were CTC-positive at both timepoints. The site of first distant disease was bone-only, visceral-only, and other-site-only in 44 (21.4%), 60 (29.1%), and 74 (35.9%) patients, respectively, while 28 (13.6%) patients had multiple sites of first metastatic disease. Patients with CTCs at both timepoints more often showed bone-only first distant disease (37.5% vs. 21.0%) and first distant disease at multiple sites (31.3% vs. 12.6%) than patients without CTCs before and/or after chemotherapy (p = 0.027). In conclusion, the presence of CTCs before and after chemotherapy is associated with multiple-site or bone-only first-distant disease and may trigger intensified follow-up and perhaps further treatment.
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Affiliation(s)
- Elisabeth K. Trapp
- Department of Gynecology and Obstetrics, Medical University of Graz, 8036 Graz, Austria
- Correspondence:
| | - Peter A. Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Duesseldorf, Heinrich-Heine University Duesseldorf, 40225 Düsseldorf, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, 69120 Heidelberg, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics and CCC Munich, LMU University Hospital, 81337 München, Germany
| | - Ralf Lorenz
- Gynecologic Practice Dr. Lorenz, N. Hecker, Dr. Kreiss-Sender, 38100 Braunschweig, Germany
| | - Claudia Schumacher
- Department of Gynecology and Obstetrics, St. Elisabeth’s Hospital, 50935 Cologne, Germany
| | | | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Amelie de Gregorio
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Marie Tzschaschel
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
| | - Thomas W. P. Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, 89081 Ulm, Germany
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Wang H, Donnan P, Macaskill EJ, Jordan L, Thompson A, Evans A. A pre-operative prognostic model predicting all cause and cause specific mortality for women presenting with invasive breast cancer. Breast 2021; 61:11-21. [PMID: 34891035 DOI: 10.1016/j.breast.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 11/29/2021] [Accepted: 12/02/2021] [Indexed: 10/19/2022] Open
Abstract
PURPOSE The aim of this study is to develop a pre-operative prognostic model based on known pre-operative factors. METHODS A database of ultrasound (US) lesions undergoing biopsy documented US lesion size, stiffness, and patient source prospectively. Women with invasive cancer presenting between 2010 and 2015 were the study group. Breast and axillary core results and ER, PR and HER receptor status were collected prospectively. Assessment of US skin thickening, US distal enhancement and presence of chronic kidney disease (CKD) was performed retrospectively. Patient survival and cause of death were ascertained from computer records. Predictive models for (i) all-cause mortality (ACM) and (ii) breast cancer death (BCD) were built and then validated using bootstrap k-fold cross-validation. A comparison of predictive performance was made between a full cause-specific Cox model, a sub cause-specific Cox model, and a full Fine-Gray sub-distribution hazard model. RESULTS 1136 patients were included in the study. The median follow-up time was 6.2 years. 125 (11%) women died from breast cancer and 155 (14%) died from other causes. For the prediction of BCD, the cause-specific Cox sub-model performed the best. The time dependent AUC begins above 0.91 in year one to 3 reducing to 0.83 in year 6. The factors included in the Cox sub model were tumour size, skin thickening, source of detection, tumour grade, ER status, pre-operative nodal metastasis and CKD. CONCLUSION We have shown that a model based on preoperative factors can predict BCD. Such prediction if externally validated and incorporating treatment data could be useful for treatment planning and patient counselling.
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Affiliation(s)
- Huan Wang
- Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Peter Donnan
- Medical School Division of Population Health Sciences Within the Medical Research Institute, University of Dundee Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | | | - Lee Jordan
- Histopathology Breast Unit, Ninewells Hospital, Dundee, DD1 9SY, UK
| | - Alastair Thompson
- Baylor College of Medicine, 1 Baylor Plaza, Houston, TX, 77030, United States; Population Health and Genomics, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Andy Evans
- Mail Box 4, Ninewells Medical School, University of Dundee, Dundee, DD1 9SY, UK.
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Pal Mudaranthakam D, Park M, Thompson J, Alsup AM, Krebill R, Chollet Hinton L, Hu J, Gajewski B, Godwin A, Mayo MS, Wick J, Harlan-Williams L, He J, Gurley-Calvez T. A framework for personalized mammogram screening. Prev Med Rep 2021; 23:101446. [PMID: 34168953 PMCID: PMC8209666 DOI: 10.1016/j.pmedr.2021.101446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 06/01/2021] [Accepted: 06/05/2021] [Indexed: 11/28/2022] Open
Abstract
Breast cancer screening guidelines serve as crucial evidence-based recommendations in deciding when to begin regular screenings. However, due to developments in breast cancer research and differences in research interpretation, screening guidelines can vary between organizations and within organizations over time. This leads to significant lapses in adopting updated guidelines, variable decision making between physicians, and unnecessary screening for low to moderate risk patients (Jacobson and Kadiyala, 2017; Corbelli et al., 2014). For analysis, risk factors were assessed for patient screening behaviors and results. The outcome variable for the first analysis was whether the patient had undergone screening. The risk factors considered were age, marital status, education level, rural versus urban residence, and family history of breast cancer. The outcome variable for the second analysis was whether patients who had undergone breast cancer screening presented abnormal results. The risk factors considered were age, Body Mass Index, family history, smoking and alcohol status, hormonal contraceptive use, Hormone Replacement Therapy use, age of first pregnancy, number of pregnancies (parity), age of first menses, rural versus urban residence, and whether or not patients had at least one child. Logistic regression analysis displayed strong associations for both outcome variables. Risk of screening nonattendance was negatively associated with age as a continuous variable, age as a dichotomous variable, being married, any college education, and family history. Risk of one or more abnormal mammogram findings was positively associated with family history, and hormonal contraceptive use. This procedure will be further developed to incorporate additional risk factors and refine the analysis of currently implemented risk factors.
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Affiliation(s)
- Dinesh Pal Mudaranthakam
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Michele Park
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jeffrey Thompson
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Alexander M. Alsup
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Ron Krebill
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Lynn Chollet Hinton
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jinxiang Hu
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Byron Gajewski
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Andrew Godwin
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Matthew S Mayo
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Jo Wick
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
- The University of Kansas Cancer Center, Kansas City, KS, USA
| | - Lisa Harlan-Williams
- The University of Kansas Cancer Center, Kansas City, KS, USA
- Department of Anatomy and Cell Biology, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics & Data Science, University of Kansas, Medical Center, Kansas City, KS, USA
| | - Tami Gurley-Calvez
- Population Health, University of Kansas, Medical Center, Kansas City, KS, USA
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Monticciolo DL, Malak SF, Friedewald SM, Eby PR, Newell MS, Moy L, Destounis S, Leung JWT, Hendrick RE, Smetherman D. Breast Cancer Screening Recommendations Inclusive of All Women at Average Risk: Update from the ACR and Society of Breast Imaging. J Am Coll Radiol 2021; 18:1280-1288. [PMID: 34154984 DOI: 10.1016/j.jacr.2021.04.021] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/25/2022]
Abstract
Breast cancer remains the most common nonskin cancer, the second leading cause of cancer deaths, and the leading cause of premature death in US women. Mammography screening has been proven effective in reducing breast cancer deaths in women age 40 years and older. A mortality reduction of 40% is possible with regular screening. Treatment advances cannot overcome the disadvantage of being diagnosed with an advanced-stage tumor. The ACR and Society of Breast Imaging recommend annual mammography screening beginning at age 40, which provides the greatest mortality reduction, diagnosis at earlier stage, better surgical options, and more effective chemotherapy. Annual screening results in more screening-detected tumors, tumors of smaller sizes, and fewer interval cancers than longer screening intervals. Screened women in their 40s are more likely to have early-stage disease, negative lymph nodes, and smaller tumors than unscreened women. Delaying screening until age 45 or 50 will result in an unnecessary loss of life to breast cancer and adversely affects minority women in particular. Screening should continue past age 74 years, without an upper age limit unless severe comorbidities limit life expectancy. Benefits of screening should be considered along with the possibilities of recall for additional imaging and benign biopsy and the less tangible risks of anxiety and overdiagnosis. Although recall and biopsy recommendations are higher with more frequent screening, so are life-years gained and breast cancer deaths averted. Women who wish to maximize benefit will choose annual screening starting at age 40 years and will not stop screening prematurely.
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Affiliation(s)
- Debra L Monticciolo
- Vice-chair for Research, Department of Radiology, and Section Chief, Breast Imaging, Texas A&M University Health Sciences, Baylor Scott & White Healthcare-Central Texas, Temple, Texas.
| | | | - Sarah M Friedewald
- Chief of Breast and Women's Imaging; Vice Chair of Operations, Department of Radiology; Medical Director, Lynn Sage Comprehensive Breast Center, Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Peter R Eby
- Chief of Breast Imaging, Radiology Representative to the Cancer Committee, Virginia Mason Medical Center, Seattle, Washington
| | - Mary S Newell
- Associate Division Director; Associate Director of Breast Center, Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia
| | - Linda Moy
- Laura and Isaac Perlutter Cancer Center, NYU School of Medicine, New York City, New York
| | - Stamatia Destounis
- Chair of Clinical Research and Medical Outcomes Department, Elizabeth Wende Breast Care, Rochester, New York
| | - Jessica W T Leung
- Deputy Chair of Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - R Edward Hendrick
- Department of Radiology, University of Colorado School of Medicine, Aurora, Colorado
| | - Dana Smetherman
- Department Chair and Associate Medical Director of the Medical Specialties, Department of Radiology, Ochsner Medical Center, New Orleans, Louisiana
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9
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Gaudet MM, Deubler E, Diver WR, Puvanesarajah S, Patel AV, Gansler T, Sherman ME, Gapstur SM. Breast cancer risk factors by mode of detection among screened women in the Cancer Prevention Study-II. Breast Cancer Res Treat 2021; 186:791-805. [PMID: 33398477 DOI: 10.1007/s10549-020-06025-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/16/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Identifying risk factors for women at high risk of symptom-detected breast cancers that were missed by screening would enable targeting of enhanced screening regimens. To this end, we examined associations of breast cancer risk factors by mode of detection in screened women from the Cancer Prevention Study (CPS)-II Nutrition Cohort. METHODS Among 77,206 women followed for a median of 14.8 years, 2711 screen-detected and 1281 symptom-detected breast cancer cases were diagnosed. Multivariable-adjusted associations were estimated using joint Cox proportional hazards regression models with person-time calculated contingent on screening. RESULTS Factors associated with higher risks of symptom-detected and screen-detected breast cancer included current combined hormone therapy (HT) use (HR 2.07, 95% CI 1.72-2.48 and 1.45, 1.27-1.65, respectively) and history of benign breast disease (1.85, 1.64-2.08 and 1.43, 1.31-1.55, respectively). Current estrogen-only HT use was associated with symptom-detected (1.40, 1.15-1.71) but not screen-detected (0.95, 0.83-1.09) breast cancer. Higher risk of screen-detected but not symptom-detected breast cancer was observed for obese vs. normal body mass index (1.22, 1.01-1.48 and 0.76, 0.56-1.01, respectively), per 3 h/day sitting time (1.10, 1.04-1.16 and 0.97, 0.89-1.06, respectively), and ≥ 2 drinks per day vs. nondrinker (1.40, 1.16-1.69 and 1.27, 0.97-1.66, respectively). CONCLUSIONS Differences in risk factors for symptom-detected vs. screen-detected breast cancer were observed and most notably, use of combined and estrogen-only HT and a history of benign breast disease were associated with increased risk of symptomatic detected breast cancer. IMPACT If confirmed, these data suggest that such women may benefit from more intensive screening to facilitate early detection.
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Affiliation(s)
- Mia M Gaudet
- Behavioral and Epidemiology Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA.
| | - Emily Deubler
- Behavioral and Epidemiology Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - W Ryan Diver
- Behavioral and Epidemiology Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - Samantha Puvanesarajah
- Behavioral and Epidemiology Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - Alpa V Patel
- Behavioral and Epidemiology Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - Ted Gansler
- Behavioral and Epidemiology Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - Mark E Sherman
- Departments of Epidemiology and of Laboratory Medicine and Pathology, Mayo Clinical College of Medicine, Jacksonville, FL, USA
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Program, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
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10
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Evans A, Petty R, Macaskill J. Why is renal impairment associated with poorer cancer specific survival in breast cancer patients?: a comparison with patients with other comorbidities. Int J Clin Oncol 2020; 25:1786-1792. [PMID: 32617752 PMCID: PMC7498492 DOI: 10.1007/s10147-020-01733-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 06/21/2020] [Indexed: 02/07/2023]
Abstract
Background Our aim is to assess whether the poor breast cancer specific survival (BCSS) seen in women with breast cancer and impaired renal function can be explained by associations with other prognostic factors. Methods The study group was a consecutive series of patients undergoing breast ultrasound (US) who had invasive breast cancer (n = 1171). All women had their US diameter and mean stiffness (kPa) at shear wave elastography (SWE) recorded. The core biopsy grade and receptor status were noted. Core biopsy of abnormal axillary nodes and the patient referral source was also noted. Survival including cause of death was ascertained. Comorbidities at diagnosis were recorded. Patients were divided into those with a GFR<60 (“renal group”), those with other comorbidities and those with none. BCSS was assessed using Kaplan–Meier survival curves and Cox proportional hazards regression. Results One thousand, one hundred and forty-one patients constituted the study group. 107 (9%) patients had impaired renal function, 182 (16%) had other comorbidities while 852 (75%) had no comorbidities. Mean follow-up was 5.8 years. 109 breast cancer and 122 non-breast cancer deaths occurred. BCSS in the renal group was significantly worse than the other groups. Women with renal comorbidity were older, more likely to present symptomatically, have a pre-operative diagnosis of axillary metastases, and have larger and stiffer cancers. Cox proportional hazards regression showed that renal impairment maintained independent significance. Conclusion The poor BCSS in women with impaired renal function is partially explained by advanced tumour stage at presentation. However, impaired renal function maintains an independent prognostic effect.
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Affiliation(s)
- Andy Evans
- Breast Imaging Group, Ninewells Hospital and Medical School, Mailbox 4, Dundee, DD1 9SY Scotland
| | - Russell Petty
- Medical Oncology, Ninewells Hospital and Medical School, Mailbox 4, Dundee, DD1 9SY Scotland
| | - Jane Macaskill
- Department of Breast Surgery, Ninewells Hospital, Level 6, Dundee, DD1 9SY Scotland
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11
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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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