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Mares-Quiñones MD, Galán-Vásquez E, Pérez-Rueda E, Pérez-Ishiwara DG, Medel-Flores MO, Gómez-García MDC. Identification of modules and key genes associated with breast cancer subtypes through network analysis. Sci Rep 2024; 14:12350. [PMID: 38811600 PMCID: PMC11137066 DOI: 10.1038/s41598-024-61908-4] [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: 07/13/2023] [Accepted: 05/10/2024] [Indexed: 05/31/2024] Open
Abstract
Breast cancer is the most common malignancy in women around the world. Intratumor and intertumoral heterogeneity persist in mammary tumors. Therefore, the identification of biomarkers is essential for the treatment of this malignancy. This study analyzed 28,143 genes expressed in 49 breast cancer cell lines using a Weighted Gene Co-expression Network Analysis to determine specific target proteins for Basal A, Basal B, Luminal A, Luminal B, and HER2 ampl breast cancer subtypes. Sixty-five modules were identified, of which five were characterized as having a high correlation with breast cancer subtypes. Genes overexpressed in the tumor were found to participate in the following mechanisms: regulation of the apoptotic process, transcriptional regulation, angiogenesis, signaling, and cellular survival. In particular, we identified the following genes, considered as hubs: IFIT3, an inhibitor of viral and cellular processes; ETS1, a transcription factor involved in cell death and tumorigenesis; ENSG00000259723 lncRNA, expressed in cancers; AL033519.3, a hypothetical gene; and TMEM86A, important for regulating keratinocyte membrane properties, considered as a key in Basal A, Basal B, Luminal A, Luminal B, and HER2 ampl breast cancer subtypes, respectively. The modules and genes identified in this work can be used to identify possible biomarkers or therapeutic targets in different breast cancer subtypes.
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Affiliation(s)
- María Daniela Mares-Quiñones
- Laboratorio de Biomedicina Molecular, Programa de Doctorado en Biotecnología, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - Edgardo Galán-Vásquez
- Departamento de Ingeniería de Sistemas Computacionales y Automatización, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Ciudad Universitaria, Ciudad de México, Mexico
| | - Ernesto Pérez-Rueda
- Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas, Universidad Nacional Autónoma de México, Unidad Académica del Estado de Yucatán, Mérida, Mexico
| | - D Guillermo Pérez-Ishiwara
- Laboratorio de Biomedicina Molecular, Programa de Doctorado en Biotecnología, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - María Olivia Medel-Flores
- Laboratorio de Biomedicina Molecular, Programa de Doctorado en Biotecnología, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, Mexico
| | - María Del Consuelo Gómez-García
- Laboratorio de Biomedicina Molecular, Programa de Doctorado en Biotecnología, Escuela Nacional de Medicina y Homeopatía, Instituto Politécnico Nacional, Ciudad de México, Mexico.
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Kuklinski D, Blum M, Subelack J, Geissler A, Eichenberger A, Morant R. Breast cancer patients enrolled in the Swiss mammography screening program "donna" demonstrate prolonged survival. Breast Cancer Res 2024; 26:84. [PMID: 38802897 PMCID: PMC11131279 DOI: 10.1186/s13058-024-01841-6] [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: 01/22/2024] [Accepted: 05/16/2024] [Indexed: 05/29/2024] Open
Abstract
STUDY GOAL We compared the survival rates of women with breast cancer (BC) detected within versus outside the mammography screening program (MSP) "donna". METHODS We merged data from the MSP with the data from corresponding cancer registries to categorize BC cases as within MSP (screen-detected and interval carcinomas) and outside the MSP. We analyzed the tumor stage distribution, tumor characteristics and the survival of the women. We further estimated hazard ratios using Cox-regressions to account for different characteristics between groups and corrected the survival rates for lead-time bias. RESULTS We identified 1057 invasive (ICD-10: C50) and in-situ (D05) BC cases within the MSP and 1501 outside the MSP between 2010 and 2019 in the Swiss cantons of St. Gallen and Grisons. BC within the MSP had a higher share of stage I carcinoma (46.5% vs. 33.0%; p < 0.01), a smaller (mean) tumor size (19.1 mm vs. 24.9 mm, p < 0.01), and fewer recurrences and metastases in the follow-up period (6.7% vs. 15.6%, p < 0.01). The 10-year survival rates were 91.4% for women within and 72.1% for women outside the MSP (p < 0.05). Survival difference persisted but decreased when women within the same tumor stage were compared. Lead-time corrected hazard ratios for the MSP accounted for age, tumor size and Ki-67 proliferation index were 0.550 (95% CI 0.389, 0.778; p < 0.01) for overall survival and 0.469 (95% CI 0.294, 0.749; p < 0.01) for BC related survival. CONCLUSION Women participating in the "donna" MSP had a significantly higher overall and BC related survival rate than women outside the program. Detection of BC at an earlier tumor stage only partially explains the observed differences.
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Affiliation(s)
- David Kuklinski
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Jakobstr. 21, 9000, St. Gallen, Switzerland.
| | - Marcel Blum
- Cancer League of Eastern Switzerland, St. Gallen, Switzerland
| | - Jonas Subelack
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Jakobstr. 21, 9000, St. Gallen, Switzerland
| | - Alexander Geissler
- Chair of Health Economics, Policy and Management, School of Medicine, University of St. Gallen, St. Jakobstr. 21, 9000, St. Gallen, Switzerland
| | | | - Rudolf Morant
- Cancer League of Eastern Switzerland, St. Gallen, Switzerland
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Vratanar B, Pohar Perme M. Evaluating cancer screening programs using survival analysis. Biom J 2023; 65:e2200344. [PMID: 37278228 DOI: 10.1002/bimj.202200344] [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: 12/07/2022] [Revised: 03/23/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023]
Abstract
The main purpose of cancer screening programs is to provide early treatment to patients that are diagnosed with cancer on a screening test, thus increasing their chances of survival. To test this hypothesis directly, one should compare the survival of screen-detected cases to the survival of their counterparts not included to the program. In this study, we develop a general notation and use it to formally define the comparison of interest. We explain why the naive comparison between screen-detected and interval cases is biased and show that the total bias that arises in this case can be decomposed as a sum of lead time bias, length time bias, and bias due to overdetection. With respect to the estimation, we show what can be estimated using existing methods. To fill in the missing gap, we develop a new nonparametric estimator that allows us to estimate the survival of the control group, that is, the survival of cancer cases that would be screen-detected among those not included to the program. By joining the proposed estimator with existing methods, we show that the contrast of interest can be estimated without neglecting any of the biases. Our approach is illustrated using simulations and empirical data.
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Affiliation(s)
- Bor Vratanar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Pohar Perme
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Heinig M, Schäfer W, Langner I, Zeeb H, Haug U. German mammography screening program: adherence, characteristics of (non-)participants and utilization of non-screening mammography-a longitudinal analysis. BMC Public Health 2023; 23:1678. [PMID: 37653487 PMCID: PMC10469853 DOI: 10.1186/s12889-023-16589-5] [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: 05/08/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND In Germany, all women aged 50-69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups. METHODS Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1-2, 3-4, 5-6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy. RESULTS Overall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1-2 times, 31.7% participated 3-4 times and 25.6% participated regularly (5-6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50-59 were 25%, 18%, and 15%, respectively. CONCLUSIONS Using a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50-59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.
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Affiliation(s)
- Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Wiebke Schäfer
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
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Strandberg R, Abrahamsson L, Isheden G, Humphreys K. Tumour Growth Models of Breast Cancer for Evaluating Early Detection-A Summary and a Simulation Study. Cancers (Basel) 2023; 15:cancers15030912. [PMID: 36765870 PMCID: PMC9913080 DOI: 10.3390/cancers15030912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
With the advent of nationwide mammography screening programmes, a number of natural history models of breast cancers have been developed and used to assess the effects of screening. The first half of this article provides an overview of a class of these models and describes how they can be used to study latent processes of tumour progression from observational data. The second half of the article describes a simulation study which applies a continuous growth model to illustrate how effects of extending the maximum age of the current Swedish screening programme from 74 to 80 can be evaluated. Compared to no screening, the current and extended programmes reduced breast cancer mortality by 18.5% and 21.7%, respectively. The proportion of screen-detected invasive cancers which were overdiagnosed was estimated to be 1.9% in the current programme and 2.9% in the extended programme. With the help of these breast cancer natural history models, we can better understand the latent processes, and better study the effects of breast cancer screening.
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Affiliation(s)
- Rickard Strandberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence: (R.S.); (K.H.)
| | - Linda Abrahamsson
- Center for Primary Health Care Research, Lund University, 205 02 Malmö, Sweden
| | | | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Correspondence: (R.S.); (K.H.)
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Dhawan D, Ramos-Vara JA, Utturkar SM, Ruple A, Tersey SA, Nelson JB, Cooper B, Heng HG, Ostrander EA, Parker HG, Hahn NM, Adams LG, Fulkerson CM, Childress MO, Bonney P, Royce C, Fourez LM, Enstrom AW, Ambrosius LA, Knapp DW. Identification of a naturally-occurring canine model for early detection and intervention research in high grade urothelial carcinoma. Front Oncol 2022; 12:1011969. [PMID: 36439482 PMCID: PMC9692095 DOI: 10.3389/fonc.2022.1011969] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/24/2022] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND Early detection and intervention research is expected to improve the outcomes for patients with high grade muscle invasive urothelial carcinoma (InvUC). With limited patients in suitable high-risk study cohorts, relevant animal model research is critical. Experimental animal models often fail to adequately represent human cancer. The purpose of this study was to determine the suitability of dogs with high breed-associated risk for naturally-occurring InvUC to serve as relevant models for early detection and intervention research. The feasibility of screening and early intervention, and similarities and differences between canine and human tumors, and early and later canine tumors were determined. METHODS STs (n=120) ≥ 6 years old with no outward evidence of urinary disease were screened at 6-month intervals for 3 years with physical exam, ultrasonography, and urinalysis with sediment exam. Cystoscopic biopsy was performed in dogs with positive screening tests. The pathological, clinical, and molecular characteristics of the "early" cancer detected by screening were determined. Transcriptomic signatures were compared between the early tumors and published findings in human InvUC, and to more advanced "later" canine tumors from STs who had the typical presentation of hematuria and urinary dysfunction. An early intervention trial of an oral cyclooxygenase inhibitor, deracoxib, was conducted in dogs with cancer detected through screening. RESULTS Biopsy-confirmed bladder cancer was detected in 32 (27%) of 120 STs including InvUC (n=29, three starting as dysplasia), grade 1 noninvasive cancer (n=2), and carcinoma in situ (n=1). Transcriptomic signatures including druggable targets such as EGFR and the PI3K-AKT-mTOR pathway, were very similar between canine and human InvUC, especially within luminal and basal molecular subtypes. Marked transcriptomic differences were noted between early and later canine tumors, particularly within luminal subtype tumors. The deracoxib remission rate (42% CR+PR) compared very favorably to that with single-agent cyclooxygenase inhibitors in more advanced canine InvUC (17-25%), supporting the value of early intervention. CONCLUSIONS The study defined a novel naturally-occurring animal model to complement experimental models for early detection and intervention research in InvUC. Research incorporating the canine model is expected to lead to improved outcomes for humans, as well as pet dogs, facing bladder cancer.
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Affiliation(s)
- Deepika Dhawan
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - José A. Ramos-Vara
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
- Purdue University Center for Cancer Research, West Lafayette, IN, United States
| | - Sagar M. Utturkar
- Purdue University Center for Cancer Research, West Lafayette, IN, United States
| | - Audrey Ruple
- Purdue University Center for Cancer Research, West Lafayette, IN, United States
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, United States
| | - Sarah A. Tersey
- Department of Medicine, Section of Endocrinology, Metabolism, and Diabetes, University of Chicago, Chicago, IL, United States
| | - Jennifer B. Nelson
- Department of Medicine, Section of Endocrinology, Metabolism, and Diabetes, University of Chicago, Chicago, IL, United States
| | - Bruce R. Cooper
- Bindley Bioscience Center, Purdue University, West Lafayette, IN, United States
| | - Hock Gan Heng
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Elaine A. Ostrander
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Heidi G. Parker
- National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Noah M. Hahn
- Department of Oncology and Urology, Johns Hopkins University School of Medicine, and Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, United States
| | - Larry G. Adams
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Christopher M. Fulkerson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Michael O. Childress
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
- Department of Comparative Pathobiology, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Patty L. Bonney
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Christine Royce
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Lindsey M. Fourez
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Alexander W. Enstrom
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Lisbeth A. Ambrosius
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
| | - Deborah W. Knapp
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN, United States
- Purdue University Center for Cancer Research, West Lafayette, IN, United States
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Lim ZL, Ho PJ, Khng AJ, Yeoh YS, Ong ATW, Tan BKT, Tan EY, Tan SM, Lim GH, Lee JA, Tan VKM, Hu J, Li J, Hartman M. Mammography screening is associated with more favourable breast cancer tumour characteristics and better overall survival: case-only analysis of 3739 Asian breast cancer patients. BMC Med 2022; 20:239. [PMID: 35922814 PMCID: PMC9351273 DOI: 10.1186/s12916-022-02440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/15/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early detection of breast cancer (BC) through mammography screening (MAM) is known to reduce mortality. We examined the differential effect that mammography has on BC characteristics and overall survival and the sociodemographic determinants of MAM utilization in a multi-ethnic Asian population. METHODS This study included 3739 BC patients from the Singapore Breast Cancer Cohort (2010-2018). Self-reported sociodemographic characteristics were collected using a structured questionnaire. Clinical data were obtained through medical records. Patients were classified as screeners (last screening mammogram ≤ 2 years before diagnosis), non-screeners (aware but did not attend or last screen > 2years), and those unaware of MAM. Associations between MAM behaviour (MB) and sociodemographic factors and MB and tumour characteristics were examined using multinomial regression. Ten-year overall survival was modelled using Cox regression. RESULTS Patients unaware of screening were more likely diagnosed with late stage (ORstage III vs stage I (Ref) [95% CI]: 4.94 [3.45-7.07], p < 0.001), high grade (ORpoorly vs well-differentiated (reference): 1.53 [1.06-2.20], p = 0.022), nodal-positive, large size (OR>5cm vs ≤2cm (reference): 5.06 [3.10-8.25], p < 0.001), and HER2-positive tumours (ORHER2-negative vs HER2-positive (reference): 0.72 [0.53-0.97], p = 0.028). Similar trends were observed between screeners and non-screeners with smaller effect sizes. Overall survival was significantly shorter than screeners in the both groups (HRnon-screeners: 1.89 [1.22-2.94], p = 0.005; HRunaware: 2.90 [1.69-4.98], p < 0.001). Non-screeners and those unaware were less health conscious, older, of Malay ethnicity, less highly educated, of lower socioeconomic status, more frequently ever smokers, and less physically active. Among screeners, there were more reported personal histories of benign breast surgeries or gynaecological conditions and positive family history of breast cancer. CONCLUSIONS Mammography attendance is associated with more favourable BC characteristics and overall survival. Disparities in the utility of MAM services suggest that different strategies may be needed to improve MAM uptake.
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Affiliation(s)
- Zi Lin Lim
- Genome Institute of Singapore, Laboratory of Women's Health & Genetics, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Peh Joo Ho
- Genome Institute of Singapore, Laboratory of Women's Health & Genetics, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Alexis Jiaying Khng
- Genome Institute of Singapore, Laboratory of Women's Health & Genetics, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Yen Shing Yeoh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Amanda Tse Woon Ong
- Department of Surgery, National University Hospital, Singapore, 119054, Singapore
| | - Benita Kiat Tee Tan
- Department of General Surgery, Sengkang General Hospital, Singapore, 544886, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, 168753, Singapore.,Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore
| | - Su-Ming Tan
- Division of Breast Surgery, Changi General Hospital, Singapore, 529889, Singapore
| | - Geok Hoon Lim
- Breast Department, KK Women's and Children's Hospital, Singapore, 229899, Singapore.,Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Jung Ah Lee
- Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Veronique Kiak-Mien Tan
- Department of Breast Surgery, Singapore General Hospital, Singapore, 168753, Singapore.,Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Jesse Hu
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, 609606, Singapore
| | - Jingmei Li
- Genome Institute of Singapore, Laboratory of Women's Health & Genetics, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore.
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore.,Department of Surgery, National University Hospital, Singapore, 119054, Singapore
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Eby PR, Ghate S, Hooley R. The Benefits of Early Detection: Evidence From Modern International Mammography Service Screening Programs. JOURNAL OF BREAST IMAGING 2022; 4:346-356. [PMID: 38416986 DOI: 10.1093/jbi/wbac041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 03/01/2024]
Abstract
Research from randomized controlled trials initiated up to 60 years ago consistently confirms that regular screening with mammography significantly reduces breast cancer mortality. Despite this success, there is ongoing debate regarding the efficacy of screening, which is confounded by technologic advances and concerns about cost, overdiagnosis, overtreatment, and equitable care of diverse patient populations. More recent screening research, designed to quell the debates, derives data from variable study designs, each with unique strengths and weaknesses. This article reviews observational population-based screening research that has followed the early initial long-term randomized controlled trials that are no longer practical or ethical to perform. The advantages and disadvantages of observational data and study design are outlined, including the three subtypes of population-based observational studies: cohort/case-control, trend, and incidence-based mortality/staging. The most recent research, typically performed in countries that administer screening mammography to women through centralized health service programs and directly track patient-specific outcomes and detection data, is summarized. These data are essential to understand and inform construction of effective new databases that facilitate continuous assessment of optimal screening techniques in the current era of rapidly developing medical technology, combined with a focus on health care that is both personal and equitable.
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Affiliation(s)
- Peter R Eby
- Virginia Mason Medical Center, Department of Radiology, Seattle, WA, USA
| | - Sujata Ghate
- Duke University School of Medicine, Department of Radiology, Durham, NC, USA
| | - Regina Hooley
- Yale New Haven Hospital, Department of Radiology and Biomedical Imaging, New Haven, CT, USA
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Habbous S, Homenauth E, Barisic A, Kandasamy S, Majpruz V, Forster K, Yurcan M, Chiarelli AM, Groome P, Holloway CMB, Eisen A. Differences in breast cancer diagnosis by patient presentation in Ontario: a retrospective cohort study. CMAJ Open 2022; 10:E313-E330. [PMID: 35383035 PMCID: PMC9259434 DOI: 10.9778/cmajo.20210254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND In Ontario, patients with breast cancer typically receive their diagnoses through the Ontario Breast Screening Program (OBSP) after an abnormal screen, through screening initiated by a primary care provider or other referring physician, or through follow-up of symptoms by patients' primary care providers. We sought to explore the association of the route to diagnosis (screening within or outside the OBSP or via symptomatic presentation) with use of OBSP-affiliated breast assessment sites (O-BAS), wait times until diagnosis or treatment, health care use and overall survival for patients with breast cancer. METHODS In this retrospective cohort study, we used the Ontario Cancer Registry to identify adults (aged 18-105 yr) who received a diagnosis of breast cancer from 2013 to 2017. We excluded patients if they were not Ontario residents or had missing age or sex, or who died before diagnosis. We used logistic regression to evaluate factors associated with categorical variables (whether patients were or were not referred to an OBAS, whether patients were screened or symptomatic) and Cox proportional hazards regression to identify factors associated with all-cause mortality. RESULTS Of 51 460 patients with breast cancer, 42 598 (83%) received their diagnoses at an O-BAS. Patients whose cancer was first detected through the OBSP were more likely than symptomatic patients to be given a diagnosis at an O-BAS (adjusted odds ratio 1.68, 95% confidence interval [CI] 1.57 to 1.80). Patients screened by the OBSP were given their diagnoses 1 month earlier than symptomatic patients, but diagnosis at an O-BAS did not affect the time until either diagnosis or treatment. Patients referred to an O-BAS had significantly better overall survival than those who were not referred (adjusted hazard ratio 0.73, 95% CI 0.66 to 0.80). INTERPRETATION Patients screened through the OBSP were given their diagnoses earlier than symptomatic patients and were more likely to be referred to an O-BAS, which was associated with better survival. Our findings suggest that individuals with signs and symptoms of breast cancer would benefit from similar referral processes, oversight and standards to those used by the OBSP.
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Affiliation(s)
- Steven Habbous
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Esha Homenauth
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Andriana Barisic
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Sharmilaa Kandasamy
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Vicky Majpruz
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Katharina Forster
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Marta Yurcan
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Anna M Chiarelli
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Patti Groome
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Claire M B Holloway
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Andrea Eisen
- Ontario Health (Cancer Care Ontario) (Habbous, Homenauth, Barisic, Kandasamy, Majpruz, Forster, Yurcan, Chiarelli, Holloway, Eisen); Dalla Lana School of Public Health (Chiarelli), Toronto, Ont.; ICES Queen's (Groome), Kingston, Ont.; Department of Surgery (Holloway), University of Toronto; Department of Medical Oncology (Eisen), Sunnybrook Health Sciences Centre, Toronto, Ont
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10
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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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11
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Do low-fat foods alter risk of colorectal cancer from processed meat? Public Health 2020; 183:138-145. [PMID: 32502700 DOI: 10.1016/j.puhe.2020.03.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVES We investigated potential causes of the high incidence rate of colorectal cancer (CRC) in New Zealand. STUDY DESIGN A national population-based case-control study of 806 cases and 1025 controls was conducted to determine the risk factors for CRC in this population. METHODS Information about family history of CRC, ethnicity, diet, school milk consumption, exercise, and height and weight at age 20 years were collected by a self-administered questionnaire from cases and controls. RESULTS Response rates were 84% for cases and 65% for controls. Increasing preference for low-fat food alternatives was associated with reducing odds ratios (OR) for CRC (Ptrend<0.001) with a considerably reduced OR of always versus never choosing low-fat food alternatives (OR = 0.39, 95% confidence interval = 0.26, 0.58). Increased consumption of dairy products or milk was associated with reduced risk of CRC. Belonging to the male gender, having a first degree relative with CRC, and increasing consumption of processed meat, lamb, pork, and bread were associated with elevated risks of CRC. The increased risk from consumption of processed meat was not evident in subjects who regularly or always preferred low-fat food. CONCLUSIONS A preference for low-fat food may ameliorate an increased risk of CRC from the consumption of processed meat.
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12
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Wang F, Shu XO. Lead-Time Bias in the Analyses of Overall Mortality of Breast Cancer in Men vs Women—Reply. JAMA Oncol 2020; 6:442. [DOI: 10.1001/jamaoncol.2019.6298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Fei Wang
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Xiao-Ou Shu
- Vanderbilt Epidemiology Center, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, Tennessee
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13
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Bertrand KA, Bethea TN, Rosenberg L, Bandera EV, Khoury T, Troester MA, Ambrosone CB, Palmer JR. Risk factors for estrogen receptor positive ductal carcinoma in situ of the breast in African American women. Breast 2020; 49:108-114. [PMID: 31786415 PMCID: PMC7012668 DOI: 10.1016/j.breast.2019.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 10/15/2019] [Accepted: 10/21/2019] [Indexed: 11/26/2022] Open
Abstract
Background Compared to U.S. white women, African American women are more likely to die from ductal carcinoma in situ (DCIS). Elucidation of risk factors for DCIS in African American women may provide opportunities for risk reduction. Methods We used data from three epidemiologic studies in the African American Breast Cancer Epidemiology and Risk Consortium to study risk factors for estrogen receptor (ER) positive DCIS (488 cases; 13,830 controls). Results were compared to associations observed for ER+ invasive breast cancer (n = 2,099). Results First degree family history of breast cancer was associated with increased risk of ER+ DCIS [odds ratio (OR): 1.69, 95% confidence interval (CI): 1.31, 2.17]. Oral contraceptive use within the past 10 years (vs. never) was also associated with increased risk (OR: 1.43, 95%CI: 1.03, 1.97), as was late age at first birth (≥25 years vs. <20 years) (OR: 1.26, 95%CI: 0.96, 1.67). Risk was reduced in women with older age at menarche (≥15 years vs. <11 years) (OR: 0.62, 95%CI: 0.42, 0.93) and higher body mass index (BMI) in early adulthood (≥25 vs. <20 kg/m2 at age 18 or 21) (OR: 0.75, 95%CI: 0.55, 1.01). There was a positive association of recent BMI with risk in postmenopausal women only. In general, associations of risk factors for ER+ DCIS were similar in magnitude and direction to those for invasive ER+ breast cancer. Conclusions Our findings suggest that most risk factors for invasive ER+ breast cancer are also associated with increased risk of ER+ DCIS among African American women. Few studies of risk factors for ductal carcinoma in situ (DCIS) have evaluated associations for African American women. We analyzed data from the African American African American Breast Cancer Epidemiology and Risk (AMBER) Consortium. Family history of breast cancer, reproductive factors, and anthropometric factors were associated with risk of ER+ DCIS. In general, risk factor associations for ER+ DCIS were similar to those for ER+ invasive breast cancer. Our findings support a common etiology and pathogenesis between ER+ DICS and ER+ invasive cancer in African American women.
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14
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Abrahamsson L, Isheden G, Czene K, Humphreys K. Continuous tumour growth models, lead time estimation and length bias in breast cancer screening studies. Stat Methods Med Res 2019; 29:374-395. [DOI: 10.1177/0962280219832901] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Comparisons of survival times between screen-detected and symptomatically detected breast cancer cases are subject to lead time and length biases. Whilst the existence of these biases is well known, correction procedures for these are not always clear, as are not the interpretation of these biases. In this paper we derive, based on a recently developed continuous tumour growth model, conditional lead time distributions, using information on each individual's tumour size, screening history and percent mammographic density. We show how these distributions can be used to obtain an individual-based (conditional) procedure for correcting survival comparisons. In stratified analyses, our correction procedure works markedly better than a previously used unconditional lead time correction, based on multi-state Markov modelling. In a study of postmenopausal invasive breast cancer patients, we estimate that, in large (>12 mm) tumours, the multi-state Markov model correction over-corrects five-year survival by 2–3 percentage points. The traditional view of length bias is that tumours being present in a woman's breast for a long time, due to being slow-growing, have a greater chance of being screen-detected. This gives a survival advantage for screening cases which is not due to the earlier detection by screening. We use simulated data to share the new insight that, not only the tumour growth rate but also the symptomatic tumour size will affect the sampling procedure, and thus be a part of the length bias through any link between tumour size and survival. We explain how this has a bearing on how observable breast cancer-specific survival curves should be interpreted. We also propose an approach for correcting survival comparisons for the length bias.
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Affiliation(s)
- Linda Abrahamsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Gabriel Isheden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Keith Humphreys
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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15
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Risk factors for Luminal A ductal carcinoma in situ (DCIS) and invasive breast cancer in the Carolina Breast Cancer Study. PLoS One 2019; 14:e0211488. [PMID: 30682163 PMCID: PMC6347264 DOI: 10.1371/journal.pone.0211488] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 01/15/2019] [Indexed: 12/21/2022] Open
Abstract
Purpose Invasive breast cancers are thought to arise from in situ lesions, but some ductal carcinoma in situ (DCIS) are indolent with low likelihood of progressing to invasive carcinoma. Comparison of risk factor associations between DCIS and invasive disease may elucidate which factors influence early versus late stages of carcinogenesis. Therefore, we determined whether there were differences in risk factor profiles for screen-detected DCIS and invasive breast cancer among Luminal A lesions. Methods We conducted a case-control analysis using data from the Carolina Breast Cancer Study (1993–2001). Analyses were restricted to Luminal A tumors and screen-detected tumors among mammography-eligible women, to limit confounding by mode of detection (N = 108 DCIS; N = 203 invasive). Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for associations between risk factors and lesion type. Results In stratified analyses, we observed qualitative differences in the direction of association for ever smoking, obese BMI, high waist-to-hip-ratio (WHR), and ≥10 years of oral contraceptive use between DCIS and invasive disease. Breastfeeding was inversely associated with invasive disease and was not associated with DCIS. Interaction tests for risk factor associations between Luminal A DCIS and invasive breast cancer were not statistically significant (p>0.05). Conclusions Among Luminal A tumors, established breast cancer risk factors may exert stronger effects on progression of early lesions to invasive disease, with lesser effects on risk of DCIS.
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16
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Yoshimura A, Ito H, Nishino Y, Hattori M, Matsuda T, Miyashiro I, Nakayama T, Iwata H, Matsuo K, Tanaka H, Ito Y. Recent Improvement in the Long-term Survival of Breast Cancer Patients by Age and Stage in Japan. J Epidemiol 2018; 28:420-427. [PMID: 29479003 PMCID: PMC6143379 DOI: 10.2188/jea.je20170103] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Recent improvements in 5-year survival of breast cancer have been reported in Japan and other countries. Though the number of long-term breast cancer survivors has been increasing, recent improvements in 10-year survival have not been reported. Moreover, the degree of improvement according to age and disease stage remains unclear. Methods We calculated long-term survival using data on breast cancer diagnosed from 1993 through 2006 from six prefectural population-based cancer registries in Japan. The recent increase in 10-year relative survival was assessed by comparing the results of period analysis in 2002–2006 with the results of cohort analysis in 1993–1997. We also conducted stratified analyses by age group (15–34, 35–49, 50–69, and 70–99 years) and disease stage (localized, regional, and distant). Results A total of 63,348 patients were analysed. Ten-year relative survival improved by 2.4% (76.9% vs 79.3%) from 1993 through 2006. By age and stage, 10-year relative survival clearly improved in the age 35–49 years (+2.9%; 78.1% vs 81.0%), 50–69 years (+2.8%; 75.2% vs 78.0%) and regional disease (+3.4%; 64.9% vs 68.3%). In contrast, the degree of improvement was small in the age 15–34 years (+0.1%; 68.2% vs 68.3%), 70–99 years (+1.0%; 87.6% vs 88.6%), localized disease (+1.1%; 92.6% vs 93.7%) and distant metastasis (+0.9%; 13.8% vs 14.7%). Conclusions These population-based cancer registry data show that 10-year relative survival improved 2.4% over this period in Japan. By age and stage, improvement in the age 15–34 years and distant metastasis was very small, which suggests the need for new therapeutic strategies in these patients.
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Affiliation(s)
- Akiyo Yoshimura
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Research Institute.,Department of Breast Oncology, Aichi Cancer Center Hospital.,Department of Epidemiology, Nagoya University Graduate School of Medicine
| | - Hidemi Ito
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Research Institute.,Department of Epidemiology, Nagoya University Graduate School of Medicine.,Division of Epidemiology & Prevention, Aichi Cancer Research Institute
| | - Yoshikazu Nishino
- Department of Epidemiology and Public Health, Kanazawa Medical University
| | | | - Tomohiro Matsuda
- Cancer Information Services and Surveillance Division, Center for Cancer Control and Information Services, National Cancer Center
| | - Isao Miyashiro
- Department of Cancer Strategy, Cancer Control Center, Osaka International Cancer Institute
| | - Tomio Nakayama
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital
| | - Keitaro Matsuo
- Division of Molecular and Clinical Epidemiology, Aichi Cancer Research Institute.,Department of Epidemiology, Nagoya University Graduate School of Medicine
| | - Hideo Tanaka
- Division of Epidemiology & Prevention, Aichi Cancer Research Institute
| | - Yuri Ito
- Department of Cancer Epidemiology, Cancer Control Center, Osaka International Cancer Institute
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17
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Kaniklidis C. Mammography, Martin Yaffe, and me: response and appreciation. Curr Oncol 2015; 22:e404-8. [PMID: 26628887 DOI: 10.3747/co.22.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
I thank Dr. Martin Yaffe for his many constructive comments in his thoughtful review of my previous invited editorial, providing valuable insights into the complex and controversial issues of the current mammography debate. [...]
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18
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Kyrø C, Zamora-Ros R, Scalbert A, Tjønneland A, Dossus L, Johansen C, Bidstrup PE, Weiderpass E, Christensen J, Ward H, Aune D, Riboli E, His M, Clavel-Chapelon F, Baglietto L, Katzke V, Kühn T, Boeing H, Floegel A, Overvad K, Lasheras C, Travier N, Sánchez MJ, Amiano P, Chirlaque MD, Ardanaz E, Khaw KT, Wareham N, Perez-Cornago A, Trichopoulou A, Lagiou P, Vasilopoulou E, Masala G, Grioni S, Berrino F, Tumino R, Sacerdote C, Mattiello A, Bueno-de-Mesquita HB, Peeters PH, van Gils C, Borgquist S, Butt S, Zeleniuch-Jacquotte A, Sund M, Hjartåker A, Skeie G, Olsen A, Romieu I. Pre-diagnostic polyphenol intake and breast cancer survival: the European Prospective Investigation into Cancer and Nutrition (EPIC) cohort. Breast Cancer Res Treat 2015; 154:389-401. [PMID: 26531755 PMCID: PMC6281163 DOI: 10.1007/s10549-015-3595-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/05/2015] [Indexed: 12/22/2022]
Abstract
The aim was to investigate the association between pre-diagnostic intakes of polyphenol classes (flavonoids, lignans, phenolic acids, stilbenes, and other polyphenols) in relation to breast cancer survival (all-cause and breast cancer-specific mortality). We used data from the European Prospective Investigation into Cancer and Nutrition cohort. Pre-diagnostic usual diet was assessed using dietary questionnaires, and polyphenol intakes were estimated using the Phenol-Explorer database. We followed 11,782 breast cancer cases from time of diagnosis until death, end of follow-up or last day of contact. During a median of 6 years, 1482 women died (753 of breast cancer). We related polyphenol intake to all-cause and breast cancer-specific mortality using Cox proportional hazard models with time since diagnosis as underlying time and strata for age and country. Among postmenopausal women, an intake of lignans in the highest versus lowest quartile was related to a 28 % lower risk of dying from breast (adjusted model: HR, quartile 4 vs. quartile 1, 0.72, 95 % CI 0.53; 0.98). In contrast, in premenopausal women, a positive association between lignan intake and all-cause mortality was found (adjusted model: HR, quartile 4 vs. quartile 1, 1.63, 95 % CI 1.03; 2.57). We found no association for other polyphenol classes. Intake of lignans before breast cancer diagnosis may be related to improved survival among postmenopausal women, but may on the contrary worsen the survival for premenopausal women. This suggests that the role of phytoestrogens in breast cancer survival is complex and may be dependent of menopausal status.
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Affiliation(s)
- Cecilie Kyrø
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
- International Agency for Research on Cancer (WHO-IARC), Lyon, France.
| | - Raul Zamora-Ros
- International Agency for Research on Cancer (WHO-IARC), Lyon, France
| | - Augustin Scalbert
- International Agency for Research on Cancer (WHO-IARC), Lyon, France
| | - Anne Tjønneland
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Laure Dossus
- Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
- Université Paris-Sud, Villejuif, France
| | - Christoffer Johansen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
- 5073, Oncology Clinic, Finsen Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | - Elisabete Weiderpass
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Department of Research, Cancer Registry of Norway, Institute of Population Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Genetic Epidemiology Group, Folkhälsan Research Center, Samfundet Folkhälsan, Helsinki, Finland
| | - Jane Christensen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Heather Ward
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Mathilde His
- Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
- Université Paris-Sud, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Françoise Clavel-Chapelon
- Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
- Université Paris-Sud, Villejuif, France
- Gustave Roussy, Villejuif, France
| | - Laura Baglietto
- Inserm, CESP Centre for Research in Epidemiology and Population Health, Villejuif, France
- Université Paris-Sud, Villejuif, France
- Gustave Roussy, Villejuif, France
- Cancer Epidemiology Centre, Cancer Council of Victoria, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Verena Katzke
- Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Tilman Kühn
- Division of Cancer Epidemiology, German Cancer Research Center, DKFZ, Heidelberg, Germany
| | - Heiner Boeing
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Anna Floegel
- Department of Epidemiology, German Institute of Human Nutrition Potsdam-Rehbruecke, Nuthetal, Germany
| | - Kim Overvad
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Cristina Lasheras
- Department of Functional Biology, Faculty of Medicine, University of Oviedo, Asturias, Spain
| | - Noémie Travier
- Unit of Nutrition and Cancer, Catalan Institute of Oncology (ICO-IDIBELL), Barcelona, Spain
| | - Maria-José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Pilar Amiano
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Public Health Division of Gipuzkoa, BioDonostia Research Institute, San Sebastián, Spain
| | - Maria-Dolores Chirlaque
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Epidemiology, Regional Health Council, IMIB-Arrixaca, Murcia, Spain
- Department of Health and Social Sciences, Universidad de Murcia, Murcia, Spain
| | - Eva Ardanaz
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Navarra Public Health Institute, Pamplona, Spain
- Navarra Institute for Health Research (IdiSNA), Pamplona, Spain
| | - Kay-Tee Khaw
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Nick Wareham
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Aurora Perez-Cornago
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Antonia Trichopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Pagona Lagiou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Effie Vasilopoulou
- Hellenic Health Foundation, Athens, Greece
- WHO Collaborating Center for Nutrition and Health, Unit of Nutritional Epidemiology and Nutrition in Public Health, Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, Athens, Greece
| | - Giovanna Masala
- Molecular and Nutritional Epidemiology Unit, Cancer Research and Prevention Institute - ISPO, Florence, Italy
| | - Sara Grioni
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Franco Berrino
- Epidemiology and Prevention Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosario Tumino
- Cancer Registry and Histopathology Unit, "Civile-M.P. Arezzo" Hospital, ASP, Ragusa, Italy
| | - Carlotta Sacerdote
- Cancer Epidemiology Unit, San Giovanni Battista Hospital, CPO Piemonte and University of Turin, Turin, Italy
| | - Amalia Mattiello
- Dipartimento di Medicina Clinica e Chirurgia, Federico II University, Naples, Italy
| | - H Bas Bueno-de-Mesquita
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department for Determinants of Chronic Diseases (DCD), National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Gastroenterology and Hepatology, University Medical Centre, Utrecht, The Netherlands
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Petra H Peeters
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Carla van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Signe Borgquist
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Salma Butt
- Department of Surgery, Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
| | | | - Malin Sund
- Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden
| | - Anette Hjartåker
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Guri Skeie
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
| | - Anja Olsen
- Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Isabelle Romieu
- International Agency for Research on Cancer (WHO-IARC), Lyon, France
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Bleyer A. Screening mammography: update and review of publications since our report in the New England Journal of Medicine on the magnitude of the problem in the United States. Acad Radiol 2015; 22:949-60. [PMID: 26100188 DOI: 10.1016/j.acra.2015.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 02/15/2015] [Accepted: 03/08/2015] [Indexed: 12/16/2022]
Abstract
RATIONALE AND OBJECTIVES After a half century of clinical trials, expansive observations, vigorous advocacy and debate, screening mammography could not be in a more controversial condition, especially the potential harm of overdiagnosis. Despite a simple rationale (catch the cancer early and either prevent death or at least decrease the amount of therapy needed for cure), the estimates to date of overdiagnosis rates are conflicting and the interpretations complex. MATERIALS AND METHODS Since the author's 2012 publication in the New England Journal of Medicine (NEJM), the peer-reviewed publications on overdiagnosis caused by screening mammography are reviewed and the NEJM analyses updated with three additional calendar years of results. RESULTS The recent peer-reviewed medical literature on screening mammography induced overdiagnosis of breast cancer has increased exponentially, nearly 10-fold in 10 years. The average estimate of overdiagnosis is about 30%, but the range extends from 0% to 70+%. An update of the NEJM report estimates that in the US, 78,000 women and 30%-31% of those diagnosed with breast cancer at the age of 40 years or older during 2011 were overdiagnosed. CONCLUSIONS Until we have better screening procedures that identify who really has cancer and needs to be treated, the risk of overdiagnosis relative to the benefit of screening merits more effective public and professional education. Radiologists, pathologists, and other professionals involved with screening mammography should recognize that the potential harm of overdiagnosis is downplayed or not discussed with the patient and family, despite agreement that the objective is informed choice.
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Saadatmand S, Obdeijn IM, Rutgers EJ, Oosterwijk JC, Tollenaar RA, Woldringh GH, Bergers E, Verhoef C, Heijnsdijk EA, Hooning MJ, de Koning HJ, Tilanus-Linthorst MM. Survival benefit in women with BRCA1 mutation or familial risk in the MRI screening study (MRISC). Int J Cancer 2015; 137:1729-38. [PMID: 25820931 DOI: 10.1002/ijc.29534] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/09/2015] [Accepted: 03/16/2015] [Indexed: 11/05/2022]
Abstract
Adding MRI to annual mammography screening improves early breast cancer detection in women with familial risk or BRCA1/2 mutation, but breast cancer specific metastasis free survival (MFS) remains unknown. We compared MFS of patients from the largest prospective MRI Screening Study (MRISC) with 1:1 matched controls. Controls, unscreened if<50 years, and screened with biennial mammography if ≥50 years, were matched on risk category (BRCA1, BRCA2, familial risk), year and age of diagnosis. Of 2,308 MRISC participants, breast cancer was detected in 93 (97 breast cancers), who received MRI <2 years before breast cancer diagnosis; 33 BRCA1 mutation carriers, 18 BRCA2 mutation carriers, and 42 with familial risk. MRISC patients had smaller (87% vs. 52% <T2, p < 0.001), more often node negative (69% vs. 44%, p = 0.001) tumors and received less chemotherapy (39% vs. 77%, p < 0.001) and hormonal therapy (14% vs. 47%, p < 0.001) than controls. Median follow-up time was 9 years (range 0-14). Breast cancer metastasized in 9% (8/93) of MRISC patients and in 23% (21/93) of controls (p = 0.009). MFS was better in MRISC patients overall (log-rank p = 0.008, HR 0.36, 95% CI 0.16-0.80), with familial risk (log-rank p = 0.024, HR: 0.21, 95% CI 0.04-0.95), and in BRCA1 mutation carriers (log-rank p = 0.055, HR 0.30, 95% CI 0.08-1.13). MFS remained better in MRISC patients after lead time correction (log-rank p = 0.020, HR 0.40, 95% CI 0.18-0.90). Overall survival was non-significantly better in MRISC patients (log-rank p = 0.064, HR 0.51, CI 0.24-1.06). Annual screening with MRI and mammography improves metastasis free survival in women with BRCA1 mutation or familial predisposition.
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Affiliation(s)
- Sepideh Saadatmand
- Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | - Inge-Marie Obdeijn
- Department of Radiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Emiel J Rutgers
- Department of Surgery, the Netherlands Cancer Institute, Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jan C Oosterwijk
- Department of Genetics, University Medical Center, Groningen University, Groningen, The Netherlands
| | - Rob A Tollenaar
- Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Gwendolyn H Woldringh
- Department of Human Genetics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Elisabeth Bergers
- Department of Radiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Cornelis Verhoef
- Department of Surgery, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | | | - Maartje J Hooning
- Department of Medical Oncology, Erasmus Medical Center-Cancer Institute, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands
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de Glas NA, de Craen AJM, Bastiaannet E, Op 't Land EG, Kiderlen M, van de Water W, Siesling S, Portielje JEA, Schuttevaer HM, de Bock GTH, van de Velde CJH, Liefers GJ. Effect of implementation of the mass breast cancer screening programme in older women in the Netherlands: population based study. BMJ 2014; 349:g5410. [PMID: 25224469 PMCID: PMC4164134 DOI: 10.1136/bmj.g5410] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the incidence of early stage and advanced stage breast cancer before and after the implementation of mass screening in women aged 70-75 years in the Netherlands in 1998. DESIGN Prospective nationwide population based study. SETTING National cancer registry, the Netherlands. PARTICIPANTS Patients aged 70-75 years with a diagnosis of invasive or ductal carcinoma in situ breast cancer between 1995 and 2011 (n=25,414). Incidence rates were calculated using population data from Statistics Netherlands. MAIN OUTCOME MEASURE Incidence rates of early stage (I, II, or ductal carcinoma in situ) and advanced stage (III and IV) breast cancer before and after implementation of screening. Hypotheses were formulated before data collection. RESULTS The incidence of early stage tumours significantly increased after the extension for implementation of screening (248.7 cases per 100,000 women before screening up to 362.9 cases per 100,000 women after implementation of screening, incidence rate ratio 1.46, 95% confidence interval 1.40 to 1.52, P<0.001). However, the incidence of advanced stage breast cancers decreased to a far lesser extent (58.6 cases per 100,000 women before screening to 51.8 cases per 100,000 women after implementation of screening, incidence rate ratio 0.88, 0.81 to 0.97, P<0.001). CONCLUSIONS The extension of the upper age limit to 75 years has only led to a small decrease in incidence of advanced stage breast cancer, while that of early stage tumours has strongly increased.
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Affiliation(s)
- Nienke A de Glas
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Ester G Op 't Land
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands
| | - Mandy Kiderlen
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Willemien van de Water
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Sabine Siesling
- Department of Research, Comprehensive Cancer Centre the Netherlands, Utrecht, Netherlands
| | | | | | - Geertruida Truuske H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Cornelis J H van de Velde
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands
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