1
|
Miles RC, Chou SH, Vijapura C, Patel A. Breast Cancer Screening in Women With Dense Breasts: Current Status and Future Directions for Appropriate Risk Stratification and Imaging Utilization. JOURNAL OF BREAST IMAGING 2022; 4:559-567. [PMID: 38416999 DOI: 10.1093/jbi/wbac066] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Indexed: 03/01/2024]
Abstract
Breast density continues to be a prevailing topic in the field of breast imaging, with continued complexities contributing to overall confusion and controversy among patients and the medical community. In this article, we explore the current status of breast cancer screening in women with dense breasts including breast density legislation. Risk-based approaches to supplemental screening may be more financially cost-effective. While all advanced imaging modalities detect additional primarily invasive, node-negative cancers, the degree to which this occurs can vary by density category. Future directions include expanding the use of density-inclusive risk models with appropriate risk stratification and imaging utilization. Further research is needed, however, to better understand how to optimize population-based screening programs with knowledge of patients' individualized risk, including breast density assessment, to improve the benefit-to-harm ratio of breast cancer screening.
Collapse
Affiliation(s)
| | - Shinn-Huey Chou
- Massachusetts General Hospital, Department of Radiology, Boston, MA, USA
| | - Charmi Vijapura
- University of Cincinnati Medical Center, Department of Radiology, Cincinnati, OH, USA
| | - Amy Patel
- Liberty Hospital, Department of Radiology, Kansas City, MO, USA
- Alliance Radiology, Kansas City, MO, USA
- University of Missouri-Kansas City School of Medicine, Department of Radiology, Kansas City, MO, USA
| |
Collapse
|
2
|
Wilding R, Sheraton VM, Soto L, Chotai N, Tan EY. Deep learning applied to breast imaging classification and segmentation with human expert intervention. J Ultrasound 2022; 25:659-666. [PMID: 35000127 PMCID: PMC9402837 DOI: 10.1007/s40477-021-00642-3] [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: 10/17/2021] [Accepted: 11/22/2021] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Automatic classification and segmentation of tumors in breast ultrasound images enables better diagnosis and planning treatment strategies for breast cancer patients. METHODS We collected 953 breast ultrasound images from two open-source datasets and classified them with help of an expert radiologist according to BI-RADS criteria. The data was split into normal, benign and malignant classes. We then used machine learning to develop classification and segmentation algorithms. RESULTS We found 3.92% of the images across the open-source datasets had erroneous classifications. Post-radiologist intervention, three algorithms were developed based on the classification categories. Classification algorithms distinguished images with healthy breast tissue from those with abnormal tissue with 96% accuracy, and distinguished benign from malignant images with 85% accuracy. Both algorithms generated robust F1 and AUROC metrics. Finally, the masses within images were segmented with an 80.31% DICE score. CONCLUSIONS Our work illustrates the potential of deep learning algorithms to improve the accuracy of breast ultrasound assessments and to facilitate automated assessments.
Collapse
Affiliation(s)
| | | | - Lysabella Soto
- Research Department, RESOMED, Maracaibo, Venezuela
- Postgraduate Division Studies of Radiology, Medicine School of Zulia's University, Maracaibo, Venezuela
| | - Niketa Chotai
- Department of Radiology, RadLink Diagnostic Imaging Center, Singapore, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
| |
Collapse
|
3
|
Nduka IJ, Ejie IL, Okafor CE, Eleje GU, Ekwunife OI. Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a protocol for a systematic review. BMJ Open 2022; 12:e056901. [PMID: 35354628 PMCID: PMC8968630 DOI: 10.1136/bmjopen-2021-056901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women in low and middle-income countries (LMICs), including sub-Saharan Africa. Mammography screening is the most effective screening method for the early detection of breast cancers in asymptomatic individuals and the only screening test that decreases the risk of breast cancer mortality. Despite the perceived benefits, it has a low utilisation rate in comparison with breast self-examination and clinical breast examination. Several interventions to increase the uptake of mammography have been assessed as well as systematic reviews on mammography uptake. Nonetheless, none of the published systematic reviews focused on women living in LMICs. The review aims to identify interventions that increase mammography screening uptake among women living in LMICs. METHODS AND ANALYSIS Relevant electronic databases will be systematically searched from 1 January 1990 to 30 June 2021 for published and grey literature, including citation and reference list tracking, on studies focusing on interventions to increase mammography screening uptake carried out in LMICs and written in the English language. The search will incorporate the key terms: mammography, interventions, low- and middle-income countries and their associated synonyms. Randomised controlled trials, observational studies and qualitative and mixed methods studies of interventions (carried out with and without comparison groups) reporting interventions to increase mammography screening uptake in LMICs will be identified, data extracted and assessed for methodological quality by two independent reviewers with disagreements to be resolved by consensus or by a third author. We will use narrative synthesis and/or meta-analysis depending on the characteristics of the data. ETHICS AND DISSEMINATION Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021269556.
Collapse
Affiliation(s)
- Ifeoma Jovita Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Charles Ebuka Okafor
- Centre for Applied Health Economics, Griffith University School of Medicine, Brisbane, Queensland, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Obinna Ikechukwu Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| |
Collapse
|
4
|
Broeders M, Elfström KM. Importance of International Networking and Comparative Research in Screening to Meet the Global Challenge of Cancer Control. JCO Glob Oncol 2021; 6:180-181. [PMID: 32031454 PMCID: PMC6998027 DOI: 10.1200/jgo.19.00388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mireille Broeders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands.,Dutch Expert Centre for Screening, Nijmegen, the Netherlands
| | - K Miriam Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden.,Regional Cancer Center of Stockholm-Gotland, Stockholm, Sweden
| |
Collapse
|
5
|
Vogel AL, Puricelli Perin DM, Lu YL, Taplin SH. Understanding the Value of International Research Networks: An Evaluation of the International Cancer Screening Network of the US National Cancer Institute. J Glob Oncol 2019; 5:1-12. [PMID: 31600086 PMCID: PMC6825249 DOI: 10.1200/jgo.19.00197] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2019] [Indexed: 11/29/2022] Open
Abstract
PURPOSE International research networks have the potential to accelerate scientific progress via knowledge sharing and collaboration. In 2018, the US National Cancer Institute evaluated the International Cancer Screening Network (ICSN), in operation since 1988. METHODS ICSN hosts a biennial scientific meeting and scientific working groups. A survey was fielded to 665 ICSN participants, and a bibliometric analysis was conducted for ICSN publications. RESULTS A total of 243 individuals completed the survey (36.5%). They reported that participating in the ICSN helped advance their knowledge of cancer screening research (75.7%), policy development (56%), and implementation (47.7%). Approximately three-quarters agreed that ICSN facilitated knowledge sharing and networking among researchers and implementers (79.9%) and those working on different continents (74.0%) and cancer sites (73.7%). More than half reported that participating helped them form new collaborations in screening implementation (58.0%) or research (57.6%). Most agreed that ICSN helped to advance screening research and evaluation (75.4%), effective screening practices (71.2%), and screening policies (60.9%). Many reported that participating informed advances in their own research (68.7%) and screening implementation (50.2%) and policies (49.4%) in their settings. Approximately two-thirds agreed that ICSN helped advance career development among current experts (66.6%) and train the next generation (62.2%). Half (51.4%) reported that participating advanced their own careers. The 20 ICSN publications included 75 coauthors. They were cited in 589 publications with more than 2,000 coauthors. CONCLUSION Findings provide evidence of the influence of ICSN on international knowledge dissemination, collaboration, and advances in cancer screening research, implementation, and policies and highlight the potential value of longstanding international research networks.
Collapse
Affiliation(s)
- Amanda L. Vogel
- Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, MD
| | - Douglas M. Puricelli Perin
- Frederick National Laboratory for Cancer Research Sponsored by the National Cancer Institute, Frederick, MD
| | - Ya-Ling Lu
- National Institutes of Health Library, National Institutes of Health, Bethesda, MD
| | - Stephen H. Taplin
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| |
Collapse
|
6
|
Clendenen TV, Ge W, Koenig KL, Afanasyeva Y, Agnoli C, Brinton LA, Darvishian F, Dorgan JF, Eliassen AH, Falk RT, Hallmans G, Hankinson SE, Hoffman-Bolton J, Key TJ, Krogh V, Nichols HB, Sandler DP, Schoemaker MJ, Sluss PM, Sund M, Swerdlow AJ, Visvanathan K, Zeleniuch-Jacquotte A, Liu M. Breast cancer risk prediction in women aged 35-50 years: impact of including sex hormone concentrations in the Gail model. Breast Cancer Res 2019; 21:42. [PMID: 30890167 PMCID: PMC6425605 DOI: 10.1186/s13058-019-1126-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 03/05/2019] [Indexed: 12/28/2022] Open
Abstract
Background Models that accurately predict risk of breast cancer are needed to help younger women make decisions about when to begin screening. Premenopausal concentrations of circulating anti-Müllerian hormone (AMH), a biomarker of ovarian reserve, and testosterone have been positively associated with breast cancer risk in prospective studies. We assessed whether adding AMH and/or testosterone to the Gail model improves its prediction performance for women aged 35–50. Methods In a nested case-control study including ten prospective cohorts (1762 invasive cases/1890 matched controls) with pre-diagnostic serum/plasma samples, we estimated relative risks (RR) for the biomarkers and Gail risk factors using conditional logistic regression and random-effects meta-analysis. Absolute risk models were developed using these RR estimates, attributable risk fractions calculated using the distributions of the risk factors in the cases from the consortium, and population-based incidence and mortality rates. The area under the receiver operating characteristic curve (AUC) was used to compare the discriminatory accuracy of the models with and without biomarkers. Results The AUC for invasive breast cancer including only the Gail risk factor variables was 55.3 (95% CI 53.4, 57.1). The AUC increased moderately with the addition of AMH (AUC 57.6, 95% CI 55.7, 59.5), testosterone (AUC 56.2, 95% CI 54.4, 58.1), or both (AUC 58.1, 95% CI 56.2, 59.9). The largest AUC improvement (4.0) was among women without a family history of breast cancer. Conclusions AMH and testosterone moderately increase the discriminatory accuracy of the Gail model among women aged 35–50. We observed the largest AUC increase for women without a family history of breast cancer, the group that would benefit most from improved risk prediction because early screening is already recommended for women with a family history. Electronic supplementary material The online version of this article (10.1186/s13058-019-1126-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Tess V Clendenen
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA
| | - Wenzhen Ge
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA
| | - Karen L Koenig
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA
| | - Yelena Afanasyeva
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA
| | - Claudia Agnoli
- Epidemiology and Prevention Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Louise A Brinton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Farbod Darvishian
- Department of Pathology, New York University School of Medicine, New York, NY, USA.,Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Joanne F Dorgan
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Roni T Falk
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Göran Hallmans
- Department of Biobank Research, Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Susan E Hankinson
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, and Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Biostatistics and Epidemiology, School of Public Health and Health Sciences, University of Massachusetts, Amherst, MA, USA
| | - Judith Hoffman-Bolton
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy J Key
- Cancer Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Vittorio Krogh
- Epidemiology and Prevention Unit, Fondazione IRCCS - Istituto Nazionale dei Tumori, Milan, Italy
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, NC, USA
| | - Minouk J Schoemaker
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK.,Division of Breast Cancer Research, The Institute of Cancer Research, London, UK
| | - Patrick M Sluss
- Department of Pathology, Harvard Medical School, Boston, MA, USA
| | - Malin Sund
- Department of Surgery, Umeå University Hospital, Umeå, Sweden
| | - Anthony J Swerdlow
- Division of Genetics and Epidemiology, The Institute of Cancer Research, London, UK
| | - Kala Visvanathan
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Sidney Kimmel Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Anne Zeleniuch-Jacquotte
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA.,Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Mengling Liu
- Department of Population Health, New York University School of Medicine, 650 First Avenue, New York, NY, 10016, USA. .,Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA.
| |
Collapse
|
7
|
Fleury EFC, Gianini AC, Marcomini K, Oliveira V. The Feasibility of Classifying Breast Masses Using a Computer-Assisted Diagnosis (CAD) System Based on Ultrasound Elastography and BI-RADS Lexicon. Technol Cancer Res Treat 2018; 17:1533033818763461. [PMID: 29551088 PMCID: PMC5882047 DOI: 10.1177/1533033818763461] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/26/2017] [Accepted: 02/05/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To determine the applicability of a computer-aided diagnostic system strain elastography system for the classification of breast masses diagnosed by ultrasound and scored using the criteria proposed by the breast imaging and reporting data system ultrasound lexicon and to determine the diagnostic accuracy and interobserver variability. METHODS This prospective study was conducted between March 1, 2016, and May 30, 2016. A total of 83 breast masses subjected to percutaneous biopsy were included. Ultrasound elastography images before biopsy were interpreted by 3 radiologists with and without the aid of computer-aided diagnostic system for strain elastography. The parameters evaluated by each radiologist results were sensitivity, specificity, and diagnostic accuracy, with and without computer-aided diagnostic system for strain elastography. Interobserver variability was assessed using a weighted κ test and an intraclass correlation coefficient. The areas under the receiver operating characteristic curves were also calculated. RESULTS The areas under the receiver operating characteristic curve were 0.835, 0.801, and 0.765 for readers 1, 2, and 3, respectively, without computer-aided diagnostic system for strain elastography, and 0.900, 0.926, and 0.868, respectively, with computer-aided diagnostic system for strain elastography. The intraclass correlation coefficient between the 3 readers was 0.6713 without computer-aided diagnostic system for strain elastography and 0.811 with computer-aided diagnostic system for strain elastography. CONCLUSION The proposed computer-aided diagnostic system for strain elastography system has the potential to improve the diagnostic performance of radiologists in breast examination using ultrasound associated with elastography.
Collapse
Affiliation(s)
| | | | | | - Vilmar Oliveira
- School of Medical Sciences of Santa Casa de São Paulo, São Paulo, Brazil
| |
Collapse
|
8
|
Schiller-Frühwirth IC, Jahn B, Arvandi M, Siebert U. Cost-Effectiveness Models in Breast Cancer Screening in the General Population: A Systematic Review. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2017; 15:333-351. [PMID: 28185134 DOI: 10.1007/s40258-017-0312-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Many Western countries have long-established population-based mammography screening programs. Prior to implementing these programs, decision-analytic modeling was widely used to inform decisions. OBJECTIVE The aim of this study was to perform a systematic review of cost-effectiveness models in breast cancer screening in the general population to analyze their structural and methodological approaches. METHODS A systematic literature search for health economic models was performed in the electronic databases MEDLINE (Ovid), EMBASE, CRD Databases, Cochrane Library, and EconLit in August 2011 with updates in June 2013, April 2015, and November 2016. To assess studies systematically, a standardized form was applied to extract relevant information that was then summarized in evidence tables. RESULTS Thirty-five studies were included; 27 state-transition models were analyzed using cohort (n = 12) and individual-level simulation (n = 15). Twenty-one studies modeled the natural history of breast cancer and predicted mortality as a function of the early detection modality. The models employed different assumptions regarding ductal carcinoma in situ. Thirteen studies performed cost-utility analyses with different sources for utility values, but assumptions were often made about utility weights. Twenty-two models did not report any validation. CONCLUSION State-transition modeling was the most frequently applied analytic approach. Different methods in modeling the progression of ductal carcinoma in situ to invasive cancer were identified because there is currently no agreement on the biological behavior of noninvasive breast cancer. Main weaknesses were the lack of precise utility estimates and insufficient reporting of validation. Sensitivity analyses of assumptions regarding ductal carcinoma in situ and in particular adequate validation are critical to minimize the risk of biased model outcomes.
Collapse
Affiliation(s)
- Irmgard C Schiller-Frühwirth
- Department of Evidence-Based Economic Health Care, Main Association of Austrian Social Security Institutions, Kundmanngasse 21, 1030, Vienna, Austria.
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.
| | - Beate Jahn
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Marjan Arvandi
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology Assessment, University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL-Center for Personalized Cancer Medicine, Innsbruck, Austria
- Department of Radiology, Institute for Technology Assessment, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Health Policy and Management, Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
9
|
Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey. Prev Med 2016; 91:250-263. [PMID: 27527575 DOI: 10.1016/j.ypmed.2016.08.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population-based breast cancer screening programmes based on mammography every other year for women aged 50 to 69years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population-based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population-based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged.
Collapse
|
10
|
Performance indicators evaluation of the population-based breast cancer screening programme in Northern Portugal using the European Guidelines. Cancer Epidemiol 2015; 39:783-9. [PMID: 26315486 DOI: 10.1016/j.canep.2015.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/08/2015] [Accepted: 08/12/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the first 10 years of operation of the population-based breast cancer screening programme implemented in the Northern Region of Portugal, using selected recommended standard performance indicators. METHODS Data from women aged 50-69 screened with two-view mammography, biennially, in the period 2000-2009, were included. Main performance indicators were compared with the recommended levels of the European Guidelines. RESULTS A total of 202,039 screening examinations were performed, 71,731 (35.5%) in the initial screening and 130,308 (64.5%) in the subsequent screening. Coverage rate by examination reached 74.3% of the target population, in the last period evaluated. Recall rates were 8.1% and 2.4% and cancer detection rates were 4.4/1000 and 2.9/1000 respectively, for initial and subsequent screenings. The breast cancer detection rate, expressed as a multiple of the background expected incidence was 3.1 in initial screen and 2.2 in subsequent screen. The incidence of invasive interval cancers met the desirable recommended levels both the first and second years since last screening examination, in the initial and subsequent screenings. Invasive tumours <15mm were 50.4% and 53.8% of the invasive cancers detected in initial and subsequent screenings. Less favourable size, grading and biomarkers expression were found in interval cancers compared to screen-detected cancers. CONCLUSIONS Breast cancer screening programme in the Northern Region of Portugal was well accepted by the population. Most of the performance indicators were consistent with the desirable levels of the European Guidelines, which indicate an effective screening programme. Future research should verify the consistency of some of these results by using updated information from a larger population.
Collapse
|
11
|
Onega T, Beaber EF, Sprague BL, Barlow WE, Haas JS, Tosteson ANA, D Schnall M, Armstrong K, Schapira MM, Geller B, Weaver DL, Conant EF. Breast cancer screening in an era of personalized regimens: a conceptual model and National Cancer Institute initiative for risk-based and preference-based approaches at a population level. Cancer 2014; 120:2955-64. [PMID: 24830599 DOI: 10.1002/cncr.28771] [Citation(s) in RCA: 102] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/24/2014] [Accepted: 04/03/2014] [Indexed: 12/11/2022]
Abstract
Breast cancer screening holds a prominent place in public health, health care delivery, policy, and women's health care decisions. Several factors are driving shifts in how population-based breast cancer screening is approached, including advanced imaging technologies, health system performance measures, health care reform, concern for "overdiagnosis," and improved understanding of risk. Maximizing benefits while minimizing the harms of screening requires moving from a "1-size-fits-all" guideline paradigm to more personalized strategies. A refined conceptual model for breast cancer screening is needed to align women's risks and preferences with screening regimens. A conceptual model of personalized breast cancer screening is presented herein that emphasizes key domains and transitions throughout the screening process, as well as multilevel perspectives. The key domains of screening awareness, detection, diagnosis, and treatment and survivorship are conceptualized to function at the level of the patient, provider, facility, health care system, and population/policy arena. Personalized breast cancer screening can be assessed across these domains with both process and outcome measures. Identifying, evaluating, and monitoring process measures in screening is a focus of a National Cancer Institute initiative entitled PROSPR (Population-based Research Optimizing Screening through Personalized Regimens), which will provide generalizable evidence for a risk-based model of breast cancer screening, The model presented builds on prior breast cancer screening models and may serve to identify new measures to optimize benefits-to-harms tradeoffs in population-based screening, which is a timely goal in the era of health care reform.
Collapse
Affiliation(s)
- Tracy Onega
- Department of Community & Family Medicine and The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Lebanon, New Hampshire
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
12
|
Buranaruangrote S, Sindhu S, Mayer DK, Ratinthorn A, Khuhaprema T. Factors influencing the stages of breast cancer at the time of diagnosis in Thai women. Collegian 2014; 21:11-20. [PMID: 24772986 DOI: 10.1016/j.colegn.2012.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Early diagnosis of breast cancer leads to early treatment therefore improving women's health. However, most Thai women are diagnosed at a late stage. OBJECTIVE This cross-sectional correlational study was designed to explore factors influencing the diagnosis of early stage breast cancer in Thai women. METHOD Thai women (n = 400) newly diagnosed breast cancer at all clinical stages from public hospitals in Bangkok Metropolitan completed a questionnaire about knowledge of breast cancer and screening. The questionnaire addressed pre-diagnosis data about: (1) health care provider's recommendations to undertake breast screening, (2) health coverage for mammography (MM) costs and (3) regularity of breast screening behaviors in terms of breast self-examination (BSE), clinical breast examination (CBE) and MM including stage breast cancer at diagnosis. Data analysis was determined by PASW Statistics version 18 as univariate and multivariate logistic regression. RESULTS Health coverage for MM costs and all three behaviors were significantly related to and could predict the early stages breast cancer at diagnosis (p < 0.05): health coverage for MM costs (OR = 0.32, 95% confidence interval [CI], 0.17-0.63), BSE (OR = 8.08, CI 95%, 3.93-16.63), CBE (OR = 12.54, CI 95%, 2.29-68.65) and MM (OR = 5.89, CL 95%, 1.13-30.73). CONCLUSIONS All three behaviors are essential and related to one another. CBE on a regular basis is the best predictor for early stages breast cancer at diagnosis in Thai context. Nurses should provide information and teach including re-check the woman's skills to perform BSE regularly.
Collapse
|
13
|
Giordano L, Von Karsa L, Tomatis M, Majek O, De Wolf C, Lancucki L, Hofvind S, Nystrom L, Segnan N, Ponti A. Mammographic Screening Programmes in Europe: Organization, Coverage and Participation. J Med Screen 2012; 19 Suppl 1:72-82. [PMID: 22972813 DOI: 10.1258/jms.2012.012085] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Livia Giordano
- Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | - Lawrence Von Karsa
- European Cancer Network (ECN) for Screening and Prevention, Quality Assurance Group, Section of Early Detection and Prevention, International, Agency for Research on Cancer, Lyon, France
| | - Mariano Tomatis
- Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | - Ondrej Majek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Chris De Wolf
- Swiss Federation of Breast Cancer Screening, Bern, Switzerland
| | | | - Solveig Hofvind
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Lennarth Nystrom
- Department of Public Health and Clinical Medicine, Umeá University, Umeá, Sweden
| | - Nereo Segnan
- Cancer Epidemiology Unit, Department of Cancer Screening, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | - Antonio Ponti
- Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| |
Collapse
|
14
|
Timmers JM, den Heeten GJ, Adang EM, Otten JD, Verbeek AL, Broeders MJ. Dutch digital breast cancer screening: implications for breast cancer care. Eur J Public Health 2011; 22:925-9. [DOI: 10.1093/eurpub/ckr170] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
15
|
Simou E, Tsimitselis D, Tsopanlioti M, Anastasakis I, Papatheodorou D, Kourlaba G, Gerasimos P, Maniadakis N. Early evaluation of an organised mammography screening program in Greece 2004-2009. Cancer Epidemiol 2011; 35:375-80. [PMID: 21474412 DOI: 10.1016/j.canep.2011.02.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2010] [Revised: 02/16/2011] [Accepted: 02/17/2011] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The aim of the current study was to present early performance indicators of a breast cancer screening program in Greece. METHODS Between March 2004 and July 2009, 9621 women aged between 40 and 69 years were recruited into programme on a voluntary basis. The participating women were residents of two adjacent administrative regions of Greece. Several performance indicators were calculated for the first and subsequent screen, separately. RESULTS A total of 9621 mammograms were 1st screens and 4462 were subsequent screens. The attendance rate was almost 1.5%. The technical repeat rate was 1.7%. On the 1st screen, the recall rate was 11.4%, while the recall rate of the subsequent screens was 5.5%. The vast majority of detected cancers were invasive and only the 1/7 of cancers was identified as DCIS. As concerns tumour size of invasive cancers, the 1.9% and 16.7% was unknown, in the first and subsequent screen, respectively. Moreover, 38.5% and 44.4% of cancers detected in the 1st and subsequent screen, respectively, were less than 15 mm in diameter. Almost 1/5 of diagnosed cancers were interval cancers. CONCLUSIONS This breast cancer screening programme is the first one in Greece and the attendance rate is extremely low. Taking into account that an organised screening programme may benefit women with a reduction in breast cancer mortality, there is an urgent need to develop a national-based screening programme, to increase participation and to improve the information system used to monitor programme performance.
Collapse
Affiliation(s)
- Effie Simou
- Centre for the Prevention of Breast Cancer, General Oncology Hospital Agioi Anargyroi, 17, Laodikeias Ave, 11528 Ilisia, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
PURPOSE OF REVIEW To describe the rationale behind the new recommendations for breast cancer screening issued by the U.S. Preventive Services Task Force (USPSTF). RECENT FINDINGS The USPSTF reviewed new summary evidence provided by the Oregon Evidence-based Practice Center and the Cancer Intervention Surveillance and Modeling Network about benefits and harms including radiation exposure and the likelihood of false-positive testing, unnecessary biopsies and treatments that may not impact overall breast cancer mortality. SUMMARY The USPSTF concluded maximal benefit in breast cancer mortality with least harms can be achieved with biennial mammography screening commenced at age 50 and continuing until age 74 years. A small additional benefit could be realized if screening starts at age 40 years. The USPSTF concluded that the decision to start biennial screening before age 50 years should be a personal one and take into account individual patient context, including an individual's values regarding specific benefits and harms. Evidence from large-scale randomized trials led the USPSTF to recommend against the teaching of breast self-examination. The USPSTF found insufficient evidence to recommend for or against performing clinical breast examination.
Collapse
|
17
|
Goelen G, De Clercq G, Hanssens S. A community peer-volunteer telephone reminder call to increase breast cancer-screening attendance. Oncol Nurs Forum 2010; 37:E312-7. [PMID: 20591795 DOI: 10.1188/10.onf.e312-e317] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To assess the effect of a tailored telephone reminder call by community peer volunteers on mammography rates in women who do not attend a breast cancer-screening program. DESIGN Individual-level randomized trial. SETTING Four semirural communities in Belgium. SAMPLE Women aged 50-69 years who had not had a mammogram. METHODS Women in the usual care (control) arm received an invitation letter for screening mammography and an information leaflet; women in the intervention arm received usual care as well as a telephone reminder call. The call was tailored on four variables: individual mammography history, mailing of the invitation letter, mammography appointment date, and type of mammography facility in the area (e.g., mobile unit versus fixed site). Community peer volunteers made up to three attempts to call the women in the intervention arm. MAIN RESEARCH VARIABLES Mammography rates verified by screening registration review and adverse events identified in contacts with peer volunteers, radiologists, and community workers of local authorities. FINDINGS A total of 3,880 women were included in the study and individually randomized into control and intervention groups. Phone numbers were identified for 79% of the women in the intervention group, and 69% were contacted. Twenty-two percent had screening mammography, which was 4% higher than controls (relative risk = 1.22). No adverse effects were identified. An additional mammogram came at an average cost of 17 phone conversations and two hours of volunteer work. CONCLUSIONS The tested telephone reminder call is suitable for Belgian women. IMPLICATIONS FOR NURSING The telephone reminder call may be implemented in settings similar to the studied context.
Collapse
Affiliation(s)
- Guido Goelen
- Department of Nursing and Midwifery, Vrije Universiteit Brussel, Brussels, Belgium.
| | | | | |
Collapse
|
18
|
Dowling EC, Klabunde C, Patnick J, Ballard-Barbash R. Breast and cervical cancer screening programme implementation in 16 countries. J Med Screen 2010; 17:139-46. [PMID: 20956724 DOI: 10.1258/jms.2010.010033] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Objective There is a continuing need to monitor and evaluate the impact of organized screening programmes on cancer incidence and mortality. We report results from a programme assessment conducted within the International Cancer Screening Network (ICSN) to understand the characteristics of cervical screening programmes within countries that have established population-based breast cancer screening programmes. Methods In 2007-2008, we asked 26 ICSN country representatives to complete a web-based survey that included questions on breast and cervical cancer screening programmes. We summarized information from 16 countries with both types of organized programmes. Results In 63% of these countries, the organization of the cervical cancer screening programme was similar to that of the breast cancer screening programme in the same country. There were differences in programme characteristics, including year established (1962-2003 cervical; 1986-2002 breast) and ages covered (15-70+ cervical; 40-75+ breast). Adoption of new screening technologies was evident (44% liquid-based Pap tests; 13% human papillomavirus (HPV)-triage tests cervical; 56% digital mammography breast). There was wide variation in participation rates for both programme types (<4-80% cervical; 12-88% breast), and participation rates tended to be higher for cervical (70-80%) than for breast (60-70%) cancer screening programmes. Eleven ICSN member countries had approved the HPV vaccine and five more were considering its use in their organized programmes. Conclusion Overall, there were similarities and differences in the organization of breast and cervical cancer screening programmes among ICSN countries. This assessment can assist established and new screening programmes in understanding the organization and structure of cancer screening programmes.
Collapse
Affiliation(s)
- Emily C Dowling
- Public Health Adviser, Applied Research Program, Division of
Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Carrie Klabunde
- Epidemiologist, Applied Research Program, Division of Cancer
Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | - Julietta Patnick
- Director, National Health Service Cancer Screening Programmes,
Fulwood House, Sheffield, UK
| | - Rachel Ballard-Barbash
- Associate Director, Applied Research Program, Division of
Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
| | | |
Collapse
|
19
|
Berlin L, Hall FM. More Mammography Muddle: Emotions, Politics, Science, Costs, and Polarization. Radiology 2010; 255:311-316. [DOI: 10.1148/radiol.10100056] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
20
|
Cox B, Ballard-Barbash R, Broeders M, Dowling E, Malila N, Shumak R, Taplin S, Buist D, Miglioretti D. Recording of hormone therapy and breast density in breast screening programs: summary and recommendations of the International Cancer Screening Network. Breast Cancer Res Treat 2010; 124:793-800. [PMID: 20414718 DOI: 10.1007/s10549-010-0893-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Accepted: 04/07/2010] [Indexed: 11/30/2022]
Abstract
Breast density and the use of hormone therapy (HT) for menopausal symptoms alter the risk of breast cancer and both factors influence screening mammography performance. The International Cancer Screening Network (ICSN) surveyed its 29 member countries and found that few programs record breast density or the use of HT among screening participants. This may affect the ability of programs to assess their effectiveness in reducing breast cancer mortality. Seven countries recorded the use of HT at screening, and some were able to link screening records to individual prescribing records of HT. Eight countries reported recording breast density at screening mammography for some or all women screened. The recommendations of the ICSN for recording information about breast density and HT are presented.
Collapse
Affiliation(s)
- Brian Cox
- Hugh Adam Cancer Epidemiology Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
| | | | | | | | | | | | | | | | | | | |
Collapse
|