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Karavasiloglou N, Matthes KL, Berlin C, Limam M, Wanner M, Korol D, Rohrmann S. Increasing trends in in situ breast cancer incidence in a region with no population-based mammographic screening program: results from Zurich, Switzerland 2003-2014. J Cancer Res Clin Oncol 2018; 145:653-660. [PMID: 30547321 DOI: 10.1007/s00432-018-2822-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 12/10/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE Increase in in situ breast cancer (BCIS) incidence has been reported across Europe and the USA. However, little is known about the trends in BCIS incidence in regions without population-based mammographic screening programs. We set out to investigate these trends in Zurich, Switzerland, where only opportunistic mammographic screening exists. METHODS Data from 989 women diagnosed with a primary BCIS between 2003 and 2014 were used in our analyses. Age-standardized incidence rates per 100,000 person-years (ASR) were computed per year. Additional analyses by BCIS subtype, by age group at diagnosis and by incidence period were conducted. Incidence trends over time were assessed using joinpoint regression analysis. RESULTS The overall BCIS ASR was 10.7 cases per 100,000 person-years with an increasing trend over the study period. A similar trend was observed for the ductal carcinoma in situ (DCIS) ASR, while the lobular carcinoma in situ (LCIS) ASR decreased. Age-specific analyses revealed that the 50-59 year age group had the highest BCIS ASR. The highest increase in BCIS ASR, even though not statistically significant, was observed for the < 40 year age group. CONCLUSIONS BCIS ASR increased linearly over a 12-year period. The increase was reflected by an increase in DCIS ASR, whereas LCIS ASR decreased over time. The highest increase in BCIS ASR over the study period was observed for the < 40 year age group, even though not statistically significant. Patient and tumor characteristics of this group that may be associated with BCIS development warrant further investigation.
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Affiliation(s)
- Nena Karavasiloglou
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 82, 8001, Zurich, Switzerland.,Cancer Registry Zurich and Zug, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Katarina L Matthes
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 82, 8001, Zurich, Switzerland.,Cancer Registry Zurich and Zug, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Manuela Limam
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 82, 8001, Zurich, Switzerland.,Cancer Registry Zurich and Zug, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Miriam Wanner
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 82, 8001, Zurich, Switzerland.,Cancer Registry Zurich and Zug, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Dimitri Korol
- Cancer Registry Zurich and Zug, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Hirschengraben 82, 8001, Zurich, Switzerland. .,Cancer Registry Zurich and Zug, University Hospital Zurich, Vogelsangstrasse 10, 8091, Zurich, Switzerland.
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2
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Roca-Barceló A, Viñas G, Pla H, Carbó A, Comas R, Izquierdo Á, Pinheiro PS, Vilardell L, Solans M, Marcos-Gragera R. Mortality of women with ductal carcinoma in situ of the breast: a population-based study from the Girona province, Spain (1994-2013). Clin Transl Oncol 2018; 21:891-899. [PMID: 30536209 DOI: 10.1007/s12094-018-1994-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/17/2018] [Indexed: 12/15/2022]
Abstract
PURPOSE We aim to comprehensively describe the incidence and mortality trends of ductal carcinoma in situ (DCIS) in the Girona province, Spain (1994-2013) and to estimate the all-cause mortality excess risk of diagnosed women. METHODS Age-standardized rates of DCIS were estimated between 1994 and 2013. Standard mortality ratios (SMR) and absolute excess mortality were calculated overall and by tumor and patient characteristics. A sensitivity analysis was conducted excluding cases with a subsequent invasive breast cancer (sIBC). RESULTS Of the 641 women included, 56 died (follow-up time: 8.4 person-years). Between 1994 and 2013, a significant increase in incidence and decrease in mortality was identified among women aged between 50 and 69 years old. Neoplasms and circulatory system disease were the most common causes of death. No excess risk of death was found overall, except for women aged < 50 years (SMR = 3.44, 95% CI 1.85; 6.40) and those with a sIBC (SMR = 2.51, 95% CI 1.26; 5.02), risk that lessened when cases with sIBC were excluded. Patients with sIBC also showed an excess risk (SMR = 2.29, 95% CI 1.03; 5.10). CONCLUSIONS Among women aged 50-69 years old, incidence of DCIS has significantly increased yet mortality has decreased. Overall, the all-cause mortality risk of women diagnosed with DCIS remains similar to that of the general population except for women diagnosed before age 50 and those with sIBC, who showed a significant increased risk. Differential management of these patients should be considered.
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Affiliation(s)
- A Roca-Barceló
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain. .,UK Small Area Health Statistics Unit, MRC-PHE Centre for Environment and Health, Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK.
| | - G Viñas
- Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - H Pla
- Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - A Carbó
- Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - R Comas
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain.,Oncology Data Science (ODysSey) Group, Vall d' Hebron University Hospital and Institute of Oncology (VHIO), Barcelona, Spain
| | - Á Izquierdo
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain.,Department of Medical Oncology, Institut Català d'Oncologia Hospital Universitari de Girona Dr Josep Trueta, Girona, Spain
| | - P S Pinheiro
- Department of Epidemiology, University of Miami Miller School of Medicine, Slvester Comprehensive Cancer Center, Miami, FL, USA
| | - L Vilardell
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain
| | - M Solans
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Carrer de la Universitat de Girona 10, 17003, Girona, Spain.,Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain
| | - R Marcos-Gragera
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Autonomous Government of Catalonia, Catalan Institute of Oncology, Carrer del Sol, 15, 17004, Girona, Spain.,Centro de Investigación Biomédica en Red: Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5, Pabellón 11, Planta 0, 28029, Madrid, Spain.,Descriptive Epidemiology, Genetics and Cancer Prevention Group, Biomedical Research Institute (IDIBGI), Girona, Spain.,Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
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3
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Grande E, Inghelmann R, Francisci S, Verdecchia A, Micheli A, Baili P, Capocaccia R, De Angelis R. Regional Estimates of Breast Cancer Burden in Italy. TUMORI JOURNAL 2018; 93:374-9. [PMID: 17899868 DOI: 10.1177/030089160709300408] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Breast cancer is the most common cancer and the leading cause of cancer death among women. Knowledge of the present and future burden of the disease at a regional and national scale is a major issue in Italy, where the frequency and coverage of screening programs vary considerably across the country. This study presents estimates and projections of the female breast cancer incidence, prevalence and mortality for Italy and all Italian regions in the period 1970-2010. Methods The estimates were obtained by applying the MIAMOD method, a statistical back-calculation approach to derive incidence and prevalence figures from mortality and relative survival data. Published data from the Italian cancer registries were modelled to obtain regional and national estimates of breast cancer survival. Results Breast cancer mortality has been declining from the late 1980s in the northern-central regions and from the mid 1990s in the southern regions Puglia, Sicilia and Sardegna. Stable mortality rates are estimated for the other southern regions in the 2000's first decade. The incidence rate in Italy is estimated as increasing until the late 1990s, and stable thereafter (93 per 100,000). The incidence curve is also estimated to flatten in many northern-central regions from the late 1990s or later. Rising incidence trends are estimated in all southern regions, with the exception of Puglia. About 8,500 deaths, 37,000 new diagnoses and 416,000 prevalent cases for breast cancer are estimated among Italian women in 2005. In the same year, the proportion of prevalent cases in the northern area (1,221 per 100,000) is about twice that estimated in the South (685 per 100,000). Discussion The geographical variation in female breast cancer burden can be explained by the unequal distribution of screening. A more widespread screening activity in the southern regions would help to bridge the gap between northern-central and southern regions. Continuous monitoring of regional epidemiological indicators for breast cancer is crucial to evaluate the effect of different health measures taken to control breast cancer in Italy.
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Affiliation(s)
- Enrico Grande
- Reparto di Epidemiologia dei Tumori, Centro Nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Istituto Superiore di Sanità, Rome, Italy.
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4
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Jacklyn G, Morrell S, McGeechan K, Houssami N, Irwig L, Pathmanathan N, Barratt A. Carcinoma in situ of the breast in New South Wales, Australia: Current status and trends over the last 40 year. Breast 2017; 37:170-178. [PMID: 28882419 DOI: 10.1016/j.breast.2017.08.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 08/17/2017] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND The incidence of non-invasive breast cancer has increased substantially over time. We aim to describe temporal trends in the incidence of carcinoma in situ of the breast in New South Wales (NSW), Australia. METHODS Descriptive study of trends in the incidence of ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) in women who received a diagnosis from 1972 to 2012, recorded in the NSW Cancer Registry. RESULTS Carcinoma in situ as a proportion of all breast cancer was 0.4% during the prescreening period 1972 to 1987 and is currently 14.1% (2006 to 2012). Among 10,810 women diagnosed with DCIS, incidence across all ages rose from 0.15 per 100,000 during 1972 to 1983 to 16.81 per 100,000 over 2006 to 2012, representing a 100-fold increase (IRR 113.10; 95% CI 81.94 to 156.08). Among women in the target age group for screening (50-69 years) incidence rose from 0.27 per 100,000 to 51.96 over the same period (IRR 195.50; 95% CI 117.26 to 325.89). DCIS incidence peaks in women aged 60-69 years. DCIS incidence has not stabilized despite screening being well established for over 20 years, and participation rates in the target age range remaining stable. CONCLUSIONS Our findings raise questions about the value of the increasing detection of DCIS and aggressive treatment of these lesions, especially among older women, and support trials of de-escalated treatment.
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Affiliation(s)
- Gemma Jacklyn
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia.
| | - Stephen Morrell
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Les Irwig
- Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
| | - Nirmala Pathmanathan
- Sydney Medical School - Westmead, The University of Sydney, Westmead, NSW, 2145, Australia; Westmead Breast Cancer Institute, Westmead Hospital, Westmead, NSW, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, NSW, 2006, Australia
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5
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Lazzeroni M, Dunn BK, Pruneri G, Jereczek-Fossa BA, Orecchia R, Bonanni B, DeCensi A. Adjuvant therapy in patients with ductal carcinoma in situ of the breast: The Pandora's box. Cancer Treat Rev 2017; 55:1-9. [PMID: 28262606 DOI: 10.1016/j.ctrv.2017.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/26/2017] [Accepted: 01/30/2017] [Indexed: 12/23/2022]
Abstract
Most patients with ductal carcinoma in situ of the breast (DCIS) are eligible for breast conservation treatment. The key management decision is whether to add radiotherapy and/or endocrine therapy to minimize the risk of a subsequent recurrence. Recent analyses indicating a lack of benefit in terms of breast cancer-associated mortality have suggested that more conservative approaches, omitting adjuvant therapy or even surgery, may be advisable in selected patients. These mortality observations are directly influenced by widespread use of mammographic screening which has opened a Pandora's box of subclinical DCIS and early invasive lesions. Confusion as to how aggressively such possibly indolent lesions should be treated has led to misunderstandings among patients and medical professionals. While awaiting further prospective evidence from clinical trials, we endorse an active treatment of DCIS as the standard of care. Our rationale is twofold: invasive recurrences are associated with an increase in breast cancer mortality, which is not the only relevant endpoint for DCIS. The benefit of complete surgical excision, adjuvant radiotherapy and endocrine treatment in preventing recurrence and invasive progression has been demonstrated in DCIS. The challenge now is how to identify DCIS patients who will not progress to invasive carcinoma even without complete excision and, at the other extreme, those patients at the highest risk who require mastectomy for local control. The current controversies over whether and which adjuvant therapy should be implemented can at least in part be addressed by developing effective doctor-patient communications that enable mutual understanding about the management of this biologically heterogeneous disease.
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Affiliation(s)
- Matteo Lazzeroni
- Divisions of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Barbara K Dunn
- Division of Cancer Prevention, National Cancer Institute, Bethesda, MD 20892, USA
| | - Giancarlo Pruneri
- Pathology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Roberto Orecchia
- Radiotherapy, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Italy
| | - Bernardo Bonanni
- Divisions of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy
| | - Andrea DeCensi
- Divisions of Cancer Prevention and Genetics, European Institute of Oncology, Milan, Italy; Division of Medical Oncology, E.O. Ospedali Galliera, Genoa, Italy; Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, United Kingdom.
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6
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Missinne S, Bracke P. A cross-national comparative study on the influence of individual life course factors on mammography screening. Health Policy 2015; 119:709-19. [PMID: 25921692 DOI: 10.1016/j.healthpol.2015.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/05/2015] [Accepted: 04/07/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Drawing on insights from the life course perspective, the aim of this paper is to gain a better understanding of persistent socioeconomic inequalities related to the uptake of mammography screening in 13 European countries. We examine whether these inequalities originate in childhood and relate them to the history and progression of each country's screening programs. METHODS Retrospective data from the third wave of the Survey of Health, Ageing and Retirement (SHARELIFE) is analyzed by means of event-history analyses to examine the role of childhood preventive health behavior on mammography screening initiation. The results are framed within the context of policy developments concerning mammography screening in each of the separate European countries. RESULTS Childhood preventive health care behavior predicts mammography screening in 9 of the 13 countries after conventional measurements of socioeconomic position in childhood and adulthood are accounted for. Net effects of education and income are still found for respectively 6 and 7 countries, but in about half of these countries national screening programs are able to reduce the social gradient. Very strong cohort and period effects are found for every country. CONCLUSIONS In a substantial number of the European countries, socioeconomic inequalities in preventive health behavior originate in childhood, which point to the deeply rooted nature of these inequalities. A long-term perspective is essential to further unravel how health policies can reduce or eliminate these persistent inequalities.
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Affiliation(s)
- Sarah Missinne
- HeDeRa (Health and Demographic Research), Department of Sociology, Ghent University, Belgium; Research Foundation (FWO), Flanders, Belgium.
| | - Piet Bracke
- HeDeRa (Health and Demographic Research), Department of Sociology, Ghent University, Belgium.
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7
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Román M, Rué M, Sala M, Ascunce N, Baré M, Baroja A, De la Vega M, Galcerán J, Natal C, Salas D, Sánchez-Jacob M, Zubizarreta R, Castells X. Trends in detection of invasive cancer and ductal carcinoma in situ at biennial screening mammography in Spain: a retrospective cohort study. PLoS One 2013; 8:e83121. [PMID: 24376649 PMCID: PMC3871523 DOI: 10.1371/journal.pone.0083121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Breast cancer incidence has decreased in the last decade, while the incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world. The phenomenon has been attributed to the widespread adaption of screening mammography. The aim of the study was to evaluate the temporal trends in the rates of screen detected invasive cancers and DCIS, and to compare the observed trends with respect to hormone replacement therapy (HRT) use along the same study period. METHODS Retrospective cohort study of 1,564,080 women aged 45-69 years who underwent 4,705,681 screening mammograms from 1992 to 2006. Age-adjusted rates of screen detected invasive cancer, DCIS, and HRT use were calculated for first and subsequent screenings. Poisson regression was used to evaluate the existence of a change-point in trend, and to estimate the adjusted trends in screen detected invasive breast cancer and DCIS over the study period. RESULTS The rates of screen detected invasive cancer per 100.000 screened women were 394.0 at first screening, and 229.9 at subsequent screen. The rates of screen detected DCIS per 100.000 screened women were 66.8 at first screen and 43.9 at subsequent screens. No evidence of a change point in trend in the rates of DCIS and invasive cancers over the study period were found. Screen detected DCIS increased at a steady 2.5% per year (95% CI: 1.3; 3.8), while invasive cancers were stable. CONCLUSION Despite the observed decrease in breast cancer incidence in the population, the rates of screen detected invasive cancer remained stable during the study period. The proportion of DCIS among screen detected breast malignancies increased from 13% to 17% throughout the study period. The rates of screen detected invasive cancer and DCIS were independent of the decreasing trend in HRT use observed among screened women after 2002.
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MESH Headings
- Aged
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Early Detection of Cancer/trends
- Female
- Hormone Replacement Therapy/statistics & numerical data
- Humans
- Incidence
- Mammography
- Mass Screening/statistics & numerical data
- Middle Aged
- Retrospective Studies
- Spain/epidemiology
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Affiliation(s)
- Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
| | - Montse Rué
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA)-University of Lleida, Lleida, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nieves Ascunce
- Navarra Breast Cancer Screening Programme, Public Health Institute, Pamplona, Navarra, Spain
| | - Marisa Baré
- Oficina Tècnica de Cribratge, Corporació Sanitaria Parc Taulí-Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
| | - Araceli Baroja
- La Rioja Breast Cancer Screening Programme, Fundacion Rioja Salud, Logroño, La Rioja, Spain
| | - Mariola De la Vega
- Dirección General de Programas Asistenciales, Consejería de Sanidad, Servicio Canario de Salud, Tenerife, Santa Cruz de Tenerife, Spain
| | - Jaume Galcerán
- Foundation Society for Cancer Research and Prevention, Pere Virgili Health Research Institute, Reus, Tarragona, Spain
| | - Carmen Natal
- Program & Analysis Unit, Health Office, Oviedo, Principado de Asturias, Spain
| | - Dolores Salas
- General Directorate Public Health & Centre for Public Health Research, Valencia, Comunidad Valenciana, Spain
| | - Mercedes Sánchez-Jacob
- Servicio de Promoción de la Salud y Programas Preventivos, Consejería de Sanidad, Valladolid, Castilla y León, Spain
| | - Raquel Zubizarreta
- Galician Breast Cancer Screening Programme, Public Health & Planning Directorate, Health Office, Santiago de Compostela, La Coruña, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
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8
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Lynge E, Ponti A, James T, Májek O, von Euler-Chelpin M, Anttila A, Fitzpatrick P, Frigerio A, Kawai M, Scharpantgen A, Broeders M, Hofvind S, Vidal C, Ederra M, Salas D, Bulliard JL, Tomatis M, Kerlikowske K, Taplin S. Variation in detection of ductal carcinoma in situ during screening mammography: a survey within the International Cancer Screening Network. Eur J Cancer 2013; 50:185-92. [PMID: 24041876 DOI: 10.1016/j.ejca.2013.08.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 08/13/2013] [Accepted: 08/19/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND There is concern about detection of ductal carcinoma in situ (DCIS) in screening mammography. DCIS accounts for a substantial proportion of screen-detected lesions but its effect on breast cancer mortality is debated. The International Cancer Screening Network conducted a comparative analysis to determine variation in DCIS detection. PATIENTS AND METHODS Data were collected during 2004-2008 on number of screening examinations, detected breast cancers, DCIS cases and Globocan 2008 breast cancer incidence rates derived from national or regional cancer registers. We calculated screen-detection rates for breast cancers and DCIS. RESULTS Data were obtained from 15 screening settings in 12 countries; 7,176,050 screening examinations; 29,605 breast cancers and 5324 DCIS cases. The ratio between highest and lowest breast cancer incidence was 2.88 (95% confidence interval (CI) 2.76-3.00); 2.97 (95% CI 2.51-3.51) for detection of breast cancer; and 3.49 (95% CI 2.70-4.51) for detection of DCIS. CONCLUSIONS Considerable international variation was found in DCIS detection. This variation could not be fully explained by variation in incidence nor in breast cancer detection rates. It suggests the potential for wide discrepancies in management of DCIS resulting in overtreatment of indolent DCIS or undertreatment of potentially curable disease. Comprehensive cancer registration is needed to monitor DCIS detection. Efforts to understand discrepancies and standardise management may improve care.
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Affiliation(s)
- Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Antonio Ponti
- CPO Piemonte, AOU San Giovanni Battista, Torino, Italy
| | - Ted James
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Ondřej Májek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | | | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | | | - Alfonso Frigerio
- Regional Reference Centre for Breast Cancer Screening, Torino, Italy
| | - Masaaki Kawai
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | - Mireille Broeders
- National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands
| | | | - Carmen Vidal
- Cancer and Prevention Control Program, Catalan Institute of Oncology, Barcelona, Spain
| | - Maria Ederra
- Breast Cancer Screening Program, Instituto de Salud Pública, Navarra, Spain
| | - Dolores Salas
- General Directorate Research and Public Health and Centre for Public Health Research, Valencia, Spain
| | | | | | - Karla Kerlikowske
- Department of Medicine and Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Stephen Taplin
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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9
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Patterns of breast cancer mortality trends in Europe. Breast 2013; 22:244-53. [PMID: 23478201 DOI: 10.1016/j.breast.2013.02.007] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 01/25/2013] [Accepted: 02/11/2013] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES To identify patterns of variation in breast cancer mortality in Europe (1980-2010), using a model-based approach. METHODS Mortality data were obtained from the World Health Organization database and mixed models were used to describe the time trends in the age-standardized mortality rates (ASMR). Model-based clustering was used to identify clusters of countries with homogeneous variation in ASMR. RESULTS Three patterns were identified. Patterns 1 and 2 are characterized by stable or slightly increasing trends in ASMR in the first half of the period analysed, and a clear decline is observed thereafter; in pattern 1 the median of the ASMR is higher, and the highest rates were achieved sooner. Pattern 3 is characterised by a rapid increase in mortality until 1999, declining slowly thereafter. CONCLUSION This study provides a general model for the description and interpretation of the variation in breast cancer mortality in Europe, based in three main patterns.
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Vidali C, Caffo O, Aristei C, Bertoni F, Bonetta A, Guenzi M, Iotti C, Leonardi MC, Mussari S, Neri S, Pietta N. Conservative treatment of breast ductal carcinoma in situ: results of an Italian multi-institutional retrospective study. Radiat Oncol 2012; 7:177. [PMID: 23098066 PMCID: PMC3573934 DOI: 10.1186/1748-717x-7-177] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 10/21/2012] [Indexed: 12/21/2022] Open
Abstract
Background The incidence of ductal carcinoma in situ (DCIS) has increased markedly in recent decades. In the past, mastectomy was the primary treatment for patients with DCIS, but as with invasive cancer, breast-conserving surgery followed by radiation therapy (RT) has become the standard approach. We present the final results of a multi-institutional retrospective study of an Italian Radiation Oncology Group for the study of conservative treatment of DCIS, characterized by a very long period of accrual, from February 1985 to March 2000, and a median follow-up longer than 11 years. Methods A collaborative multi-institutional study was conducted in Italy in 10 Radiation Oncology Departments. A consecutive series of 586 women with DCIS histologically confirmed, treated between February 1985 and March 2000, was retrospectively evaluated. Median age at diagnosis was 55 years (range: 29–84); 32 patients were 40 years old or younger. All women underwent conservative surgery followed by whole breast RT. Irradiation was delivered to the entire breast, for a median total dose of 50 Gy; the tumour bed was boosted in 295 cases (50%) at a median dose of 10 Gy. Results After a median follow-up of 136 months (range: 16–292 months), 59/586 patients (10%) experienced a local recurrence: invasive in 37 cases, intraductal in 20 and not specified in two. Salvage mastectomy was the treatment of choice in 46 recurrent patients; conservative surgery in 10 and it was unknown in three patients. The incidence of local recurrence was significantly higher in women younger than 40 years (31.3%) (p= 0.0009). Five patients developed distant metastases. Furthermore 40 patients developed a contralateral breast cancer and 31 a second primary tumour in a different site. The 10-year actuarial overall survival (OS) was 95.5% and the 10-year actuarial disease-specific survival (DSS) was 99%. Conclusions Our results are consistent with those reported in the literature. In particular it has been defined the importance of young age (40 years or less) as a relevant risk factor for local recurrence. This retrospective multi-institutional Italian study confirms the long term efficacy of breast conserving surgery with RT in women with DCIS.
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Affiliation(s)
- Cristiana Vidali
- S.C. Radioterapia Oncologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Via Pietà 19, 34139, Trieste, Italy.
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Rapid increase in incidence of breast ductal carcinoma in situ in Girona, Spain 1983–2007. Breast 2012; 21:646-51. [DOI: 10.1016/j.breast.2012.01.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 11/21/2022] Open
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Holleczek B, Brenner H. Trends of population-based breast cancer survival in Germany and the US: decreasing discrepancies, but persistent survival gap of elderly patients in Germany. BMC Cancer 2012; 12:317. [PMID: 22838641 PMCID: PMC3522526 DOI: 10.1186/1471-2407-12-317] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2012] [Accepted: 07/18/2012] [Indexed: 01/07/2023] Open
Abstract
Background Studies have revealed both higher cancer survival in the US than in Germany and substantial improvement of cancer survival in the past in these countries. This population-based study aims at comparing most recent 5-year relative survival of breast cancer patients and preceding trends in both countries. Methods Women with a first invasive breast cancer diagnosed and followed up between 1988 and 2008 from Germany and the US (utilizing data from the Saarland Cancer Registry and the Surveillance, Epidemiology, and End Results Program, respectively) were included. Period analysis was used to derive most up-to-date 5-year relative survival and preceding survival trends according to age and stage. Results Since 1993, age standardized relative survival has steadily improved in Germany and the US to 83% and 88%, respectively. In the period 2005–08, relative survival of localized cancer was above 97% in both countries, and 79% and 83% for locally/regionally spread breast cancer, respectively. Prognosis of metastasized disease has remained very poor overall, with improvement essentially being restricted to younger patients. The proportion of patients diagnosed with localized breast cancer was consistently higher in the US. If adjusted for stage, the differences in relative survival between both countries diminished over time and eventually disappeared. Conclusions Similar survival is now observed in both countries for patients below the age of 70 years, but in Germany survival is still much lower for elderly patients. The observed trends point to treatment advances as a major cause for improved survival. However, substantial differences in mammography usage existed between both countries and might probably also account for the observed differences (to a lesser extent, also differences in health care systems, and delivery of cancer care). Encouraging, survival of breast cancer patients has improved in Germany to a much greater extent than in the US, albeit the persisting survival gap for elderly patients in Germany requires particular attention by researchers, public health authorities, and clinicians.
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Affiliation(s)
- Bernd Holleczek
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Im Neuenheimer Feld 581, 69120 Heidelberg, Germany.
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Glover JA, Bannon FJ, Hughes CM, Cantwell MM, Comber H, Gavin A, Deady S, Murray LJ. Increased diagnosis and detection rates of carcinoma in situ of the breast. Breast Cancer Res Treat 2012; 133:779-84. [DOI: 10.1007/s10549-012-1975-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 01/13/2012] [Indexed: 11/24/2022]
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Holleczek B, Arndt V, Stegmaier C, Brenner H. Trends in breast cancer survival in Germany from 1976 to 2008—A period analysis by age and stage. Cancer Epidemiol 2011; 35:399-406. [DOI: 10.1016/j.canep.2011.01.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2010] [Revised: 01/10/2011] [Accepted: 01/18/2011] [Indexed: 12/15/2022]
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Trends in incidence of ductal carcinoma in situ: The effect of a population-based screening programme. Breast 2010; 19:499-505. [DOI: 10.1016/j.breast.2010.05.014] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 05/21/2010] [Accepted: 05/21/2010] [Indexed: 11/18/2022] Open
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Bastos J, Peleteiro B, Gouveia J, Coleman MP, Lunet N. The state of the art of cancer control in 30 European countries in 2008. Int J Cancer 2010; 126:2700-15. [PMID: 19830695 DOI: 10.1002/ijc.24963] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Inequalities in cancer incidence, mortality and survival represent a major challenge for public health. Addressing this challenge requires complex and multidisciplinary approaches. Sharing successful experiences from across Europe may therefore be of benefit. We describe the state of the art of cancer control structures in the 27 European Union countries, plus Iceland, Norway and Switzerland, at the beginning of 2008. Information on cancer plans, cancer registries, cancer screening, Human Papillomavirus (HPV) vaccination and smoking restrictions in each country was identified through PubMed, the official websites of national and international organizations and Google searches. Experts and/or health authorities from each country completed and validated the information. Sixteen countries had implemented national cancer plans in 2008. Twenty four countries had population-based cancer registries with 100% coverage. The exceptions were Greece and Luxembourg (no population-based registry yet), France, Italy and Spain (<50%), and Switzerland (62%). In 9 countries, population coverage of breast cancer screening was 100% with participation ranging from 26 to 87%; 8 countries did not have organized programmes. Seven countries had cervical cancer screening programmes with 100% coverage with participation ranging from 10 to 80%; 8 countries had no organized programme. Nine countries had announced national HPV vaccination policies by early 2008. Six countries had organized colorectal cancer screening programmes. Five countries had complete bans on smoking in public places. There is wide international heterogeneity in cancer control structures in Europe. This provides considerable scope and motivation for cooperation and sharing of experience.
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Affiliation(s)
- Joana Bastos
- Department of Hygiene and Epidemiology, University of Porto Medical School, Portugal
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Tarlov E, Zenk SN, Campbell RT, Warnecke RB, Block R. Characteristics of mammography facility locations and stage of breast cancer at diagnosis in Chicago. J Urban Health 2009; 86:196-213. [PMID: 18972211 PMCID: PMC2648885 DOI: 10.1007/s11524-008-9320-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2008] [Accepted: 08/28/2008] [Indexed: 10/21/2022]
Abstract
In the United States, despite substantial investment in public health initiatives to promote early detection of breast cancer through screening mammography, the proportion of female breast cancers that have advanced beyond the localized stage by the time of diagnosis remains high. Our objective in this exploratory study was to investigate whether stage of breast cancer at diagnosis among Chicago residents is associated with characteristics of the neighborhoods in which proximate mammography facilities are located. Those characteristics may influence likelihood of utilizing the service routinely and partly explain differences in stage at diagnosis. We used a retrospective cohort design and combined 3 years of data from the Illinois State Cancer Registry (ISCR) with information on locations of mammography facilities, public transportation service, crime, and area demographic and economic characteristics. Using a Geographic Information System (GIS), we identified the five facilities located nearest to each case's residence. Estimates of the association between characteristics of mammography facility locations and breast cancer stage at diagnosis were obtained using the partial proportional odds regression model. We found that the number of homicides in areas in which the nearest mammography facilities were located was associated with increased odds of later stage diagnosis. This effect was independent of age, race, and residential area education and income. We found no effect on stage of distance, public transportation service, or measures of neighborhood social similarity. The "spatial dynamics" of health may involve geographies beyond the immediate neighborhood. The results of our study suggest that areas in which the nearest mammography facilities are located may be one such geography. We hope that this study will spark research interest in the impact of health service locations on utilization.
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Affiliation(s)
- Elizabeth Tarlov
- VA Information Resource Center, Edward Hines, Jr. VA Hospital, Hines, IL, USA.
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Screening caused rising incidence rates of ductal carcinoma in situ of the breast. Breast Cancer Res Treat 2008; 115:181-3. [DOI: 10.1007/s10549-008-0067-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 05/14/2008] [Indexed: 11/30/2022]
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Boncz I, Sebestyén A, Döbrossy L, Péntek Z, Budai A, Kovács A, Dózsa C, Ember I. The organisation and results of first screening round of the Hungarian nationwide organised breast cancer screening programme. Ann Oncol 2007; 18:795-9. [PMID: 17259642 DOI: 10.1093/annonc/mdl489] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this paper is to give an overview of organisational issues of the Hungarian nationwide organised breast cancer screening programme and to provide the results of the first screening round of the programme for the years 2002-2003. PATIENTS AND METHODS Data were derived from the financial database of the National Health Insurance Fund Administration covering the period 2000-2003. Women who underwent mammography screening were included into the study. RESULTS Uptake of the organised screening programme in 2002-2003 was 45.09%, while the recall rate was 7.23%. Malignant cases represented 65.38% of total surgeries and 0.36% of total number of screened women yielding a cancer detection rate 3.6 per 1000 screened women. Malignant cases of 10.78% were identified as ductal carcinoma in situ, while 89.22% was invasive cancer. Benign to malignant ratio was 0.54 : 1. CONCLUSION There is therefore an urgent need to closely monitor performance and to review programme policies and procedures with the aim of increasing both the participation rate and the proportion of women eligible to attend screening.
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Affiliation(s)
- I Boncz
- Department of Health Policy, National Health Insurance Fund Administration, Váci út 73/A., 1139 Budapest, Hungary.
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