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Verhoeven D, Siesling S, Allemani C, Roy PG, Travado L, Bhoo-Pathy N, Rhayns C, Junkermann H, Nakamura S, Lasebikan N, Tucker FL. High-value breast cancer care within resource limitations. Oncologist 2024; 29:e899-e909. [PMID: 38780115 PMCID: PMC11224985 DOI: 10.1093/oncolo/oyae080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 03/19/2024] [Indexed: 05/25/2024] Open
Abstract
Breast cancer care is a costly global health issue where effective management depends on early detection and treatment. A breast cancer diagnosis can result in financial catastrophe especially in low- and middle-income countries (LMIC). Large inequities in breast cancer care are observed and represent a global challenge to caregivers and patients. Strategies to improve early diagnosis include awareness and clinical breast examination in LMIC, and screening in high-income countries (HIC). The use of clinical guidelines for the management of breast cancer is needed. Adapted guidelines from HIC can address disparities in populations with limited resources. Locally developed strategies still provide effective guidance in improving survival. Integrated practice units (IPU) with timely multidisciplinary breast care conferences and patient navigators are required to achieve high-value, personalized breast cancer management in HIC as well as LMIC. Breast cancer patient care should include a quality of life evaluation using ideally patient-reported outcomes (PROM) and experience measurements (PREM). Evaluation of breast cancer outcomes must include the financial cost of delivered care. The resulting value perspective should guide resource allocation and program priorities. The value of care must be improved by translating the findings of social and economic research into practice and resolving systemic inequity in clinical breast cancer research. Cancer survivorship programs must be put in place everywhere. The treatment of patients with metastatic breast cancer must require more attention in the future, especially in LMIC.
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Affiliation(s)
- Didier Verhoeven
- Department of Medical Oncology, University of Antwerp, AZ KLINA, Brasschaat, Belgium
| | - Sabine Siesling
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, The Netherlands
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Claudia Allemani
- Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Pankaj Gupta Roy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
| | - Luzia Travado
- Champalimaud Clinical and Research Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Nirmala Bhoo-Pathy
- Department of Epidemiology, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | - Seigo Nakamura
- Division of Breast Surgical Oncology, Department of Surgery, Showa University, Tokyo, Japan
| | - Nwamaka Lasebikan
- Department of Radiation and Clinical Oncology, University of Nigeria Teaching Hospital, Enugu, Nigeria
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Inchai P, Tsai WC, Chiu LT, Kung PT. Cancer stages and mortality risk of breast cancer between women with and without disabilities: A national population-based cohort study in Taiwan. Disabil Health J 2024; 17:101632. [PMID: 38658214 DOI: 10.1016/j.dhjo.2024.101632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 04/07/2024] [Accepted: 04/14/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND The second-most common cause of cancer-related death for women worldwide is breast cancer. However, there is little information about breast cancer among women with disabilities in Taiwan. OBJECTIVES This study investigated differences between women with and without disabilities regarding breast cancer stages and evaluated the probability of developing an advanced stage and the mortality risk of breast cancer. METHODS This study conducted a nationwide retrospective cohort study using the National Health Insurance Research Database and other nationwide databases. Our participants were newly diagnosed breast cancer patients, including women with and without disabilities, between 2004 and 2010. We matched both of them with propensity score matching methods (1:5), and all were followed up until the end of 2016. RESULTS This study included 50,683 participants with breast cancer. After matching, women with disabilities who did not receive breast cancer screening had a more significant proportion of advanced-stage breast cancer (19.95 %) than those without disabilities who did not receive breast cancer screening (16.87 %). After adjusting for related variables, women with disabilities were 1.27 times more likely to have advanced-stage breast cancer than those without disabilities. Additionally, after suffering from breast cancer, individuals with disabilities had a 1.23 times greater mortality risk compared to those without disabilities. CONCLUSIONS Although cancer stages were controlled, women with disabilities still had a higher mortality risk of breast cancer. Hence, policymakers should pay more attention to women with disabilities to treat them at an early stage, which can reduce the mortality risk attributable to advanced stages.
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Affiliation(s)
- Puchong Inchai
- Department of Epidemiology, Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Wen-Chen Tsai
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan.
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3
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Lammers SWM, Meegdes M, Vriens IJH, Voogd AC, de Munck L, van Nijnatten TJA, Keymeulen KBMI, Tjan-Heijnen VCG, Geurts SME. Treatment and survival of patients diagnosed with high-risk HR+/HER2- breast cancer in the Netherlands: a population-based retrospective cohort study. ESMO Open 2024; 9:103008. [PMID: 38677006 PMCID: PMC11067336 DOI: 10.1016/j.esmoop.2024.103008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/21/2024] [Accepted: 03/03/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND Several factors may increase the risk of recurrence of patients diagnosed with hormone receptor-positive human epidermal growth factor receptor 2-negative (HR+/HER2-) breast cancer (BC). We aim to determine the proportion of patients with high-risk HR+/HER2- BC within the total HR+/HER2- BC cohort and compare their systemic treatments and survival rates with those of patients with low- and intermediate-risk HR+/HER2- BC and triple-negative (TN) BC. PATIENTS AND METHODS Women diagnosed with nonmetastatic invasive HR+/HER2- BC and TNBC in the Netherlands between 2011 and 2019 were identified from the Netherlands Cancer Registry. Patients with HR+/HER2- BC were categorised according to risk profile, defined by nodal status, tumour size, and histological grade. High-risk HR+/HER2- BC was defined by either four or more positive lymph nodes or one to three positive lymph nodes with a tumour size of ≥5 cm or a histological grade 3 tumour. Overall survival (OS) and relative survival (RS) were calculated using the Kaplan-Meier and Pohar-Perme method. RESULTS In this study of 87 455 patients with HR+/HER2- BC, 44 078 (50%) patients were diagnosed with low risk, 28 452 (33%) with intermediate risk, and 11 285 (13%) with high-risk HR+/HER2- BC. In 3640 (4%) patients, the risk profile could not be defined. Endocrine therapy and chemotherapy were used in 38% and 7% of low-risk, 90% and 47% of intermediate-risk, and 94% and 73% of high-risk patients, respectively. The 10-year OS and RS rates were 84.1% [95% confidence interval (95% CI) 83.5% to 84.7%] and 98.7% (95% CI 97.3% to 99.4%) in low-risk, 75.1% (95% CI 74.2% to 76.0%) and 91.7% (95% CI 89.7% to 93.3%) in intermediate-risk, and 63.4% (95% CI 62.0% to 64.7%) and 72.3% (70.1% to 74.3%) in high-risk patients. The 10-year OS and RS rates of 12 689 patients with TNBC were 69.7% (95% CI 68.6% to 70.8%) and 79.1% (95% CI 77.0% to 80.9%), respectively. CONCLUSION The poor prognosis of patients with high-risk HR+/HER2- BC highlights the need for a better acknowledgement of this subgroup and supports ongoing clinical trials aimed at optimising systemic therapy.
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Affiliation(s)
- S W M Lammers
- Department of Medical Oncology, Maastricht University Medical Centre, GROW, Maastricht University, Maastricht.
| | - M Meegdes
- Department of Medical Oncology, Maastricht University Medical Centre, GROW, Maastricht University, Maastricht
| | - I J H Vriens
- Department of Medical Oncology, Maastricht University Medical Centre, GROW, Maastricht University, Maastricht
| | - A C Voogd
- Department of Epidemiology, Maastricht University, Maastricht
| | - L de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht
| | - T J A van Nijnatten
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Centre, GROW, Maastricht
| | - K B M I Keymeulen
- Department of Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - V C G Tjan-Heijnen
- Department of Medical Oncology, Maastricht University Medical Centre, GROW, Maastricht University, Maastricht
| | - S M E Geurts
- Department of Medical Oncology, Maastricht University Medical Centre, GROW, Maastricht University, Maastricht.
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Buschmann L, Wellmann I, Bonberg N, Wellmann J, Hense HW, Karch A, Minnerup H. Isolating the effect of confounding from the observed survival benefit of screening participants - a methodological approach illustrated by data from the German mammography screening programme. BMC Med 2024; 22:43. [PMID: 38287392 PMCID: PMC10826012 DOI: 10.1186/s12916-024-03258-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 01/15/2024] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND Mammography screening programmes (MSP) aim to reduce breast cancer mortality by shifting diagnoses to earlier stages. However, it is difficult to evaluate the effectiveness of current MSP because analyses can only rely on observational data, comparing women who participate in screening with women who do not. These comparisons are subject to several biases: one of the most important is self-selection into the MSP, which introduces confounding and is difficult to control for. Here, we propose an approach to quantify confounding based on breast cancer survival analyses using readily available routine data sources. METHODS Using data from the Cancer Registry of North Rhine-Westphalia, Germany, we estimate the relative contribution of confounding to the observed survival benefit of participants of the German MSP. This is accomplished by comparing non-participants, participants with screen-detected and participants with interval breast cancers for the endpoints "death from breast cancer" and "death from all causes other than breast cancer" - the latter being assumed to be unrelated to any MSP effect. By using different contrasts, we eliminate the effects of stage shift, lead and length time bias. The association of breast cancer detection mode with survival is analysed using Cox models in 68,230 women, aged 50-69 years, with breast cancer diagnosed in 2006-2014 and followed up until 2018. RESULTS The hazard of dying from breast cancer was lower in participants with screen-detected cancer than in non-participants (HR = 0.21, 95% CI: 0.20-0.22), but biased by lead and length time bias, and confounding. When comparing participants with interval cancers and non-participants, the survival advantage was considerably smaller (HR = 0.62, 95% CI: 0.58-0.66), due to the elimination of stage shift and lead time bias. Finally, considering only mortality from causes other than breast cancer in the latter comparison, length time bias was minimised, but a survival advantage was still present (HR = 0.63, 95% CI: 0.56-0.70), which we attribute to confounding. CONCLUSIONS This study shows that, in addition to stage shift, lead and length time bias, confounding is an essential component when comparing the survival of MSP participants and non-participants. We further show that the confounding effect can be quantified without explicit knowledge of potential confounders by using a negative control outcome.
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Affiliation(s)
- Laura Buschmann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
| | - Ina Wellmann
- Cancer Registry of North Rhine-Westphalia, Bochum, Germany
| | - Nadine Bonberg
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Jürgen Wellmann
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - André Karch
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Heike Minnerup
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
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Oberije CJG, Sharma N, James JJ, Ng AY, Nash J, Kecskemethy PD. Comparing Prognostic Factors of Cancers Identified by Artificial Intelligence (AI) and Human Readers in Breast Cancer Screening. Cancers (Basel) 2023; 15:3069. [PMID: 37370680 PMCID: PMC10296295 DOI: 10.3390/cancers15123069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 05/25/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
Invasiveness status, histological grade, lymph node stage, and tumour size are important prognostic factors for breast cancer survival. This evaluation aims to compare these features for cancers detected by AI and human readers using digital mammography. Women diagnosed with breast cancer between 2009 and 2019 from three UK double-reading sites were included in this retrospective cohort evaluation. Differences in prognostic features of cancers detected by AI and the first human reader (R1) were assessed using chi-square tests, with significance at p < 0.05. From 1718 screen-detected cancers (SDCs) and 293 interval cancers (ICs), AI flagged 85.9% and 31.7%, respectively. R1 detected 90.8% of SDCs and 7.2% of ICs. Of the screen-detected cancers detected by the AI, 82.5% had an invasive component, compared to 81.1% for R1 (p-0.374). For the ICs, this was 91.5% and 93.8% for AI and R1, respectively (p = 0.829). For the invasive tumours, no differences were found for histological grade, tumour size, or lymph node stage. The AI detected more ICs. In summary, no differences in prognostic factors were found comparing SDC and ICs identified by AI or human readers. These findings support a potential role for AI in the double-reading workflow.
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Affiliation(s)
| | - Nisha Sharma
- Breast Screening Unit, Leeds Teaching Hospital NHS Trust, Leeds LS14 6UH, UK
| | - Jonathan J. James
- Nottingham Breast Institute, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK
| | - Annie Y. Ng
- Kheiron Medical Technologies, 112-116 Old St., London EC1V 9BG, UK
| | - Jonathan Nash
- Kheiron Medical Technologies, 112-116 Old St., London EC1V 9BG, UK
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Gold N, Christensen RAG, Arneja J, Aminoleslami A, Anderson GM, Brooks JD. Screening behaviours, demographics, and stage at diagnosis in the publicly funded Ontario Breast Screening Program. Breast Cancer Res Treat 2023; 198:523-533. [PMID: 36800117 PMCID: PMC10036268 DOI: 10.1007/s10549-022-06848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/01/2022] [Indexed: 02/18/2023]
Abstract
PURPOSE The Ontario Breast Screening Program (OBSP) offers free screening mammograms every 2 years, to women aged 50-74. Study objectives were to determine demographic characteristics associated with the adherence to OBSP and if women screened in the OBSP have a lower stage at diagnosis than non-screened eligible women. METHODS We used the Ontario cancer registry (OCR) to identify 48,927 women, aged 51-74 years, diagnosed with breast cancer between 2010 and 2017. These women were assigned as having undergone adherent screening (N = 26,108), non-adherent screening (N = 6546) or not-screened (N = 16,273) in the OBSP. We used multinomial logistic regression to investigate the demographic characteristics associated with screening behaviour, as well as the association between screening status and stage at diagnosis. RESULTS Among women with breast cancer, those living in rural areas (versus the largest urban areas) had a lower odds of not being screened (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.68, 0.78). Women in low-income (versus high-income) communities were more likely not to be screened (OR 1.42, 95% CI 1.33, 1.51). When stratified, the association between income and screening status only held in urban areas. Non-screened women were more likely to be diagnosed with stage II (OR 1.91, 95% CI 1.82, 2.01), III (OR 2.96, 95% CI 2.76, 3.17), or IV (OR 8.96, 95% CI 7.94, 10.12) disease compared to stage I and were less likely to be diagnosed with ductal carcinoma in situ (DCIS) (OR 0.91, 95% CI 0.84-0.98). CONCLUSIONS This study suggests that targeting OBSP recruitment efforts to lower income urban communities could increase screening rates. OBSP adherent women were more likely to be diagnosed with earlier stage disease, supporting the value of this initiative and those like it.
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Affiliation(s)
- Nicholas Gold
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Rebecca A G Christensen
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Jasleen Arneja
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Arian Aminoleslami
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Geoffrey M Anderson
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada.
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Dassen RRE, Pelders S, de Munck L, Jager A, Hooning MJ, van Dam JH, Heemskerk-Gerritsen BAM. The effect of attendance in the Dutch breast cancer screening program on breast tumor characteristics among migrant women. Breast 2023; 69:290-298. [PMID: 36940631 PMCID: PMC10034141 DOI: 10.1016/j.breast.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/10/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND In general, migrant women have a lower breast cancer (BC) incidence rate and higher BC mortality than autochthonous women. Further, migrant women show lower participation in the national BC screening program. To further investigate those aspects, we aimed to determine differences in incidence and tumor characteristics between autochthonous and migrant BC patients in Rotterdam, the Netherlands. METHODS We selected women diagnosed with BC in Rotterdam during 2012-2015 from the Netherlands Cancer Registry. Incidence rates were calculated by migrant status (i.e., women with or without migration background). Multivariable analyses revealed adjusted odds ratios (OR) and 95% confidence intervals (CI) on the association between migration status and patient and tumor characteristics, additionally stratified by screening attendance (yes/no). RESULTS In total 1372 autochthonous and 450 migrant BC patients were included for analysis. BC incidence was lower among migrants than among autochthonous women. Overall, migrant women were younger at BC diagnosis (53 vs. 64 years, p < 0.001), and had higher risks of positive lymph nodes (OR 1.76, 95% CI 1.33-2.33) and high grade tumors (OR 1.35, 95% CI 1.04-1.75). Especially non-screened migrant women had higher risk of positive nodes (OR 2.73, 95% CI 1.43-5.21). Among the subgroup of screened women, we observed no significant differences between migrant and autochthonous patients. CONCLUSION Migrant women have lower BC incidence than autochthonous women, but diagnosis was more often at younger age and with unfavorable tumor characteristics. Attending the screening program strongly reduces the latter. Therefore, promotion of participation in the screening program is recommended.
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Affiliation(s)
- R R E Dassen
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - S Pelders
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - L de Munck
- Netherlands Comprehensive Cancer Organization, Research and Development, Utrecht, Netherlands
| | - A Jager
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - M J Hooning
- Erasmus MC Cancer Institute, Medical Oncology, Rotterdam, Netherlands
| | - J H van Dam
- Erasmus MC Cancer Institute, Oncological Surgery, Rotterdam, Netherlands
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van Vliet ED, Eijkelboom AH, van Giessen A, Siesling S, de Wit GA. Physical and mental health outcomes of COVID-19 induced delay in oncological care: A systematic review. Front Oncol 2023; 13:998940. [PMID: 36776332 PMCID: PMC9911660 DOI: 10.3389/fonc.2023.998940] [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: 07/20/2022] [Accepted: 01/16/2023] [Indexed: 01/29/2023] Open
Abstract
Background During the COVID-19 pandemic cancer patients might have experienced delays in screening, diagnosis and/or treatment. A systematic review was conducted to give an overview of the effects of COVID-19 induced delays in oncological care on the physical and mental health outcomes of cancer patients. Methods MEDLINE and EMBASE databases were searched for articles on the effects of COVID-19 induced delays on physical and mental health outcomes. Results Out of 1333 papers, eighteen observational, and twelve modelling studies were included. In approximately half of the studies, tumor stage distribution differed during the pandemic compared to before the pandemic. Modelling studies predicted that the estimated increase in the number of deaths ranged from -0.04 to 30%, and the estimated reduction in survival ranged from 0.4 to 35%. Varying results on the impact on mental health, e.g. anxiety and depression, were seen. Conclusions Due to large methodological discrepancies between the studies and the varying results, the effect of COVID-19 induced delays on the physical and mental health outcomes of cancer patients remains uncertain. While modelling studies estimated an increase in mortality, observational studies suggest that mortality might not increase to a large extent. More longitudinal observational data from the pandemic period is needed for more conclusive results.
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Affiliation(s)
- Ella D. van Vliet
- Center for Health Protection, National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands,*Correspondence: Ella D. van Vliet,
| | - Anouk H. Eijkelboom
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Anoukh van Giessen
- Center for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - G. Ardine de Wit
- Center for Nutrition, Prevention and Healthcare, National Institute of Public Health and the Environment (RIVM), Bilthoven, Netherlands,Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam & Amsterdam Health Research Institute, Amsterdam, Netherlands
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Horsbøl TA, Michelsen SI, Lassen TH, Juel K, Bigaard J, Hoei-Hansen CE, Vejborg I, Thygesen LC. Breast Cancer Screening Among Women With Intellectual Disability in Denmark. JAMA Netw Open 2023; 6:e2248980. [PMID: 36595297 PMCID: PMC9856850 DOI: 10.1001/jamanetworkopen.2022.48980] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
IMPORTANCE Breast cancer-specific mortality is increased among women with intellectual disability (ID), and knowledge about participation in breast cancer screening in this group is needed. OBJECTIVE To examine participation in the Danish national breast cancer screening program among women with ID compared with women without ID. DESIGN, SETTING, AND PARTICIPANTS This dynamic population-based cohort study assessed participation in the Danish national breast cancer screening program initiated in 2007, targeting women aged 50 to 69 years with a screening interval of 2 years. In all, 6357 women with ID born between 1941 and 1967 and eligible for the screening program were identified in national registers. Women entered the study between January 1, 2007, and December 31, 2017. Subsequently, 273 women were excluded due to a history of carcinoma in situ or breast cancer, and 489 due to registration errors in registers. Each woman was individually age-matched with 10 women without ID (reference group). All women were followed up until March 31, 2021, or censoring (due to death, carcinoma in situ, or breast cancer). Data were analyzed from December 1, 2021, to June 31, 2022. EXPOSURES Intellectual disability was defined as being registered with an ID diagnosis or a diagnosis most likely leading to ID or residing at an institution for persons with ID. MAIN OUTCOMES AND MEASURES Participation in breast cancer screening (fully, partly, and never). RESULTS A total of 5595 women with ID and 49 423 age-matched women in the reference group were included in the analysis. Of these, 2747 women with ID (49%) and 24 723 in the reference group (50%) were 50 years of age at study entry; for those older than 50 years, the median age was 51 years (IQR, 50-58 years) in both groups. In all, 1425 women with ID (25%) were fully screened according to guidelines for the Danish breast cancer screening program compared with 30 480 women in the reference group (62%). Women with ID had nearly 5 times higher odds of never being screened compared with the reference group (odds ratio, 4.90 [95% CI, 4.60-5.22]). In all, 2498 women with ID (45%) and 6573 in the reference group (13%) were never screened. The proportion of never-screened women increased with severity of ID, from 834 of 2287 (36%) among women with mild ID to 173 of 212 (82%) among women with profound ID. CONCLUSIONS AND RELEVANCE The findings of this cohort study suggest that women with ID are markedly less likely to participate in breast cancer screening compared with women without ID. These findings further suggest a need for tailored guidelines and approaches for breast cancer screening in this group of women.
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Affiliation(s)
| | - Susan Ishøy Michelsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Tina Harmer Lassen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Knud Juel
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Janne Bigaard
- Prevention and Information, Danish Cancer Society, Copenhagen, Denmark
| | - Christina Engel Hoei-Hansen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital–Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ilse Vejborg
- Department of Breast Examinations, Copenhagen University Hospital Herlev Gentofte, Copenhagen, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Bodewes FTH, van Asselt AA, Dorrius MD, Greuter MJW, de Bock GH. Mammographic breast density and the risk of breast cancer: A systematic review and meta-analysis. Breast 2022; 66:62-68. [PMID: 36183671 PMCID: PMC9530665 DOI: 10.1016/j.breast.2022.09.007] [Citation(s) in RCA: 52] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/21/2022] [Accepted: 09/26/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature. METHODS Medline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I2 statistic, stratified and sensitivity analyses. RESULTS Nine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84-2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52-2.21) increased. Both results were statistically significant and homogenous. CONCLUSIONS Mammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.
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Affiliation(s)
- F T H Bodewes
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands
| | - A A van Asselt
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands
| | - M D Dorrius
- Department of Radiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - M J W Greuter
- Department of Radiology, University Medical Center Groningen (UMCG), University of Groningen, Groningen, the Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen (UMCG), University of Groningen, Hanzeplein 1, HPC: FA40, PO Box 30.001, Groningen, 9700 RB, the Netherlands.
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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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