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BREAst screening Tailored for HEr (BREATHE)-A study protocol on personalised risk-based breast cancer screening programme. PLoS One 2022; 17:e0265965. [PMID: 35358246 PMCID: PMC8970365 DOI: 10.1371/journal.pone.0265965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/22/2022] [Indexed: 12/29/2022] Open
Abstract
Routine mammography screening is currently the standard tool for finding cancers at an early stage, when treatment is most successful. Current breast screening programmes are one-size-fits-all which all women above a certain age threshold are encouraged to participate. However, breast cancer risk varies by individual. The BREAst screening Tailored for HEr (BREATHE) study aims to assess acceptability of a comprehensive risk-based personalised breast screening in Singapore. Advancing beyond the current age-based screening paradigm, BREATHE integrates both genetic and non-genetic breast cancer risk prediction tools to personalise screening recommendations. BREATHE is a cohort study targeting to recruit ~3,500 women. The first recruitment visit will include questionnaires and a buccal cheek swab. After receiving a tailored breast cancer risk report, participants will attend an in-person risk review, followed by a final session assessing the acceptability of our risk stratification programme. Risk prediction is based on: a) Gail model (non-genetic), b) mammographic density and recall, c) BOADICEA predictions (breast cancer predisposition genes), and d) breast cancer polygenic risk score. For national implementation of personalised risk-based breast screening, exploration of the acceptability within the target populace is critical, in addition to validated predication tools. To our knowledge, this is the first study to implement a comprehensive risk-based mammography screening programme in Asia. The BREATHE study will provide essential data for policy implementation which will transform the health system to deliver a better health and healthcare outcomes.
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Uzan C, Ndiaye-Guèye D, Nikpayam M, Oueld Es Cheikh E, Lebègue G, Canlorbe G, Azais H, Gonthier C, Belghiti J, Benusiglio PR, Séroussi B, Gligorov J, Uzan S. [First results of a breast cancer risk assessment and management consultation]. Bull Cancer 2020; 107:972-981. [PMID: 32977936 DOI: 10.1016/j.bulcan.2020.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 07/09/2020] [Accepted: 08/08/2020] [Indexed: 11/25/2022]
Abstract
INTRODUCTION In France, participation in the organized breast cancer screening program remains insufficient. A personalized approach adapted to the risk factors for breast cancer (RBC) should make screening more efficient. A RBC evaluation consultation would therefore make it possible to personalize this screening. Here we report our initial experience. MATERIAL AND METHOD This is a prospective study on women who were seen at the RBC evaluation consultation and analyzing: their profile, their risk assessed according to Tyrer Cuzick model (TC)±Mammorisk© (MMR), the existence of an indication of oncogenetic consultation (Eisinger and Manchester score), their satisfaction and the recommended monitoring. RESULTS Among the women who had had a TCS and/or MMR evaluation of SCR (n=153), 76 (50%) had a high risk (n=67) or a very high risk (n=9). Almost half (47%) had a possible (15%) or certain (32%) indication to an oncogenetic consultation. Regarding this consultation, 98% of women were satisfied or very satisfied. In total, 60% of women had a change in screening methods. CONCLUSION This RBC evaluation consultation satisfies women and for a majority of them, modifies their methods of breast cancer screening.
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Affiliation(s)
- Catherine Uzan
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S938 « Biologie et thérapeutique des cancers », Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France.
| | - Diaretou Ndiaye-Guèye
- AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Marianne Nikpayam
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Eva Oueld Es Cheikh
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Geraldine Lebègue
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Geoffroy Canlorbe
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S938 « Biologie et thérapeutique des cancers », Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Henri Azais
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Clementine Gonthier
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - Jeremie Belghiti
- AP-HP, hôpital Pitié-Salpêtrière, Sorbonne Université, service de chirurgie et cancérologie gynécologique et mammaire, 47-83, boulevard de l'Hôpital, 75013 Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
| | - Patrick R Benusiglio
- AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France; AP-HP, groupe hospitalier Pitié-Salpêtrière, Sorbonne Université, département de génétique, UF d'oncogénétique, Paris, France
| | - Brigitte Séroussi
- AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France; Département de santé publique, Tenon, France; Sorbonne Université, université Sorbonne Paris Nord, Inserm, UMR S_1142, LIMICS, Paris, France
| | - Joseph Gligorov
- Inserm UMR S938 « Biologie et thérapeutique des cancers », Paris, France; AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France; AP-HP Tenon, Sorbonne Université, oncologie médicale, Paris, France
| | - Serge Uzan
- AP-HP, institut universitaire de cancérologie, Sorbonne Université (IUC AP-HP.SU), Paris, France
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Azaïs H, Maingon P, Da Maïa E, Nikpayam M, Gonthier C, Belghiti J, Canlorbe G, Uzan C. [For which patients could we consider de-escalation in the management of ductal carcinomas in situ?]. ACTA ACUST UNITED AC 2019; 47:872-879. [PMID: 31562924 DOI: 10.1016/j.gofs.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 11/27/2022]
Abstract
Ductal carcinomas in situ (DCIS) of the breast account for 85% to 90% of breast cancer in situ. Current recommendations for the management of DCIS in France are based on surgical excision of the lesions, lumpectomy in healthy margins (margins of excision≥2mm) or mastectomy in case of extensive lesions. Radiation therapy is recommended after conservative surgical treatment. However, it seems relevant for some patients to discuss the benefit of a therapeutic de-escalation. Indeed, it has been reported that radiotherapy has no major impact on overall survival and that its interest could be discussed in the low-risk situations of invasive recurrence for which surgery alone could be sufficient, subject to sufficient margins. These questions call for the precise definition of low risk populations and to clarify the importance of taking into account decision support tools and new molecular markers. The place of scores like that of the University of Southern California - Van Nuys, and that of genomic tests such as the Oncotype test© DX DCIS (DCIS score) need to be specified. The expected results of several prospective studies could go in the direction of a significant therapeutic de-escalation for the management of DCIS in the years to come. In the meantime, however, it is advisable to remain cautious and the inclusion of patients in clinical trials should be favored.
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Affiliation(s)
- H Azaïs
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - P Maingon
- Service de radiothérapie, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - E Da Maïa
- Service d'anatomo-pathologie, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Nikpayam
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - C Gonthier
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - J Belghiti
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France
| | - G Canlorbe
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S 938 « biologie et thérapeutiques du cancer », hôpital universitaire Pitié-Salpêtrière, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Institut universitaire de cancérologie, Sorbonne Université, 75013 Paris, France
| | - C Uzan
- Service de chirurgie et oncologie gynécologique et mammaire, hôpital universitaire Pitié-Salpêtrière, AP-HP, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Inserm UMR S 938 « biologie et thérapeutiques du cancer », hôpital universitaire Pitié-Salpêtrière, 45-83, boulevard de l'Hôpital, 75013 Paris, France; Institut universitaire de cancérologie, Sorbonne Université, 75013 Paris, France.
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Ceugnart L, Rocourt N, Ben Haj-Amor M, Bachelle F, Boulanger T, Chaveron C, Pouliquen G, Renaud A, Taieb S. [French program of breast cancer screening: Radiologist viewpoint]. Bull Cancer 2019; 106:684-692. [PMID: 31047637 DOI: 10.1016/j.bulcan.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/13/2019] [Accepted: 03/21/2019] [Indexed: 11/29/2022]
Abstract
French program of breast cancer screening is implemented since15 years and results are in adequation with international guidelines except for participation. To answer to recurrent controversies about breast cancer screening, publications from National Institute of French cancer registry confirm the positive impact of screening on decreasing mortality for participating women. The harms of mammography (and not from screening) need to be communicated to the invited women to help them to make decision about participation but also the risk of worse prognosis in case of symptomatic cancer. The future of screening will be different and works are in progress to find new ways to select women who will beneficiate for screening and whose cancer needs to be treated. Until then, the only way to screen for breast cancer stays the mammographic process as well as other technics in case of dense breast or in case of family history of breast cancer.
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Affiliation(s)
- Luc Ceugnart
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France.
| | - Nathalie Rocourt
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - Mariem Ben Haj-Amor
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - Florence Bachelle
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - Thomas Boulanger
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - Céline Chaveron
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - Gwenaëlle Pouliquen
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - Armelle Renaud
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
| | - Sophie Taieb
- Centre régional de lutte contre le cancer Oscar-Lambret, département d'imagerie, 3, rue Frédéric-Combemale, 59020 Lille cedex, France
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Zhao Y, Sun H, Chen M, Gao S, Li L, Jiang H, Jin W. Clinicopathological characteristics and survival outcomes in Paget disease: a SEER population-based study. Cancer Med 2018; 7:2307-2318. [PMID: 29722170 PMCID: PMC6010794 DOI: 10.1002/cam4.1475] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 03/08/2018] [Accepted: 03/09/2018] [Indexed: 11/08/2022] Open
Abstract
The objective of this study was to investigate the clinicopathological characteristics and survival outcomes of Paget disease (PD), Paget disease concomitant infiltrating duct carcinoma (PD-IDC), and Paget disease concomitant intraductal carcinoma (PD-DCIS). We identified 501,631 female patients from 2000 to 2013 in the Surveillance, Epidemiology, and End Results (SEER) database. These identified patients included patients with PD (n = 469), patients with PD-IDC (n = 1832), and patients with PD-DCIS (n = 1130) and infiltrating ductal carcinoma (IDC) (n = 498,076). Then, we compared the clinical characteristics of these patients with those who were diagnosed with IDC during the same period. The outcomes of these subtypes of breast carcinoma were different. Based on the overall survival, the patients with PD-IDC had the worst prognosis (5-year survival rate = 84.1%). The PD-DCIS had the best prognosis (5-year survival rate = 97.5%). Besides, among patients with Paget disease, the one who was married had a better prognosis than who were not. And, according to our research, the marital status was associated with the hormone receptor status in patients with PD-IDC. Among three subtypes of Paget disease, patients with PD-IDC had the worst prognosis. Besides, patients who were unmarried had worse outcomes. And the marital status of patients with PD-IDC is associated with hormone status. The observation underscores the importance of individualized treatment.
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Affiliation(s)
- Yang Zhao
- Department of Breast SurgeryKey Laboratory of Breast Cancer in ShanghaiCollaborative Innovation Center of Cancer MedicineFudan University Shanghai Cancer CenterShanghai200030China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai200030China
| | - He‐Fen Sun
- Department of Breast SurgeryKey Laboratory of Breast Cancer in ShanghaiCollaborative Innovation Center of Cancer MedicineFudan University Shanghai Cancer CenterShanghai200030China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai200030China
| | - Meng‐Ting Chen
- Department of Breast SurgeryKey Laboratory of Breast Cancer in ShanghaiCollaborative Innovation Center of Cancer MedicineFudan University Shanghai Cancer CenterShanghai200030China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai200030China
| | - Shui‐Ping Gao
- Department of Breast SurgeryKey Laboratory of Breast Cancer in ShanghaiCollaborative Innovation Center of Cancer MedicineFudan University Shanghai Cancer CenterShanghai200030China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai200030China
| | - Liang‐Dong Li
- Department of Breast SurgeryKey Laboratory of Breast Cancer in ShanghaiCollaborative Innovation Center of Cancer MedicineFudan University Shanghai Cancer CenterShanghai200030China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai200030China
| | - Hong‐lin Jiang
- Division of Molecular Medicine & GeneticDepartment of Internal Medicine and Life Sciences InstituteUniversity of MichiganAnn ArborMichigan48109
| | - Wei Jin
- Department of Breast SurgeryKey Laboratory of Breast Cancer in ShanghaiCollaborative Innovation Center of Cancer MedicineFudan University Shanghai Cancer CenterShanghai200030China
- Department of OncologyShanghai Medical CollegeFudan UniversityShanghai200030China
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