Mammographic breast cancer screening: after the dust has settled

Population-based service mammography screening: the Icelandic experience

OBJECTIVE

This study analyzes the efficacy of the Icelandic population-based service mammography screening.

MATERIAL AND METHODS

Women aged 40-69 were invited for screening at 2-year intervals starting in November 1987. The study evaluates: (A) attendance and other screened performance parameters during 1998-2010; (B) trends in age-standardized and age-specific incidence rates during 1969-2010 and mortality rates during 1969-2010; and (C) distribution of risk factors and disease specific death rates according to mode of detection.

RESULTS

(A) In the age group of 40-69, the average 2-year attendance was 62%, recall rate was 4.1%, needle biopsy rate was 1.3%, surgery rate was 0.6%, invasive cancer rate was 0.4%, and ductal carcinoma in situ (DCIS) rate was 0.06%. (B) The linear incidence trend after the start of screening decreased significantly in the age group 40-49, increased significantly in the age group 50-69, but decreased non-significantly in the age group 70-79. The decreased age-specific incidence in the 70-79 age group was, however, greater than the increased age-specific incidence at the ages 50-69. The mortality rate decreased 41% for all age groups and the linear mortality trend decreased significantly at ages 40-49, 50-69, and 70-79. In the age group 40-74 years, the age-specific mortality decreased by 6.9 cases per 2000 during a 10-year period. (C) Screen-detected women had significantly smaller tumors, more favorable tumor grade, fewer axillary metastases and, after correction for other risk factors, the likelihood of dying from cancer decreased 54% (hazard ratio: 0.46; 95% confidence interval: 0.31-0.69) for these patients compared to cases of nonparticipators.

CONCLUSION

The study results confirm acceptable rates of recalls and referrals for further diagnosis and treatment, and significantly decreased breast cancer mortality rate after starting screening.

A two-center study of Muslim women's views of breast cancer and breast health practices in Pakistan and the UK

Breast health awareness practices of Pakistani Muslim women in the UK and Pakistan is unknown. Focus group interviews were used to investigate the impact of culture and psychosocial issues on breast health awareness involving 44 women in Lahore and London. Women based in Lahore were more inquisitive about breast cancer and held more developed views compared with British Pakistani Muslim women. Women concurred that concise and relevant breast health education is needed irrespective of faith to improve cultural sensitivity and awareness in both Pakistani communities (both men and women).

Prediction of breast tumor size by mammography and sonography--A breast screen experience

Concise preoperative assessment of breast Tumor size is important when considering surgical approach and the staging of breast cancer. A retrospective study of 400 uni-focal, invasive ductal carcinomas compared the accuracy of sonographic and mammographic measuring modalities with histological size. Sub-groups for tumor size, type and grade, with other variables, were also considered in intra-modal correlations of lesion dimension. Mammography (R2=0.74), although slightly over estimating tumor size, appeared to be more useful than sonography (R2=0.60) following logistical analysis of the data. Correlational significance for both imaging modalities decreased for tumors larger than 20mm. Sonography under estimated lesions in over 50% of cases; the average underestimate being 9.9 mm, and ranging from 1mm to 30 mm. Consideration of both imaging measurements in cohort should improve the accuracy of radiological reporting of pre-surgical tumor size.

Breast cancer control: signs of progress, but more work required

Breast cancer represents 10% of the global cancer burden and there is no population, or population sub-group, which has yet been identified to be at a truly low risk of developing the disease. Mortality rates have been steadily growing for nearly a century in many countries and it is only during the past decade that there have been signs of a sustainable decrease in mortality rates in a number of western-lifestyle countries. This represents considerable progress in breast cancer control and, although different factors contribute to different degrees in different countries, is mainly due to increased breast awareness, earlier detection and the delivery of the most appropriate therapy to women with the disease. The failure to prevent the incidence from continuing to rise represents to a great extent the failure to understand the precise mechanisms of breast carcinogenesis and the role of risk determinants whose alteration in society could lead to a reduced risk of developing the disease. The declines seen in mortality represent a considerable success, but there is no room for complacency until research can impact positively on reducing incidence.

Cancer control in women. Update 2003

The global cancer burden in women appeared to be increasing quickly at the end of the twentieth century with notable increases in the absolute numbers of cases of breast, cervix, lung and colorectal cancer of concern. However, prospects for cancer control in women appear to be good within our current knowledge and deserve close attention. Rates of lung cancer in women are increasing substantially in many countries and seem set to overtake breast cancer as the commonest form of cancer death in women in many parts of the world. These changes are due to the effects of cigarette smoking, a habit which women widely embraced during the second half of the last century. The high levels of smoking current in young women, which have yet to have their full inpact on death rates, constitute an important hazard not only for future cancer risks but for several other important causes of death. Although the breast is the commonest form of cancer in women in most western countries, the etiology of this disease remains elusive and preventable causes remain to be identified. Endogenous hormones also appear to have a role in cancer risk in women: oral contraceptives seem to increase slightly the risk of breast cancer in users in the use, and in the immediate post-use, period, but ten years after cessation the risk returns to that of never users. Oral contraceptive usage also appears to be protective against ovarian and endometrial cancer. The use of Hormonal Replacement Therapy (HRT) appears to increase the risk of endometrial cancer and a positive association with breast cancer risk appears to exist. Within the current knowledge of the epidemiology of cancer in women, the most important Cancer Control strategy is the prevention of cigarette smoking and the increase in the prevalence of adult women quitting smoking. Screening has also shown to be effective in reducing incidence and mortality of cervix cancer and mortality from breast and colorectal cancer. Although more work is needed, it is becoming clear that there could be an important role of HPV testing to further enhance cervix cancer screening.