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Sha R, Kong XM, Li XY, Wang YB. Global burden of breast cancer and attributable risk factors in 204 countries and territories, from 1990 to 2021: results from the Global Burden of Disease Study 2021. Biomark Res 2024; 12:87. [PMID: 39183342 PMCID: PMC11346191 DOI: 10.1186/s40364-024-00631-8] [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: 07/26/2024] [Accepted: 07/31/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND AND OBJECTIVE Breast cancer is a leading cause of morbidity and mortality among women worldwide. This study aimed to assess the global burden of breast cancer and identify attributable risk factors across 204 countries and territories from 1990 to 2021. METHODS Using data from the Global Burden of Disease Study 2021, we analyzed the incidence, mortality, disability-adjusted life years (DALYs), and risk factors associated with breast cancer. We obtained and analyzed the age-standardized incidence rate (ASIR), age-standardized death rate (ASDR), and age-standardized DALYs rate from 1990 to 2021. We assessed geographical variations and the impact of the Socio-demographic Index (SDI) using regression analysis and stratification by SDI quintiles. Additionally, we estimated the risk factors attributable to breast cancer deaths and DALYs using the comparative risk assessment framework of the GBD study. RESULTS Globally, breast cancer incident cases increased from 875,657 in 1990 to 2,121,564 in 2021. The ASIR rose from 16.42 to 26.88 per 100,000 (95% CI: 1.54-1.60). High SDI regions showed the highest ASIR (66.89 per 100,000 in 2021), while Low SDI regions had the lowest (6.99 per 100,000 in 2021). The global ASDR decreased from 10.42 to 8.54 per 100,000, and the age-standardized DALYs rate decreased from 313.36 to 261.5 per 100,000 between 1990 and 2021. However, these improvements were not uniform across SDI regions. Risk factors included high body-mass index, alcohol use, tobacco, and high fasting plasma glucose, with variations across SDI regions. CONCLUSION The global burden of breast cancer has increased significantly from 1990 to 2021, with disparities observed across SDI regions. While high SDI areas show improvements in mortality and DALYs, lower SDI regions face increasing burdens. Targeted interventions addressing modifiable risk factors and improving healthcare access in less developed regions are crucial for reducing the global impact of breast cancer.
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Affiliation(s)
- Rui Sha
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Zheshan West Rd No. 2, Wuhu , Anhui Province, 241001, China
| | - Xiang-Meng Kong
- Department of Cardiology, Shanghai Ninth People,s Hospital, Shanghai Jiao Tong University School of Medicine, No.639 Zhizaoju Road, Shanghai, Huangpu District, 200011, China
| | - Xin-Yu Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Ya-Bing Wang
- Department of Thyroid and Breast Surgery, The First Affiliated Hospital of Wannan Medical College (Yijishan Hospital of Wannan Medical College), Zheshan West Rd No. 2, Wuhu , Anhui Province, 241001, China.
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Li M, Ni P, Zuo T, Liu Y, Zhu B. Cancer literacy differences of basic knowledge, prevention, early detection, treatment and recovery: a cross-sectional study of urban and rural residents in Northeast China. Front Public Health 2024; 12:1367947. [PMID: 38807994 PMCID: PMC11130368 DOI: 10.3389/fpubh.2024.1367947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/01/2024] [Indexed: 05/30/2024] Open
Abstract
Background Cancer literacy as a potential health intervention tool directly impacted the success of cancer prevention and treatment initiatives. This study aimed to evaluate the cancer literacy in Northeast China, and explore the factors contributing to urban-rural disparities. Methods A cross-sectional survey was conducted in 14 cities across Liaoning Province, China, from August to October 2021, using the multistage probability proportional to size sampling (PPS) method. The survey comprised 4,325 participants aged 15-69 and encompassed 37 core knowledge-based questions spanning five dimensions. Associations between sociodemographic factors and the cancer literacy rate were evaluated using chi-square tests and multivariate logistic regression model. Results The overall cancer literacy rate was 66.9% (95% CI: 65.6-68.2%). In the primary indicators, cancer literacy were highest in treatment (75.8, 95% CI: 74.2-77.4%) and early detection (68.2, 95% CI: 66.8-69.6%), followed by basic knowledge (67.2, 95% CI: 65.8-68.6%), recovery (62.6, 95% CI: 60.7-64.5%) and prevention (59.7, 95% CI: 58.2-61.3%). Regarding secondary indicators, the awareness rates regarding cancer-related risk factors (54.7, 95% CI: 52.8-56.5%) and early diagnosis of cancer (54.6, 95% CI: 52.7-56.6%) were notably inadequate. Rural participates exhibited lower cancer literacy across all dimensions compared to urban. Multi-factor analysis showed that factors such as advanced age, limited education or low household income were barriers to health literacy in rural areas. Conclusion Strengthening awareness concerning prevention and early detection, particularly among key populations, and bridging the urban-rural cancer literacy gap are imperative steps toward achieving the Healthy China 2030 target.
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Affiliation(s)
- Mengdan Li
- Liaoning Office for Cancer Prevention and Control, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Ping Ni
- Liaoning Office for Cancer Prevention and Control, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Tingting Zuo
- Liaoning Office for Cancer Prevention and Control, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
| | - Yunyong Liu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital & Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Bo Zhu
- Liaoning Office for Cancer Prevention and Control, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, Shenyang, China
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Shi Y, Ma Z, Yao S, Lu N, Wu Y, Cheng F. Effects of interventions on the screening behavior in female first-degree relatives of breast cancer patients: A systematic review. Public Health Nurs 2024; 41:22-36. [PMID: 37712430 DOI: 10.1111/phn.13252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 08/29/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Women are more likely to develop breast cancer if their first-degree relatives (FDRs) have the disease, but they are often unaware of their individual risk and conduct screening behaviors. OBJECTIVE This study aimed to evaluate the effectiveness of interventions in increasing breast self-examination, clinical breast examination, and mammography rates in FDRs of breast cancer patients. METHODS We selected randomized clinical trials and quasi-experimental studies in eight databases. Interventions in each study were categorized as "promising", or "non-promising" according to whether they led to a positive change in screening behaviors. Interventions were also coded using the Behavioral Change Techniques (BCTs) Taxonomy and a promise ratio calculated for each. BCTs with a promise ratio ≥2 was classified as "promising". RESULTS Thirteen studies with 21 different BCTs were included. The most frequent BCTs were "Prompts/cues", "Credible source", and "Instructions on how to perform the behavior". Seven BCTs had a promise ratio of ≥2 and the four most promising were "Information about health consequences" (promise ratio = 6), "Problem solving" (promise ratio = 4), "Demonstration of the behavior" (promise ratio = 4), and "Adding objects to the environment" (promise ratio = 4). CONCLUSIONS This review indicated an overall weak use of theory, and an insufficient description of several interventions to support the assessment of how specific BCTs were activated.
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Affiliation(s)
- Yanyan Shi
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Zhuyue Ma
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Shanshan Yao
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
| | - Ningning Lu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Yuqing Wu
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Fang Cheng
- School of Nursing, Nanjing Medical University, Nanjing, China
- Jiangsu Cancer Hospital, The Affiliated Cancer Hospital of Nanjing Medical University, Jiangsu Institute of Cancer Research, Nanjing, China
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Tang W, Zhang M, Xu C, Shao Y, Tang J, Gong S, Dong H, Sheng M. Diagnostic efficiency of multi-modal MRI based deep learning with Sobel operator in differentiating benign and malignant breast mass lesions-a retrospective study. PeerJ Comput Sci 2023; 9:e1460. [PMID: 37547396 PMCID: PMC10403185 DOI: 10.7717/peerj-cs.1460] [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: 12/08/2022] [Accepted: 06/06/2023] [Indexed: 08/08/2023]
Abstract
Purpose To compare the diagnostic efficiencies of deep learning single-modal and multi-modal for the classification of benign and malignant breast mass lesions. Methods We retrospectively collected data from 203 patients (207 lesions, 101 benign and 106 malignant) with breast tumors who underwent breast magnetic resonance imaging (MRI) before surgery or biopsy between January 2014 and October 2020. Mass segmentation was performed based on the three dimensions-region of interest (3D-ROI) minimum bounding cube at the edge of the lesion. We established single-modal models based on a convolutional neural network (CNN) including T2WI and non-fs T1WI, the dynamic contrast-enhanced (DCE-MRI) first phase was pre-contrast T1WI (d1), and Phases 2, 4, and 6 were post-contrast T1WI (d2, d4, d6); and Multi-modal fusion models with a Sobel operator (four_mods:T2WI, non-fs-T1WI, d1, d2). Training set (n = 145), validation set (n = 22), and test set (n = 40). Five-fold cross validation was performed. Accuracy, sensitivity, specificity, negative predictive value, positive predictive value, and area under the ROC curve (AUC) were used as evaluation indicators. Delong's test compared the diagnostic performance of the multi-modal and single-modal models. Results All models showed good performance, and the AUC values were all greater than 0.750. Among the single-modal models, T2WI, non-fs-T1WI, d1, and d2 had specificities of 77.1%, 77.2%, 80.2%, and 78.2%, respectively. d2 had the highest accuracy of 78.5% and showed the best diagnostic performance with an AUC of 0.827. The multi-modal model with the Sobel operator performed better than single-modal models, with an AUC of 0.887, sensitivity of 79.8%, specificity of 86.1%, and positive prediction value of 85.6%. Delong's test showed that the diagnostic performance of the multi-modal fusion models was higher than that of the six single-modal models (T2WI, non-fs-T1WI, d1, d2, d4, d6); the difference was statistically significant (p = 0.043, 0.017, 0.006, 0.017, 0.020, 0.004, all were greater than 0.05). Conclusions Multi-modal fusion deep learning models with a Sobel operator had excellent diagnostic value in the classification of breast masses, and further increase the efficiency of diagnosis.
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Affiliation(s)
- Weixia Tang
- Radiology Department, Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, NanTong, Jiangsu, China
| | - Ming Zhang
- Radiology Department, Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, NanTong, Jiangsu, China
| | - Changyan Xu
- School of Transportation and Civil Engineering, Nantong University, Nantong, China
| | - Yeqin Shao
- School of Transportation and Civil Engineering, Nantong University, Nantong, China
| | - Jiahuan Tang
- Radiology Department, Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, NanTong, Jiangsu, China
| | - Shenchu Gong
- Radiology Department, Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, NanTong, Jiangsu, China
| | - Hao Dong
- Department of Research Collaboration, R&D Center, Beijing Deepwise & League of PHD Technology Co., Ltd., Beijing, China
| | - Meihong Sheng
- Radiology Department, Affiliated Hospital 2 of Nantong University, Nantong First People’s Hospital, NanTong, Jiangsu, China
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Braitmaier M, Kollhorst B, Heinig M, Langner I, Czwikla J, Heinze F, Buschmann L, Minnerup H, García-Albéniz X, Hense HW, Karch A, Zeeb H, Haug U, Didelez V. Effectiveness of Mammography Screening on Breast Cancer Mortality – A Study Protocol for Emulation of Target Trials Using German Health Claims Data. Clin Epidemiol 2022; 14:1293-1303. [PMID: 36353307 PMCID: PMC9639456 DOI: 10.2147/clep.s376107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 10/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background The efficacy of mammography screening in reducing breast cancer mortality has been demonstrated in randomized trials. However, treatment options - and hence prognosis – for advanced tumor stages as well as mammography techniques have considerably improved since completion of these trials. Consequently, the effectiveness of mammography screening under current conditions is unclear and controversial. The German mammography screening program (MSP), an organized population-based screening program, was gradually introduced between 2005 and 2008 and achieved nation-wide coverage in 2009. Objective We describe in detail a study protocol for investigating the effectiveness of the German MSP in reducing breast cancer mortality in women aged 50 to 69 years based on health claims data. Specifically, the proposed study aims at estimating per-protocol effects of several screening strategies on cumulative breast cancer mortality. The first analysis will be conducted once 10-year follow-up data are available. Methods and Analysis We will use claims data from five statutory health insurance providers in Germany, covering approximately 37.6 million individuals. To estimate the effectiveness of the MSP, hypothetical target trials will be emulated across time, an approach that has been demonstrated to minimize design-related biases. Specifically, the primary contrast will be in terms of the cumulative breast cancer mortality comparing the screening strategies of “never screen” versus “regular screening as intended by the MSP”. Ethics and Dissemination In Germany, the utilization of data from health insurances for scientific research is regulated by the Code of Social Law. All involved health insurance providers as well as the responsible authorities approved the use of the health claims data for this study. The Ethics Committee of the University of Bremen determined that studies based on claims data are exempt from institutional review. The findings of the proposed study will be published in peer-reviewed journals.
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Affiliation(s)
- Malte Braitmaier
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Bianca Kollhorst
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
| | - Jonas Czwikla
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Franziska Heinze
- SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany
| | - Laura Buschmann
- Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany
| | - Heike Minnerup
- Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany
| | - Xabiér García-Albéniz
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, MA, USA
- RTI Health Solutions, Barcelona, Spain
| | - Hans-Werner Hense
- Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany
| | - André Karch
- Institute for Epidemiology and Social Medicine, Faculty of Medicine, Westfälische Wilhelms University of Münster, Münster, Germany
| | - Hajo Zeeb
- Department of Prevention and Evaluation, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Vanessa Didelez
- Department of Biometry and Data Management, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Bremen, Germany
- Faculty of Mathematics and Computer Science, University of Bremen, Bremen, Germany
- Correspondence: Vanessa Didelez, Leibniz Institute for Prevention Research and Epidemiology – BIPS, Department of Biometry and Data Management, Achterstraße 30, Bremen, 28359, Germany, Tel +49-421-56939, Fax +49-421-56941, Email
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Saha D, Balasubramanian A, Kannan A, Pant A, Singh J, Prabhu S, Sundaramurthi S. Breast Cancer Screening in Young Women with the Advent of Newer Techniques: Current Evidence and Future Considerations. Ann Surg Oncol 2022; 29:8092-8093. [PMID: 36209328 DOI: 10.1245/s10434-022-12550-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/22/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Debdeep Saha
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Akshay Balasubramanian
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Amudhan Kannan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Arjun Pant
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Jaiveer Singh
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Selva Prabhu
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sudharsanan Sundaramurthi
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India.
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Addanki S, Meas S, Sarli VN, Singh B, Lucci A. Applications of Circulating Tumor Cells and Circulating Tumor DNA in Precision Oncology for Breast Cancers. Int J Mol Sci 2022; 23:ijms23147843. [PMID: 35887191 PMCID: PMC9315812 DOI: 10.3390/ijms23147843] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/14/2022] [Accepted: 07/15/2022] [Indexed: 11/25/2022] Open
Abstract
Liquid biopsies allow for the detection of cancer biomarkers such as circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA). Elevated levels of these biomarkers during cancer treatment could potentially serve as indicators of cancer progression and shed light on the mechanisms of metastasis and therapy resistance. Thus, liquid biopsies serve as tools for cancer detection and monitoring through a simple, non-invasive blood draw, allowing multiple longitudinal sampling. These circulating markers have significant prospects for use in assessing patients’ prognosis, monitoring response to therapy, and developing precision medicine. In addition, single-cell omics of these liquid biopsy markers can be potential tools for identifying tumor heterogeneity and plasticity as well as novel therapeutic targets. In this review, we focus on our current understanding of circulating tumor biomarkers, especially in breast cancer, and the scope of novel sequencing technologies and diagnostic methods for better prognostication and patient stratification to improve patient outcomes.
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Affiliation(s)
- Sridevi Addanki
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.M.); (V.N.S.); (B.S.)
| | - Salyna Meas
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.M.); (V.N.S.); (B.S.)
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Vanessa Nicole Sarli
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.M.); (V.N.S.); (B.S.)
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Balraj Singh
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.M.); (V.N.S.); (B.S.)
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Anthony Lucci
- Morgan Welch Inflammatory Breast Cancer Research Program and Clinic, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; (S.M.); (V.N.S.); (B.S.)
- Department of Breast Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Correspondence:
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Minella C, Villasco A, D’Alonzo M, Cellini L, Accomasso F, Actis S, Biglia N. Surgery after Neoadjuvant Chemotherapy: A Clip-Based Technique to Improve Surgical Outcomes, a Single-Center Experience. Cancers (Basel) 2022; 14:2229. [PMID: 35565357 PMCID: PMC9103394 DOI: 10.3390/cancers14092229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study aims to describe the surgical management of breast cancer patients after neoadjuvant chemotherapy, with attention to the impact on surgical outcomes of a clip-based marking technique. METHODS Patients who underwent NACT at the Breast Unit of the A. O Ordine Mauriziano of Turin from January 2018 and had a surgical intervention by January 2022 were included. Data on the feasibility of clip insertion, after-treatment visibility, and successful removal during surgery were collected prospectively. Surgical outcomes in terms of breast-conserving surgery and axillary dissection reduction were described. RESULTS In 51 patients who had surgery after NACT, 55 clips were placed (34 breast and 21 axillary clips). Ultrasound visibility of the clips was optimal (91%) as well as preoperative localization and retrieval within the surgical specimen. Moreover, the use of the clip positively affected surgical outcomes. In our study, clip insertion allowed to avoid mastectomy and axillary dissection in patients with a complete radiological response. CONCLUSIONS In our findings, the use of breast and/or lymph node clips has proved to be a simple and effective method to improve surgical conservative management of breast cancer patients after NACT.
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Affiliation(s)
- Carola Minella
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Andrea Villasco
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Marta D’Alonzo
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Lisa Cellini
- Radiology Department, A.O. Ordine Mauriziano, 10128 Turin, Italy;
| | - Francesca Accomasso
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Silvia Actis
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
| | - Nicoletta Biglia
- Academic Division of Obstetrics and Gynaecology, A.O. Ordine Mauriziano, University of Turin, 10128 Turin, Italy; (C.M.); (A.V.); (M.D.); (F.A.); (S.A.)
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9
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Favati B, Borgheresi R, Giannelli M, Marini C, Vani V, Marfisi D, Linsalata S, Moretti M, Mazzotta D, Neri E. Radiomic Applications on Digital Breast Tomosynthesis of BI-RADS Category 4 Calcifications Sent for Vacuum-Assisted Breast Biopsy. Diagnostics (Basel) 2022; 12:771. [PMID: 35453819 PMCID: PMC9026298 DOI: 10.3390/diagnostics12040771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/17/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND A fair amount of microcalcifications sent for biopsy are false positives. The study investigates whether quantitative radiomic features extracted from digital breast tomosynthesis (DBT) can be an additional and useful tool to discriminate between benign and malignant BI-RADS category 4 microcalcification. METHODS This retrospective study included 252 female patients with BI-RADS category 4 microcalcifications. The patients were divided into two groups according to micro-histopathology: 126 patients with benign lesions and 126 patients with certain or possible malignancies. A total of 91 radiomic features were extracted for each patient, and the 12 most representative features were selected by using the agglomerative hierarchical clustering method. The binary classification task of the two groups was carried out by using four different machine-learning algorithms (i.e., linear support vector machine (SVM), radial basis function (RBF) SVM, logistic regression (LR), and random forest (RF)). Accuracy, sensitivity, sensibility, and the area under the curve (AUC) were calculated for each of them. RESULTS The best performance was achieved using the RF classifier (AUC = 0.59, 95% confidence interval 0.57-0.60; sensitivity = 0.56, 95% CI 0.54-0.58; specificity = 0.61, 95% CI 0.59-0.63; accuracy = 0.58, 95% CI 0.57-0.59). CONCLUSIONS DBT-based radiomic analysis seems to have only limited potential in discriminating benign from malignant microcalcifications.
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Affiliation(s)
- Benedetta Favati
- Department of Translational Research, University of Pisa, 56126 Pisa, Italy; (B.F.); (E.N.)
| | - Rita Borgheresi
- Unit of Medical Physics, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (R.B.); (M.G.); (D.M.); (S.L.)
| | - Marco Giannelli
- Unit of Medical Physics, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (R.B.); (M.G.); (D.M.); (S.L.)
| | - Carolina Marini
- S.D. Radiologia Senologica, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56125 Pisa, Italy; (C.M.); (M.M.); (D.M.)
| | - Vanina Vani
- Department of Translational Research, University of Pisa, 56126 Pisa, Italy; (B.F.); (E.N.)
| | - Daniela Marfisi
- Unit of Medical Physics, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (R.B.); (M.G.); (D.M.); (S.L.)
| | - Stefania Linsalata
- Unit of Medical Physics, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56126 Pisa, Italy; (R.B.); (M.G.); (D.M.); (S.L.)
| | - Monica Moretti
- S.D. Radiologia Senologica, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56125 Pisa, Italy; (C.M.); (M.M.); (D.M.)
| | - Dionisia Mazzotta
- S.D. Radiologia Senologica, Azienda Ospedaliero-Universitaria Pisana, Via Roma 67, 56125 Pisa, Italy; (C.M.); (M.M.); (D.M.)
| | - Emanuele Neri
- Department of Translational Research, University of Pisa, 56126 Pisa, Italy; (B.F.); (E.N.)
- Italian Society of Medical and Interventional Radiology (SIRM), SIRM Foundation, Via della Signora 2, 20122 Milan, Italy
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10
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Autier P, Sullivan R. Population Screening for Cancer in High-Income Settings: Lessons for Low- and Middle-Income Economies. J Glob Oncol 2020; 5:1-5. [PMID: 30715958 PMCID: PMC6426516 DOI: 10.1200/jgo.18.00235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at International Prevention Research Institute, Ecully, Lyon, France.,International Prevention Research Institute, Lyon, France
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11
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Moustafa MA, Alabd AS, Ahmed AMM, Deghidy EA. Erector spinae versus paravertebral plane blocks in modified radical mastectomy: Randomised comparative study of the technique success rate among novice anaesthesiologists. Indian J Anaesth 2020; 64:49-54. [PMID: 32001909 PMCID: PMC6967376 DOI: 10.4103/ija.ija_536_19] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/08/2019] [Accepted: 10/24/2019] [Indexed: 01/07/2023] Open
Abstract
Background and Aims: Regional analgesia may play a role in pain management during breast surgery. Ultrasound approach to paravertebral block may be challenging. This study compared success rates of ultrasound-guided erector spinae plane block (ESPB) versus parasagittal in-plane thoracic paravertebral block among senior anaesthesia residents in modified radical mastectomy. Methods: One hundred and two female patients undergoing modified radical mastectomy were randomly categorized into PARA group receiving sagittal in-plane paravertebral block and ESPB group receiving erector spinae plane block. The block in the 1st six cases in each group was done by an experienced consultant as a demonstration for three anaesthesia residents not experienced in either block. Primary endpoint was assessing success rate of the blocks. Secondary endpoint was the haemodynamic response to skin incision and postoperative analgesia. Results: All patients were females undergoing modified radical mastectomy. Success rate among residents was 100% in ESPB versus 77.8% in PARA group (P = 0.002). Duration to perform the block was less in ESPB group (4.39 ± 1.2 min) than PARA group (8.18 ± 2.42 min) (P < 0.0001). Guidance frequency by consultants was significantly higher in PARA than ESPB group. Time to 1st analgesic requirement and morphine consumption postoperatively were insignificant between the groups. There was no significant difference regarding haemodynamics. Conclusion: ESPB may be a simple and safe alternative to parasagittal in-plane paravertebral block to provide postoperative analgesia in modified radical mastectomy especially in novice practitioners. It provides equivalent profile of postoperative analgesia with less time to perform the block.
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Affiliation(s)
- Moustafa A Moustafa
- Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ahmad S Alabd
- Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Aly M M Ahmed
- Anaesthesia and Surgical Intensive Care, Alexandria Faculty of Medicine, Alexandria, Egypt
| | - Ehsan A Deghidy
- Department of Biomedical Informatics and Medical Statistics, Medical Research Institute, Alexandria University, Alexandria, Egypt
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12
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Van Ourti T, O'Donnell O, Koç H, Fracheboud J, de Koning HJ. Effect of screening mammography on breast cancer mortality: Quasi-experimental evidence from rollout of the Dutch population-based program with 17-year follow-up of a cohort. Int J Cancer 2019; 146:2201-2208. [PMID: 31330046 PMCID: PMC7065105 DOI: 10.1002/ijc.32584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 06/12/2019] [Accepted: 07/02/2019] [Indexed: 12/29/2022]
Abstract
There is uncertainty about the magnitude of the effect of screening mammography on breast cancer mortality. The relevance and validity of evidence from dated randomized controlled trials has been questioned, whereas observational studies often lack a valid comparison group. There is no estimate of the effect of one screening invitation only. We exploited the geographic rollout of the Dutch screening mammography program across municipalities to estimate the effects of one additional biennial screening invitation on breast cancer and all‐cause mortality. Population administrative data provided vital status and cause of death of a cohort of women aged 49–63 in 1995 over 17 years. Linear probability models were used to estimate the mortality effects. We estimated 154 fewer breast cancer deaths (95% confidence interval: 40–267; p = 0.01) over 17 years in a population of 100,000 women aged 49–63 who received one additional biennial screening invitation, which corresponds to an 9.6% risk reduction for a woman of age 56. The estimated effect on all‐cause mortality was negative but not close to statistical significance. Our study shows that one single invitation for breast cancer screening is effective in reducing breast cancer mortality, which is important for health policy. The effect is smaller than previous estimates of the effect of invitation for multiple screens, which further emphasizes the importance of achieving regular participation. What's new? To date, there is still uncertainty about the magnitude of the effect of screening mammography on breast cancer mortality. Here, the authors exploited the geographic rollout of the Dutch screening mammography program and high‐quality national population, cancer, and death registries to avoid limitations of observational research by comparing breast cancer mortality across groups of women of the same age who joined the mammography program at different dates. The analysis provides a unique estimate of the effect of one additional invitation for screening mammography on breast cancer mortality (around 10%) and delivers evidence in favour of the effectiveness of such screening.
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Affiliation(s)
- Tom Van Ourti
- Erasmus School of Economics, Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Owen O'Donnell
- Erasmus School of Economics, Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Hale Koç
- Tinbergen Institute, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Jacques Fracheboud
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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13
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Hanley GE, McAlpine JN, Cheifetz R, Schrader KA, McCullum M, Huntsman D. Selected medical interventions in women with a deleterious BRCA mutation: a population-based study in British Columbia. ACTA ACUST UNITED AC 2019; 26:e17-e23. [PMID: 30853805 DOI: 10.3747/co.26.4068] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background We examined the uptake of risk-reducing interventions, including bilateral mastectomy, risk-reducing salpingo-oophorectomy, oral contraceptive pills, tamoxifen, and raloxifene, for the entire population of women with a deleterious BRCA1 or BRCA2 mutation in the Canadian province of British Columbia. Methods This retrospective population-based study used data available in British Columbia for all women who, between 1996 and 2014, were tested and found to have a BRCA mutation. Rates of risk-reducing interventions stratified according to the type of BRCA mutation and prior history of breast or gynecologic cancer (ovary, fallopian tube, peritoneal) are presented. Cancers diagnosed in women with a BRCA mutation after disclosure of their mutation status are also presented. Results The final study cohort consisted of 885 patients with a deleterious BRCA1 (n = 474) or BRCA2 (n = 411) mutation. Of the women with no prior breast cancer, 30.8% carrying a BRCA1 mutation and 28.3% carrying a BRCA2 mutation underwent bilateral mastectomy. Of women with no prior gynecologic cancer, 64.7% carrying a BRCA1 mutation and 62.2% carrying a BRCA2 mutation underwent risk-reducing bilateral salpingo-oophorectomy. Rates of chemoprevention with oral contraceptive pills and tamoxifen or raloxifene were low in all groups. In this cohort, 23 gynecologic and 70 breast cancers were diagnosed after disclosure of BRCA mutation status. Conclusions Our results suggest reasonable uptake of risk-reducing interventions in high-risk women. To minimize the occurrence of breast and ovarian cancer in women with a BRCA1 or BRCA2 mutation, more attention could be paid to ensuring that affected women receive proper counselling and follow-up.
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Affiliation(s)
- G E Hanley
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - J N McAlpine
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC
| | - R Cheifetz
- Department of Surgery, University of British Columbia, Vancouver, BC.,BC Cancer, Hereditary Cancer Program, High-Risk Clinic, Vancouver, BC
| | - K A Schrader
- Department of Medical Genetics, University of British Columbia, Vancouver, BC.,BC Cancer, Hereditary Cancer Program, Vancouver, BC
| | - M McCullum
- Department of Surgery, University of British Columbia, Vancouver, BC
| | - D Huntsman
- Laboratory Medicine, University of British Columbia, Vancouver, BC
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14
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Beamer LC. Hereditary Breast and Hereditary Ovarian Cancer: Implications for the Oncology Nurse. Semin Oncol Nurs 2019; 35:47-57. [DOI: 10.1016/j.soncn.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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15
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Mack DS, Lapane KL. Screening Mammography Among Older Women: A Review of United States Guidelines and Potential Harms. J Womens Health (Larchmt) 2019; 28:820-826. [PMID: 30625008 DOI: 10.1089/jwh.2018.6992] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
In the United States, older women (aged ≥65 years) continue to receive routine screening mammography surveillance, despite limited evidence supporting the benefits to this subpopulation. This article reviews screening mammography guidelines and the potential harms of such screening for older women in the United States. Published guidelines and recommendations on screening mammography for older women from professional medical societies and organizations in the United States were reviewed from the mid-20th century to present. Observational data were then synthesized to present the documented harms from screening mammography among older women. In 1976, the American Cancer Society recommended to screen all women aged ≥40 years with no upper age limit. With time, other major U.S. medical societies adopted their own screening guidelines without a consensus on age of screening cessation. A population-wide screening effort has largely continued without an upper age limit and with it, a growing body of literature on the harms of screening older women. Reported harms from screening mammography procedures have included physical pain, psychological distress, excessive use of health services from overdiagnoses/false positives, and undue financial expenses. These costs are particularly pronounced among special populations with limited life expectancies such as those of very advanced age ≥80 years, long-term nursing home residents, and the cognitively impaired. When potential harms, remaining life years, and the viability of available treatments are considered, the burdens of screening mammography often outweigh the benefits for older women. For some cases, an individualized approach to recommendations would be appropriate. National guidelines should be updated to provide clear guidance for screening women of advanced age, especially those in special populations with limited life expectancies.
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Affiliation(s)
- Deborah S Mack
- 1 Clinical and Population Health Research Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.,2 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Kate L Lapane
- 2 Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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16
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Mack DS, Epstein MM, Dubé C, Clark RE, Lapane KL. Screening mammography among nursing home residents in the United States: Current guidelines and practice. J Geriatr Oncol 2018; 9:626-634. [PMID: 29875079 PMCID: PMC6899058 DOI: 10.1016/j.jgo.2018.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 03/16/2018] [Accepted: 05/04/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE United States (US) guidelines regarding when to stop routine breast cancer screening remain unclear. No national studies to-date have evaluated the use of screening mammography among US long-stay nursing home residents. This cross-sectional study was designed to identify prevalence, predictors, and geographic variation of screening mammography among that population in the context of current US guidelines. MATERIALS AND METHODS Screening mammography prevalence, identified with Physician/Supplier Part B claims and stratified by guideline age classification (65-74, ≥75 years), was estimated for all women aged ≥65 years residing in US Medicare- and Medicaid- certified nursing homes (≥1 year) with an annual Minimum Data Set (MDS) 3.0 assessment, continuous Medicare Part B enrollment, and no clinical indication for screening mammography as of 2011 (n = 389,821). The associations between resident- and regional- level factors, and screening mammography, were estimated by crude and adjusted prevalence ratios from robust Poisson regressions clustered by facility. RESULTS Women on average were 85.4 (standard deviation ±8.1) years old, 77.9% were disabled, and 76.3% cognitively impaired. Screening mammography prevalence was 7.1% among those aged 65-74 years (95% Confidence Interval (CI): 6.8%-7.3%) and 1.7% among those ≥75 years (95% CI, 1.7%-1.8%), with geographic variation observed. Predictors of screening in both age groups included race, cognitive impairment, frailty, hospice, and some comorbidities. CONCLUSIONS These results shed light on the current screening mammography practices in US nursing homes. Thoughtful consideration about individual screening recommendations and the implementation of more clear guidelines for this special population are warranted to prevent overscreening.
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Affiliation(s)
- Deborah S Mack
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States.
| | - Mara M Epstein
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Medicine, Division of Geriatrics, University of Massachusetts Medical School, Worcester, MA, United States
| | - Catherine Dubé
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Robin E Clark
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States; Department of Family Medicine, University of Massachusetts Medical School, Worcester, MA, United States
| | - Kate L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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17
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Wengert GJ, Helbich TH, Kapetas P, Baltzer PA, Pinker K. Density and tailored breast cancer screening: practice and prediction - an overview. Acta Radiol Open 2018; 7:2058460118791212. [PMID: 30245850 PMCID: PMC6144518 DOI: 10.1177/2058460118791212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/27/2018] [Indexed: 01/13/2023] Open
Abstract
Mammography, as the primary screening modality, has facilitated a substantial
decrease in breast cancer-related mortality in the general population. However,
the sensitivity of mammography for breast cancer detection is decreased in women
with higher breast densities, which is an independent risk factor for breast
cancer. With increasing public awareness of the implications of a high breast
density, there is an increasing demand for supplemental screening in these
patients. Yet, improvements in breast cancer detection with supplemental
screening methods come at the expense of increased false-positives, recall
rates, patient anxiety, and costs. Therefore, breast cancer screening practice
must change from a general one-size-fits-all approach to a more personalized,
risk-based one that is tailored to the individual woman’s risk, personal
beliefs, and preferences, while accounting for cost, potential harm, and
benefits. This overview will provide an overview of the available breast density assessment
modalities, the current breast density screening recommendations for women at
average risk of breast cancer, and supplemental methods for breast cancer
screening. In addition, we will provide a look at the possibilities for a
risk-adapted breast cancer screening.
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Affiliation(s)
- Georg J Wengert
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Pascal At Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Medical University of Vienna, Vienna, Austria.,Department of Radiology, Breast Imaging Service, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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18
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Weigel S, Gerss J, Hense HW, Krischke M, Sommer A, Czwoydzinski J, Lenzen H, Kerschke L, Spieker K, Dickmaenken S, Baier S, Urban M, Hecht G, Heidinger O, Kieschke J, Heindel W. Digital breast tomosynthesis plus synthesised images versus standard full-field digital mammography in population-based screening (TOSYMA): protocol of a randomised controlled trial. BMJ Open 2018; 8:e020475. [PMID: 29764880 PMCID: PMC5961594 DOI: 10.1136/bmjopen-2017-020475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Development of digital breast tomosynthesis (DBT) provides a technology that generates three-dimensional data sets, thus reducing the pitfalls of overlapping breast tissue. Observational studies suggest that the combination of two-dimensional (2D) digital mammography and DBT increases diagnostic accuracy. However, because of duplicate exposure, this comes at the cost of an augmented radiation dose. This undesired adverse impact can be avoided by using synthesised 2D images reconstructed from the DBT data (s2D).We designed a diagnostic superiority trial on a high level of evidence with the aim of providing a comparison of screening efficacy parameters resulting from DBT+s2D versus the current screening standard 2D full-field digital mammography (FFDM) in a multicentre and multivendor setting on the basis of the quality-controlled, population-based, biennial mammography screening programme in Germany. METHODS AND ANALYSIS 80 000 women in the eligible age 50-69 years attending the routine mammography screening programme and willing to participate in the TOSYMA trial will be assigned by 1:1 randomisation to either the intervention arm (DBT+s2D) or the control arm (FFDM) during a 12-month recruitment period in screening units of North Rhine-Westphalia and Lower Saxony. State cancer registries will provide the follow-up of interval cancers.Primary endpoints are the detection rate of invasive breast cancers at screening examination and the cumulative incidence of interval cancers in the 2 years after a negative examination. Secondary endpoints are the detection rate of ductal carcinoma in situ and of tumour size T1, the recall rate for assessment, the positive predictive value of recall and the cumulative 12-month incidence of interval cancers. An adaptive statistical design with one interim analysis provides the option to modify the design. ETHICS AND DISSEMINATION This protocol has been approved by the local medical ethical committee (2016-132-f-S). Results will be submitted to international peer-reviewed journals. TRIAL REGISTRATION NCT03377036; Pre-results.
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Affiliation(s)
- Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, IBKF, University of Münster, Münster, Germany
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Miriam Krischke
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Alexander Sommer
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Jörg Czwoydzinski
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Horst Lenzen
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, IBKF, University of Münster, Münster, Germany
| | - Karin Spieker
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Stefanie Dickmaenken
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Sonja Baier
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Marc Urban
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Gerold Hecht
- Reference Center for Mammography North, Oldenburg, Germany
| | | | | | - Walter Heindel
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
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19
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Defossez G, Quillet A, Ingrand P. Aggressive primary treatments with favourable 5-year survival for screen-interval breast cancers. BMC Cancer 2018; 18:393. [PMID: 29625602 PMCID: PMC5889614 DOI: 10.1186/s12885-018-4319-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/28/2018] [Indexed: 11/23/2022] Open
Abstract
Background To assess the impact of the participation in screening programme according to the mode of detection on the early diagnosis, treatment, and specific survival outcomes in women with breast cancer. Methods Women diagnosed with invasive breast cancer in Poitou-Charentes region (France) between 2008 and 2009 were classified into three groups, using data linkage of cancer registry, vital statistics and French organized screening programme: the screening programme (SP), interval cancer (IC), and non-screening programme detected cancer (NSP) groups. Specific survival rates were analysed using the Kaplan–Meier method and Cox proportional hazard models. Results Among 1613 patients, 65.7% (n = 1059) participated in a screening programme. The interval cancer rate was 17.1% (n = 181). Tumours in the IC group were diagnosed at a more advanced stage, i.e. with further regional lymph node metastasis or local spread, than those in the SP group (p < 0.001), but with significantly fewer metastases at diagnosis than in the NSP group (p < 0.001). ICs underwent more aggressive primary treatments than the two other groups, with 28% of radical mastectomy and 67% undergoing chemotherapy. The five-year survival rate for IC group were 92.0% (95% CI, 89.9–94.0%). Conclusions Interval cancers had more aggressive features than screen-detected cancers but were diagnosed at a less advanced stage compared to non-screen detected cancers. Despite having cancers missed by the screening programme, women who participate in the screening process seem to benefit from early treatment. These results must be confirmed with long-term follow-up.
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Affiliation(s)
- Gautier Defossez
- Poitou-Charentes General Cancer Registry, Poitiers University Hospital, University of Poitiers, Poitiers, France. .,INSERM, CIC 1402, Poitiers, France.
| | - Alexandre Quillet
- Poitou-Charentes General Cancer Registry, Poitiers University Hospital, University of Poitiers, Poitiers, France
| | - Pierre Ingrand
- Poitou-Charentes General Cancer Registry, Poitiers University Hospital, University of Poitiers, Poitiers, France.,INSERM, CIC 1402, Poitiers, France
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20
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Tapia KA, Garvey G, Mc Entee M, Rickard M, Brennan P. Breast Cancer in Australian Indigenous Women: Incidence,
Mortality, and Risk Factors. Asian Pac J Cancer Prev 2017; 18:873-884. [PMID: 28545182 PMCID: PMC5494235 DOI: 10.22034/apjcp.2017.18.4.873] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The Indigenous people of Australia face significant health gaps compared with the general population, with lower life
expectancies, higher rates of death, and chronic illness occurring more often than in non-indigenous Australians. Cancer
is the second largest contributor to the burden of disease with breast cancer being the most common invasive cancer
diagnosed for females. Despite a lower breast cancer incidence compared with non-indigenous women, fatalities occur
at an elevated rate and breast cancers have an earlier age of onset. For indigenous women there are also more advanced
and distant tumours at diagnosis, fewer hospitalisations for breast cancer, and lower participation in breast screening.
Concomitantly there are demographic, socio-economic and lifestyle factors associated with breast cancer risks that
are heavily represented within Indigenous communities. The aim of this two-part narrative review is to examine the
available evidence on breast cancer and its risk factors in Australian Indigenous women. Part One presents a summary
of the latest incidence, survival and mortality data. Part Two presents the risk factors most strongly associated with
breast cancer including age, place of residence, family risk, genetics, reproductive history, tobacco use, alcohol intake,
physical activity, participation in screening and breast density. With increasing emphasis on personalized health care, a
clear understanding of breast cancer incidence, survival, mortality, and causal agents within the Indigenous population
is required if breast cancer prevention and management is to be optimized for Indigenous Australians.
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Affiliation(s)
- Kriscia A Tapia
- Faculty of Health Sciences, The University of Sydney, New South Wales, Australia.
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21
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Shimo T, Yoshioka N, Nakamura M, Ibaragi S, Okui T, Kunisada Y, Masui M, Yao M, Kishimoto K, Yoshida S, Nishiyama A, Kamioka H, Sasaki A. Orthognathic surgery during breast cancer treatment-A case report. Int J Surg Case Rep 2017; 31:30-34. [PMID: 28095342 PMCID: PMC5238599 DOI: 10.1016/j.ijscr.2016.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 12/23/2016] [Accepted: 12/24/2016] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION In recent years, patients with orthognathic surgery in middle-aged and elderly people have come to be a more frequent occurrence. Breast cancer is the most frequently diagnosed cancer in woman worldwide, and its prevalence rate is steadily increasing. PRESENTATION OF CASE We report a case of a 47-year-old Japanese woman in whom left-side breast cancer (Stage 1) was unexpectedly found just before orthognathic surgery in April 2012. Breast-conserving surgery was performed (estrogen receptor+, progesterone receptor+, HER2 -, surgical margin+, sentinel lymph node +) that May. From June to August docetaxel (75mg/m2) and cyclophosphamide (600mg/m2) were administrated four times every 21days and thereafter radiotherapy (total 60Gy) was completed. The cancer surgeon declared the prognosis good and the patient had a strong desire to undergo orthognathic surgery, so in November we performed a bimaxillary osteotomy, and administration of tamoxifen began 6 weeks after the osteotomy. DISCUSSION There are breast cancer cases in which the prognosis is sufficiently good for a planned orthognathic surgery to proceed. Good communication among surgeons and the patient is important. CONCLUSION We experienced a case in which breast cancer was found just before the orthognathic surgery; we performed a bimaxillary osteotomy, including follow-up tamoxifen administration, during breast cancer treatment.
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Affiliation(s)
- Tsuyoshi Shimo
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan.
| | - Norie Yoshioka
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Masahiro Nakamura
- Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Soichiro Ibaragi
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Tatsuo Okui
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Yuki Kunisada
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Masanori Masui
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Mayumi Yao
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Koji Kishimoto
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Shoko Yoshida
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Akiyoshi Nishiyama
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Hiroshi Kamioka
- Department of Orthodontics, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
| | - Akira Sasaki
- Department of Oral and Maxillofacial Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama 700-8525, Japan
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22
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Brown P. Women's Expectations for Breast Cancer Prevention and Early Detection: High Expectations Can Be Achieved. Oncologist 2015; 21:4-6. [PMID: 26675741 PMCID: PMC4709217 DOI: 10.1634/theoncologist.2015-0412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 10/27/2015] [Indexed: 01/04/2023] Open
Abstract
Additional research is needed to improve the ability to detect life-threatening cancer at an early curable stage and to prevent the development of such cancer. Many research groups are working to discover more effective and safer methods to detect and prevent life-threatening breast cancer. The results from such research studies will ultimately allow women’s expectations for breast cancer prevention and early detection to be met.
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Affiliation(s)
- Powel Brown
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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