Reduction in advanced breast cancer after introduction of a mammography screening program in Tyrol/Austria

Awareness, Knowledge, and Current Practice of Breast Cancer Among Surgeons in Jordan

PURPOSE

Breast cancer (BC) is the most prevalent cancer in Jordan. De-escalation in treatment reflects a paradigm shift in BC treatment. More tailored strategies and the adoption of a multidisciplinary approach are essential to apply recent changes in management. In the era of breast surgery fellowship, adopting well-structured training is essential to apply recent therapeutic guidelines and meet patients' expectations.

METHODS

A cross-sectional study using a customized, self-reported questionnaire was used. Data collection occurred anonymously using a link via WhatsApp in the period between February 2023 and April 2023.

RESULTS

A total of 89 surgeons were involved in this study, and only 14 (15.7%) completed a subspecialty in breast surgery. About 58.4% considered the age of 40 years as the starting point for screening, and 84.3% reported that mammogram screening is associated with improved BC survival. Only 10.1% and 28.1% acknowledged the applicability of both tomosynthesis and breast magnetic resonance imaging in screening, respectively. A significant difference in the mean knowledge score about BC is observed between general surgeon and those with subspecialty. Varying levels of awareness concerning different risk factors and their correlation with the likelihood of BC occurrence observed. Although 56.2% of participants could offer breast conserving surgery and consider it oncological safe, only 48.3% defined it correctly. Of the participants, 61.8% and 76.4% stated that sentinel lymph node biopsy can be safely applied in clinically negative or suspicious axillary nodes, respectively, with <50% of surgeon performing it in their practice.

CONCLUSION

More efforts are required to enhance the knowledge and practice of surgeons in the field of breast surgery. Adopting national guidelines can facilitate the acceptance and improvement of current practices among surgeons in Jordan.

The wisdom trial is based on faulty reasoning and has major design and execution problems

PURPOSE

To evaluate the design and plan of execution of the "WISDOM" trial.

METHODS

The rationale and reasoning behind the WISDOM Trial were reviewed and analyzed. The published parameters of the trial were reviewed.

RESULTS

The study is based on a failed understanding of the available data about breast cancer screening and is based on faulty assumptions, false reasoning, a scientifically unsupportable study design, ignoring advances in screening, a questionable endpoint, the likely lacking of power to answer the primary question, and support by insurance companies whose primary goal is almost certainly to reduce their costs.

CONCLUSION

A major part of the premise is that there is a "debate" about the efficacy of screening. WISDOM ignores the fact that the "debate" has been manufactured and is not science-based. The results of the WISDOM Trial may be misleading.

Risk of Breast Cancer Revealed by Mammographic Screening in Czech Women Aged 40-45 Years, a Monocentric Cohort Study

The aim of the present study was to evaluate breast cancer risk in women aged 40-45 years not included in the routine mammographic screening programme in the Czech Republic and to assess the suitability of the screening interval. Our cohort study was conducted using registry data of one mammography centre (Bulovka Hospital in Prague) between 1 January 2008 and 31 December 2017. The risk of breast cancer was evaluated using a positive predictive finding (PPF) corresponding to the Breast Imaging-Reporting and Data System (BI-RADS) scores of 4 and 5. The annual PPF incidence rate achieved 2.25 per 1000 women aged 40-45 years and was not significantly different from that (3.31) of women of 45-50 years of age as demonstrated by an adjusted hazard ratio of 0.75 (95% confidence interval: 0.42-1.33). It was found that a screening interval longer than 3 years increased the chance of PPF occurrence 1.7 times independently of the women's age, signalling a risk of failure of early detection of breast cancer. The same PPF incidence rates both in women aged 40-45 years and in older ones indicates that even younger women should be eligible for enrolment in the routine mammographic screening programme in the Czech Republic.

Impact of mammographic screening and advanced cancer definition on the percentage of advanced-stage cancers in a steady-state breast screening programme in the Netherlands

Background

To estimate the percentages of advanced-stage breast cancers (BCs) detected during the course of a steady-state screening programme when using different definitions of advanced BC.

Methods

Data of women aged 49–74 years, diagnosed with BC in 2006–2015, were selected from the Netherlands Cancer Registry and linked to the screening registry. BCs were classified as screen-detected, interval or non-screened. Three definitions of advanced BC were used for comparison: TNM stage (III–IV), NM stage (N+ and/or M+) and T size (invasive tumour ≥15 mm). Analyses were performed assuming a 10% overdiagnosis rate. In sensitivity analyses, this assumption varied from 0 to 30%.

Results

We included 46,734 screen-detected, 17,362 interval and 24,189 non-screened BCs. By TNM stage, 4.9% of screen-detected BCs were advanced, compared with 19.4% and 22.8% of interval and non-screened BCs, respectively (p < 0.001). Applying the other definitions led to higher percentages of advanced BC being detected. Depending on the definition interval, non-screened BCs had a 2–5-times risk of being advanced.

Conclusion

Irrespective of the definition, screen-detected BCs were less frequently in the advanced stage. These findings provide evidence of a stage shift to early detection and support the potential of mammographic screening to reduce treatment-related burdens and the mortality associated with BC.

Incidence of advanced-stage breast cancer in regular participants of a mammography screening program: a prospective register-based study

BACKGROUND

The European Guidelines for breast cancer screening suggest that the impact of population-based mammography screening programmes (MSP) may be assessed using the relative reduction in the incidence of advanced breast cancer (ABC, that is, stage UICC II and higher) as a surrogate indicator of screening effectiveness.

METHODS

This prospective, population register-based study contained individual data of 1,200,246 women (aged 50-69 years) who attended the initial prevalence screening between 2005 and 2009. Of them, 498,029 women returned for the regular (i.e., within 24 months) first subsequent, and 208,561 for the regular second subsequent incidence screenings. The incidence rate of ABC was calculated for the 24-months period following, but not including, the initial screening by incorporating all interval ABCs and all ABCs detected at the regular first incidence screening; the ABC rate for the second 24-months period was determined in the same way, including ABCs detected in the interval after the first and, respectively, at the second incidence screening. The relative reduction in the ABC incidence was derived by comparing the age-standardized rates in these two periods with an age-standardized reference incidence rate, observed in the target population before the MSP implementation. The strengths and weaknesses of this particular study design were contrasted with a recently published checklist of main methodological problems affecting studies of the effect of MSP on ABC incidence.

RESULTS

The age-standardized ABC incidence rate was 291.6 per 100,000 women for the 24-months period subsequent to the initial screening, and 275.0/100,000 for the 24-months period following the first subsequent screening. Compared to the 2-year incidence of 349.4/100,000 before the start of the MSP, this amounted to a relative reduction of 16.5 and 21.3%, respectively, in the incidence of ABC among regular MSP participants.

CONCLUSIONS

The design employed in this study avoids some of the substantial methodological limitations that compromised previous observational studies. Nevertheless, specific limitations prevail that demand a cautious interpretation of the results. Therefore, the study findings, indicating a reduction in ABC for regular MSP participants, need to be followed with respect to potential impacts on breast cancer mortality rates.

Can Breast Self-examination and Clinical Breast Examination Along With Increasing Breast Awareness Facilitate Earlier Detection of Breast Cancer in Populations With Advanced Stages at Diagnosis?

Breast cancer is the most common form of cancer among women worldwide. Early detection is central to improving disease outcomes. Three main screening methods - mammography, breast self-examination (BSE), and clinical breast examination (CBE) - have been developed and tested in Western nations. There is ongoing debate regarding the efficacy of BSE and CBE in terms of mortality reduction, and a number of international organizations no longer recommend them as screening methods. In technically less developed countries, however, where women are usually diagnosed with breast cancer at advanced stages and younger ages, the benefits of BSE and CBE might outweigh the harm and facilitate early detection of breast cancer. This paper reviews the history of BSE and CBE and discusses their value as early detection methods. It can contribute to informed decision-making by health policy-makers and clinicians who are involved in breast cancer screening in the developing world to improve women's well-being.

Global Consultation on Cancer Staging: promoting consistent understanding and use

Disease burden is the most important determinant of survival in patients with cancer. This domain, reflected by the cancer stage and codified using the tumour-node-metastasis (TNM) classification, is a fundamental determinant of prognosis. Accurate and consistent tumour classification is required for the development and use of treatment guidelines and to enable clinical research (including clinical trials), cancer surveillance and control. Furthermore, knowledge of the extent and stage of disease is frequently important in the context of translational studies. Attempts to include additional prognostic factors in staging classifications, in order to facilitate a more accurate determination of prognosis, are often made with a lack of knowledge and understanding and are one of the main causes of the inconsistent use of terms and definitions. This effect has resulted in uncertainty and confusion, thus limiting the utility of the TNM classification. In this Position paper, we provide a consensus on the optimal use and terminology for cancer staging that emerged from a consultation process involving representatives of several major international organizations involved in cancer classification. The consultation involved several steps: a focused literature review; a stakeholder survey; and a consultation meeting. This aim of this Position paper is to provide a consensus that should guide the use of staging terminology and secure the classification of anatomical disease extent as a distinct aspect of cancer classification.

Essential TNM: a registry tool to reduce gaps in cancer staging information

Accurate information on the extent of disease around the time of diagnosis is an important component of cancer care, in defining disease prognosis, and evaluating national and international cancer control policies. However, the collection of stage data by population-based cancer registries remains a challenge in both high-income and low and middle-income countries. We emphasise the lack of availability and comparability of staging information in many population-based cancer registries and propose Essential TNM, a simplified staging system for cancer registries when information on full Tumour, Node, Metastasis (TNM) is absent. Essential TNM aims at staging cancer in its most advanced disease form by summarising the extent of disease in the order of distant metastasis (M), regional lymph node involvement (N), and tumour size or extension, or both (T). Flowcharts and rules have been developed for coding these elements in breast, cervix, prostate, and colon cancers, and combining them into stage groups (I-IV) that correspond to those obtained by full TNM staging. Essential TNM is comparable to the Union for International Cancer Control TNM stage groups and is an alternative to providing staging information by the population-based cancer registries that complies with the objectives of the Global Initiative for Cancer Registry Development.

Effect of mammography screening on stage at breast cancer diagnosis: results from the Korea National Cancer Screening Program

In Asian countries, breast densities and the proportion of younger women with breast cancer are higher than those in Western countries. This study was designed to determine differences in stage at diagnosis of breast cancer among Korean women according to screening history. The study population was derived from the Korea National Cancer Screening Program (KNCSP). The study cohort comprised 17,689 women who were newly diagnosed with breast cancer in 2011 and were invited to undergo breast cancer screening via the KNCSP between 2002 and 2011. Ductal carcinoma in situ (DCIS) and localized breast cancer were most frequent in both ever-screened and never-screened patients. Late stage cancer was significantly more frequent in never-screened patients, compared with ever-screened patients. Compared to never-screened women, the odds ratio (OR) for being diagnosed with early stage breast cancer among screened women was 1.41 (95% Confidence Interval [CI] = 1.28–1.55). The OR for being diagnosed with early stage breast cancer was highest among patients who underwent screening three times or more (aOR = 1.89, 95% CI = 1.57–2.29). Screening by mammography was associated with diagnosis of early stage breast cancer in Korean women. However, significant increases in the diagnosis of DCIS and localized breast cancers among ever-screened patients suggest the possibility of overdiagnosis due to screening.