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Schoenborn NL, Gollust SE, Schonberg MA, Pollack CE, Boyd CM, Xue QL, Nagler RH. Development and Evaluation of Messages for Reducing Overscreening of Breast Cancer in Older Women. Med Care 2024; 62:296-304. [PMID: 38498875 PMCID: PMC10997450 DOI: 10.1097/mlr.0000000000001993] [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] [Indexed: 03/20/2024]
Abstract
BACKGROUND Many older women are screened for breast cancer beyond guideline-recommended thresholds. One contributor is pro-screening messaging from health care professionals, media, and family/friends. In this project, we developed and evaluated messages for reducing overscreening in older women. METHODS We surveyed women ages 65+ who were members of a nationally representative online panel. We constructed 8 messages describing reasons to consider stopping mammograms, including guideline recommendations, false positives, overdiagnosis, and diminishing benefits from screening due to competing risks. Messages varied in their format; some presented statistical evidence, and some described short anecdotes. Each participant was randomized to read 4 of 8 messages. We also randomized participants to one of 3 message sources (clinician, family member, and news story). We assessed whether the message would make participants "want to find out more information" and "think carefully" about mammograms. RESULTS Participants (N=790) had a mean age of 73.5 years; 25.8% were non-White. Across all messages, 73.0% of the time, participants agreed that the messages would make them seek more information (range among different messages=64.2%-78.2%); 46.5% of the time participants agreed that the messages would make them think carefully about getting mammograms (range =36.7%-50.7%). Top-rated messages mentioned false-positive anecdotes and overdiagnosis evidence. Ratings were similar for messages from clinicians and news sources, but lower from the family member source. CONCLUSIONS Overall, participants positively evaluated messages designed to reduce breast cancer overscreening regarding perceived effects on information seeking and deliberation. Combining the top-rated messages into messaging interventions may be a novel approach to reduce overscreening.
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Affiliation(s)
- Nancy L Schoenborn
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Sarah E Gollust
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
| | - Mara A Schonberg
- Department of Medicine, Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Craig E Pollack
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Cynthia M Boyd
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
- Johns Hopkins Center on Aging and Health, Baltimore, MD
| | - Qian-Li Xue
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD
- Johns Hopkins Center on Aging and Health, Baltimore, MD
| | - Rebekah H Nagler
- Hubbard School of Journalism and Mass Communication, University of Minnesota College of Liberal Arts, Minneapolis, MN
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Plasencia-Martínez JM, Sánchez-Canales M, Otón-González E, Casado-Alarcón NI, Molina-Lozano B, Cotillo-Ramos E, Ortiz-Mayoral H, García-Santos JM. Inappropriate requests for cranial CT scans in emergency departments increase overuse and reduce test performance. Emerg Radiol 2023; 30:733-741. [PMID: 37973624 DOI: 10.1007/s10140-023-02185-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/01/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The number of non-traumatic urgent cranial computed tomography (NT-UCCT) is exponentially increasing but limited research has been conducted on the quality of clinical justification. Accordingly, we aimed (1) to assess how clinical information in the electronic NT-UCCT request agreed with that provided in the patient's emergency department discharge summary and (2) to analyze the potential effect of those discrepancies on the NT-UCCT overload. MATERIAL AND METHODS Patients undergoing NT-UCCT in 2017-2021 were randomly selected for this retrospective research-board-approved study. Signs and symptoms (S/S) in electronic request and emergency department discharge summary, acute and relevant computed tomography (CT) findings (acute ischemia or hemorrhage, masses, brain edema, or previously undetected hydrocephalus), and final diagnosis at emergency department discharge summary were collected. Concordance between digital request and emergency department discharge summary and their association with both acute and relevant CT findings and final diagnosis were analyzed. RESULTS We recruited 156 patients: 80 men; mean age, 55. Acute, relevant CT findings were detected in 28 cases (17.9%). The final diagnosis was neurological disease, non-neurological disease, and no definitive diagnosis in 46 (29.5%), 58 (37.2%), and 51 (32.7%) cases, respectively. Full agreement between the electronic request and emergency department discharge summary occurred in only 36 patients (23.1%). Motor deficit was the most frequent false positive electronic request S/S (18; 11.54%), having low positive predictive value (30.30%; 95%CI 15.59-48.71%) and worst association with acute relevant CT findings than when true positive (OR 2.54; 95%CI 0.04-6.21 vs. OR 6.26, 95%CI 2.21-17.78). Nausea/vomiting was the third most common false negative electronic request S/S (13; 10.26%) and reduced the likelihood of acute and relevant CT findings (OR 0.126; 95%CI 0.016-0.971; p = 0.020). False S/S in electronic request predominated in non-neurological diseases (50-60.2% vs. 33-39.8%; p = 0.068). CONCLUSION Discrepancies between electronic request and emergency department discharge summary were observed in >75% of patients, leading to unnecessary NT-UCCT tests.
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Affiliation(s)
- Juana María Plasencia-Martínez
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain.
| | - Marta Sánchez-Canales
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - Elena Otón-González
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - Nuria Isabel Casado-Alarcón
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | | | - Estefanía Cotillo-Ramos
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - Herminia Ortiz-Mayoral
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
| | - José María García-Santos
- Department of Radiology, Hospital General Universitario Morales Meseguer, Avenida Marqués de los Vélez, s/n, 30008, Murcia, Spain
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Han HJ, Chu YC, Wang J, Lai YC, Tseng LM, Huang CC. Characteristics of breast cancers detected by screening mammography in Taiwan: a single institute's experience. BMC Womens Health 2023; 23:330. [PMID: 37344800 DOI: 10.1186/s12905-023-02445-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 05/18/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND/AIM Breast cancer is the most common female malignancy in the world. Nearly ninety percent of screening-detected breast cancers were diagnosed with earlier stages of 0 to II in Taiwan. It's widely acknowledged that mammography screening of breast cancer can achieve the goal of early diagnosis and treatment in terms of preventive task while neglected interval cancers are associated with unfavorable tumor characteristics and worse outcomes. The purpose of this study was to explore the characteristics of screening-detected breast cancers in Taiwan. MATERIALS AND METHODS Both screening and diagnostic mammography examinations with accompanied BI-RADS (breast imaging-reporting and data system) classification were extracted from the health information system and linked to cancer registry in Taiwan. Enrolled population included those attending their first mammography between 2012 and 2016, excluding subjects with previous breast cancer, or with missing or incomplete data. We compared treatment outcomes between breast cancers with either initial screening or diagnostic mammography (control group), and investigated the compositions of breast cancers detected by screening mammography through direct chart reviews. RESULTS A total of 84,246 screening and 61,230 diagnostic mammography sessions were performed from 2010 to 2020. More positive results (BI-RADS 0, 3, 4 and 5) were observed for those attending the first diagnostic than the first screening mammography (43.58% versus 16.12%, p < 0.001). Earlier stages (0 and I) distribution (92% versus 81%, p < 0.0001), better survivorship (overall survival: 96.91% versus 92.17%, p = 0.007) and a lower HER2 (human epidermal growth factor receptor II) positive status and lower tumor grade were noted in breast cancers with initial screening rather than diagnostic mammography. Among 26,103 mammography screening invitees between 2012 and 2016, 325 breast cancers were ascertained from cancer registry. Of these, 234 had one, 72 had two and 19 had three episodes of mammography before cancer diagnosis. Extensive chart reviews revealed that women with and without breast symptoms constituted 29.9 and 70.1% of the 325 screening-detected breast cancers, with the latter further divided into false negative results (interval cancer), diagnosed at the first mammography, diagnostic at the secondary or subsequent mammography and those with a delayed biopsy or confirmatory imaging constituted (5.2, 47, 10.5 and 7.4%). CONCLUSION Screening-detected breast cancers were a mixture of women with and without symptoms, those with a false negative result, true negative results with cancer detected at subsequent mammography and non-adherers. Despite this, efficacy of mammography screening was ascertained in Taiwan from this study. To further enhance earlier detection and decrease false negativity, the impact of repeated mammography, and additional sonography for symptomatic women, compliance following a positive screening mammography should not be overemphasized.
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Affiliation(s)
- Hsin-Ju Han
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yuan-Chia Chu
- Information Management Office, Taipei Veterans General Hospital, Taipei, Taiwan
- Big Data Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Information Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Jane Wang
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Radiology, National Taiwan University College of Medicine Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Nurse-Midwifery and Women Health, Taipei, Taiwan
- Department of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Yi-Chen Lai
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Ling-Ming Tseng
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan.
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan.
| | - Chi-Cheng Huang
- Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan.
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Taipei, Taiwan.
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Nicosia L, Gnocchi G, Gorini I, Venturini M, Fontana F, Pesapane F, Abiuso I, Bozzini AC, Pizzamiglio M, Latronico A, Abbate F, Meneghetti L, Battaglia O, Pellegrino G, Cassano E. History of Mammography: Analysis of Breast Imaging Diagnostic Achievements over the Last Century. Healthcare (Basel) 2023; 11:healthcare11111596. [PMID: 37297735 DOI: 10.3390/healthcare11111596] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/12/2023] Open
Abstract
Breast cancer is the most common forms of cancer and a leading cause of mortality in women. Early and correct diagnosis is, therefore, essential to save lives. The development of diagnostic imaging applied to the breast has been impressive in recent years and the most used diagnostic test in the world is mammography, a low-dose X-ray technique used for imaging the breast. In the first half of the 20th century, the diagnosis was in practice only clinical, with consequent diagnostic delay and an unfavorable prognosis in the short term. The rise of organized mammography screening has led to a remarkable reduction in mortality through the early detection of breast malignancies. This historical review aims to offer a complete panorama of the development of mammography and breast imaging during the last century. Through this study, we want to understand the foundations of the pillar of radiology applied to the breast through to the most modern applications such as contrast-enhanced mammography (CEM), artificial intelligence, and radiomics. Understanding the history of the development of diagnostic imaging applied to the breast can help us understand how to better direct our efforts toward an increasingly personalized and effective diagnostic approach. The ultimate goal of imaging applied to the detection of breast malignancies should be to reduce mortality from this type of disease as much as possible. With this paper, we want to provide detailed documentation of the main steps in the evolution of breast imaging for the diagnosis of breast neoplasms; we also want to open up new scenarios where the possible current and future applications of imaging are aimed at being more precise and personalized.
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Affiliation(s)
- Luca Nicosia
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Giulia Gnocchi
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Ilaria Gorini
- Centre of Research in Osteoarchaeology and Paleopathology, Department of Biotechnology and Life Sciences, University of Insubria, Via J.H. Dunant, 3, 21100 Varese, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Federico Fontana
- Diagnostic and Interventional Radiology Department, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy
- School of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Filippo Pesapane
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ida Abiuso
- Radiology Department, Università degli Studi di Torino, 10129 Turin, Italy
| | - Anna Carla Bozzini
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Maria Pizzamiglio
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Antuono Latronico
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Francesca Abbate
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Lorenza Meneghetti
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Ottavia Battaglia
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Giuseppe Pellegrino
- Postgraduation School of Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono 7, 20122 Milan, Italy
| | - Enrico Cassano
- Breast Imaging Division, Radiology Department, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy
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5
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Lee CS, Lewin A, Reig B, Heacock L, Gao Y, Heller S, Moy L. Women 75 Years Old or Older: To Screen or Not to Screen? Radiographics 2023; 43:e220166. [PMID: 37053102 DOI: 10.1148/rg.220166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Breast cancer is the most common cancer in women, with the incidence rising substantially with age. Older women are a vulnerable population at increased risk of developing and dying from breast cancer. However, women aged 75 years and older were excluded from all randomized controlled screening trials, so the best available data regarding screening benefits and risks in this age group are from observational studies and modeling predictions. Benefits of screening in older women are the same as those in younger women: early detection of smaller lower-stage cancers, resulting in less invasive treatment and lower morbidity and mortality. Mammography performs significantly better in older women with higher sensitivity, specificity, cancer detection rate, and positive predictive values, accompanied by lower recall rates and false positives. The overdiagnosis rate is low, with benefits outweighing risks until age 90 years. Although there are conflicting national and international guidelines about whether to continue screening mammography in women beyond age 74 years, clinicians can use shared decision making to help women make decisions about screening and fully engage them in the screening process. For women aged 75 years and older in good health, continuing annual screening mammography will save the most lives. An informed discussion of the benefits and risks of screening mammography in older women needs to include each woman's individual values, overall health status, and comorbidities. This article will review the benefits, risks, and controversies surrounding screening mammography in women 75 years old and older and compare the current recommendations for screening this population from national and international professional organizations. ©RSNA, 2023 Quiz questions for this article are available through the Online Learning Center.
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Affiliation(s)
- Cindy S Lee
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Alana Lewin
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Beatriu Reig
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Laura Heacock
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Yiming Gao
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Samantha Heller
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, NYU Langone Health, New York, NY (C.S.L., A.L., B.R., L.H., Y.G., S.H., L.M.); and Center for Advanced Imaging Innovation and Research, Vilcek Institute of Graduate Biomedical Sciences, New York, NY (L.M.)
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Flemban AF. Overdiagnosis Due to Screening Mammography for Breast Cancer among Women Aged 40 Years and Over: A Systematic Review and Meta-Analysis. J Pers Med 2023; 13:jpm13030523. [PMID: 36983705 PMCID: PMC10051653 DOI: 10.3390/jpm13030523] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 02/03/2023] [Accepted: 03/11/2023] [Indexed: 03/16/2023] Open
Abstract
The current systematic review and meta-analysis was conducted to estimate the incidence of overdiagnosis due to screening mammography for breast cancer among women aged 40 years and older. A PRISMA systematic search appraisal and meta-analysis were conducted. A systematic literature search of English publications in PubMed, Web of Science, EMBASE, Scopus, and Google Scholar was conducted without regard to the region or time period. Generic, methodological, and statistical data were extracted from the eligible studies. A meta-analysis was completed by utilizing comprehensive meta-analysis software. The effect size estimates were calculated using the fail-safe N test. The funnel plot and the Begg and Mazumdar rank correlation tests were employed to find any potential bias among the included articles. The strength of the association between two variables was assessed using Kendall’s tau. Heterogeneity was measured using the I-squared (I2) test. The literature search in the five databases yielded a total of 4214 studies. Of those, 30 articles were included in the final analysis, with sample sizes ranging from 451 to 1,429,890 women. The vast majority of the articles were retrospective cohort designs (24 articles). The age of the recruited women ranged between 40 and 89 years old. The incidence of overdiagnosis due to screening mammography for breast cancer among women aged 40 years and older was 12.6%. There was high heterogeneity among the study articles (I2 = 99.993), and the pooled event rate was 0.126 (95% CI: 15 0.101–0.156). Despite the random-effects meta-analysis showing a high degree of heterogeneity among the articles, the screening tests have to allow for a certain degree of overdiagnosis (12.6%) due to screening mammography for breast cancer among women aged 40 years and older. Furthermore, efforts should be directed toward controlling and minimizing the harmful consequences associated with breast cancer screening.
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Affiliation(s)
- Arwa F Flemban
- Pathology Department, Faculty of Medicine, Umm Al-Qura University, Makkah 21955, Saudi Arabia
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7
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Maimone S, Morozov AP, Letter HP, Robinson KA, Wasserman MC, Li Z, Maxwell RW. Abbreviated Molecular Breast Imaging: Feasibility and Future Considerations. JOURNAL OF BREAST IMAGING 2022; 4:590-599. [PMID: 38416994 DOI: 10.1093/jbi/wbac060] [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: 05/20/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE Molecular breast imaging (MBI) is a supplemental screening modality consistently demonstrating incremental cancer detection over mammography alone; however, its lengthy duration may limit widespread utilization. The study purpose was to assess feasibility of an abbreviated MBI protocol, providing readers with mediolateral oblique (MLO) projections only and assessing performance in lesion detection and localization. METHODS Retrospective IRB-exempt blinded reader study administered to 5 fellowship-trained breast imaging radiologists. Independent reads performed for 124 screening MBI cases, half abnormal and half negative/normal. Readers determined whether an abnormality was present, side of abnormality, and location of abnormality (medial/lateral). Abnormal cases had confirmatory biopsy or surgical pathology; normal cases had imaging follow-up ensuring true negative results. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated to assess performance. A false negative result indicated that a reader failed to detect abnormal uptake; a false positive result indicated a reader incorrectly called an abnormality for a negative case. Tests for association included chi-square, Fisher-exact, and analysis of variance. RESULTS Mean reader performance for detecting abnormal uptake: sensitivity 96.8%, specificity 98.7%, PPV 98.8%, and NPV 96.9%. Accuracy in localizing lesions to the medial or lateral breast was 100%. There were no associations in reader performance with reader experience, reader technique, lesion morphology, or lesion pathology. Median lesion size was 1.0 cm (range: 0.4-8.0 cm). All readers correctly identified 97.7% (42/43) of lesions with malignant or elevated risk pathology. CONCLUSION An abbreviated MBI protocol (MLO images only) maintained high accuracy in lesion detection and localization.
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Affiliation(s)
- Santo Maimone
- Mayo Clinic Florida, Department of Radiology, Jacksonville, FL, USA
| | - Andrey P Morozov
- Mayo Clinic Florida, Department of Radiology, Jacksonville, FL, USA
| | - Haley P Letter
- Mayo Clinic Florida, Department of Radiology, Jacksonville, FL, USA
| | | | | | - Zhuo Li
- Mayo Clinic Florida, Department of Biostatistics, Jacksonville, FL, USA
| | - Robert W Maxwell
- Mayo Clinic Florida, Department of Radiology, Jacksonville, FL, USA
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8
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Chiu S, Williams B, Shahbazian K, Lee MV. Estimation of Breast Cancer Overdiagnosis in a U.S. Breast Screening Cohort. Ann Intern Med 2022; 175:W115-W116. [PMID: 36252262 DOI: 10.7326/l22-0276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Sherwin Chiu
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | | | - Kevin Shahbazian
- Medical College of Georgia at Augusta University, Augusta, Georgia
| | - Michelle V Lee
- Medical College of Georgia at Augusta University, Augusta, Georgia
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9
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Wang J, Greuter MJ, Zheng S, van Veldhuizen DW, Vermeulen KM, Wang Y, Lu W, de Bock GH. Assessment of the Benefits and Cost-Effectiveness of Population-Based Breast Cancer Screening in Urban China: A Model-Based Analysis. Int J Health Policy Manag 2022; 11:1658-1667. [PMID: 34273933 PMCID: PMC9808213 DOI: 10.34172/ijhpm.2021.62] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 05/30/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND To decrease the burden of breast cancer (BC), the Chinese government recently introduced biennial mammography screening for women aged 45-70 years. In this study, we assess the effectiveness and cost-effectiveness of implementing this programme in urban China using a micro-simulation model. METHODS The 'Simulation Model on radiation Risk and breast cancer Screening' (SiMRiSc) was applied, with parameters updated based on available data for the Chinese population. The base scenario was biennial mammography screening for women aged 45-70 years, and this was compared to a reference population with no screening. Seven alternative scenarios were then simulated by varying the screening intervals and participant ages. This analysis was conducted from a societal perspective. The discounted incremental cost-effectiveness ratio (ICER) was compared to a threshold of triple the gross domestic product (GDP) per life years gained (LYG), which was 30 785 USD/LYG. Univariate sensitivity analyses were conducted to evaluate model robustness. In addition, a budget impact analysis was performed by comparing biennial screening with no screening at a time horizon of 10 years. RESULTS Compared with no screening, the base scenario was cost-effective in urban China, giving a discounted average cost-effectiveness ratio (ACER) of 17 309 USD/LYG. The model was most sensitive to the cost of mammography per screen, followed by mean size of self-detected tumours, mammographic breast density and the cumulative lifetime risk of BC. The efficient frontier showed that at a threshold of 30 785 USD/LYG, the base scenario was the optimal scenario with a discounted ICER of 25 261 USD/LYG. Over 10 years, screening would incur a net cost of almost 38.1 million USD for a city with 1 million citizens. CONCLUSION Compared to no screening, biennial mammography screening for women aged from 45-70 is cost-effective in urban China.
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Affiliation(s)
- Jing Wang
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marcel J.W. Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Robotics and Mechatronics (RaM) Group, Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - Senshuang Zheng
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Daniëlle W.A. van Veldhuizen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Karin M. Vermeulen
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Yuan Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Collaborative Innovation Center of Chronic Disease Prevention and Control, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Wenli Lu
- Department of Epidemiology and Health Statistics, School of Public Health, Tianjin Medical University, Tianjin, China
- Collaborative Innovation Center of Chronic Disease Prevention and Control, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Geertruida H. de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Breast Cancer in Asia: Incidence, Mortality, Early Detection, Mammography Programs, and Risk-Based Screening Initiatives. Cancers (Basel) 2022; 14:cancers14174218. [PMID: 36077752 PMCID: PMC9454998 DOI: 10.3390/cancers14174218] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/09/2022] Open
Abstract
Simple Summary Nearly all breast cancer patients survive for more than five years when the tumor is found early and in the localized stage. Regular clinical breast examinations, mammograms, and monthly self-exams of the breasts all contribute to early detection. However, late-stage breast cancers are common in many Asian countries. Low-income countries suffer from a lack of resources for breast cancer screening. High-income countries, on the other hand, are not benefiting fully from national breast screening programs due to an underutilization of the preventive healthcare services available. Existing reviews on Asian breast cancers are heavily focused on risk factors. The question of whether we should adopt or adapt the knowledge generated from non-Asian breast cancers would benefit from an extension into screening guidelines. In addition, several Asian countries are piloting studies that move away from the age-based screening paradigm. Abstract Close to half (45.4%) of the 2.3 million breast cancers (BC) diagnosed in 2020 were from Asia. While the burden of breast cancer has been examined at the level of broad geographic regions, literature on more in-depth coverage of the individual countries and subregions of the Asian continent is lacking. This narrative review examines the breast cancer burden in 47 Asian countries. Breast cancer screening guidelines and risk-based screening initiatives are discussed.
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11
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Martei YM, Dauda B, Vanderpuye V. Breast cancer screening in sub-Saharan Africa: a systematic review and ethical appraisal. BMC Cancer 2022; 22:203. [PMID: 35197002 PMCID: PMC8867875 DOI: 10.1186/s12885-022-09299-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 02/08/2022] [Indexed: 11/22/2022] Open
Abstract
Background The aim of this systematic review was to evaluate the evidence and clinical outcomes of screening interventions and implementation trials in sub-Saharan Africa (SSA) and also appraise some ethical issues related to screening in the region through quantitative and qualitative narrative synthesis of the literature. Methods We searched Pubmed, OvidMEDLINE, Embase, and Web of Science to identify studies published on breast cancer screening interventions and outcomes in SSA. Descriptive statistics were used to summarize the frequency and proportions of extracted variables, and narrative syntheses was used to evaluate the clinical outcomes of the different screening modalities. The mixed methods appraisal tool was used to assess the quality of studies included in the review. Results Fifteen studies were included, which consisted of 72,572 women in ten countries in SSA. 63% (8/15) of the included publications evaluated Clinical Breast Examination (CBE), 47% (7/15) evaluated mammography and 7% (1/15) evaluated ultrasound screening. The cancer detection rate was < 1/1000 to 3.3/1000 and 3.3/100 to 56/1000 for CBE and mammography screening respectively. There was a lot of heterogeneity in CBE methods, target age for screening and no clear documentation of screening interval. Cost-effective analyses showed that CBE screening linked to comprehensive cancer care is most cost effective. There was limited discussion of the ethics of screening, including the possible harms of screening in the absence of linkage to care. The gap between conducting good screening program and the appropriate follow-up with diagnosis and treatment remains one of the major challenges of screening in SSA. Discussion There is insufficient real-world data to support the systematic implementation of national breast cancer screening in SSA. Further research is needed to answer important questions about screening, and national and international partnerships are needed to ensure that appropriate diagnostic and treatment modalities are available to patients who screen positive. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09299-5.
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Affiliation(s)
- Yehoda M Martei
- Department of Medicine (Division of Hematology-Oncology), University of Pennsylvania, Philadelphia, PA, USA. .,Botswana UPenn Partnership, Gaborone, Botswana.
| | - Bege Dauda
- Center for Global Genomics and Health Equity, University of Pennsylvania, Philadelphia, PA, USA
| | - Verna Vanderpuye
- National Center for Radiotherapy Oncology and Nuclear Medicine, Korle-Bu Teaching Hospital, Accra, Ghana
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12
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Destounis S, Friedewald SM. Letter to the editor on article by Dinh et al. Is it ethical to incentivize mammography screening in Medicaid populations? - A policy review and conceptual analysis. By Stamatia Destounis, MD and Sarah Friedewald MD. Prev Med 2022; 154:106598. [PMID: 34974879 DOI: 10.1016/j.ypmed.2021.106598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 04/20/2021] [Accepted: 05/01/2021] [Indexed: 11/19/2022]
Abstract
Letter to the Editor on article by Dinh et al- response to the authors comments on " Is it ethical to incentivize mammography screening in Medicaid populations? - A policy review and conceptual analysis".
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Affiliation(s)
- Stamatia Destounis
- Elizabeth Wende Breast Care, Clinical Professor University of Rochester Imaging Sciences, 170 Sawgrass Drive, Rochester, NY 14620, United States of America.
| | - Sarah M Friedewald
- Department of Radiology, Northwestern University, Feinberg School of Medicine, Lynn Sage Comprehensive Breast Center, 250 E. Superior Street Rm 4-2304, Chicago, IL 60611, United States of America
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13
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Cè M, Caloro E, Pellegrino ME, Basile M, Sorce A, Fazzini D, Oliva G, Cellina M. Artificial intelligence in breast cancer imaging: risk stratification, lesion detection and classification, treatment planning and prognosis-a narrative review. EXPLORATION OF TARGETED ANTI-TUMOR THERAPY 2022; 3:795-816. [PMID: 36654817 PMCID: PMC9834285 DOI: 10.37349/etat.2022.00113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 09/28/2022] [Indexed: 12/28/2022] Open
Abstract
The advent of artificial intelligence (AI) represents a real game changer in today's landscape of breast cancer imaging. Several innovative AI-based tools have been developed and validated in recent years that promise to accelerate the goal of real patient-tailored management. Numerous studies confirm that proper integration of AI into existing clinical workflows could bring significant benefits to women, radiologists, and healthcare systems. The AI-based approach has proved particularly useful for developing new risk prediction models that integrate multi-data streams for planning individualized screening protocols. Furthermore, AI models could help radiologists in the pre-screening and lesion detection phase, increasing diagnostic accuracy, while reducing workload and complications related to overdiagnosis. Radiomics and radiogenomics approaches could extrapolate the so-called imaging signature of the tumor to plan a targeted treatment. The main challenges to the development of AI tools are the huge amounts of high-quality data required to train and validate these models and the need for a multidisciplinary team with solid machine-learning skills. The purpose of this article is to present a summary of the most important AI applications in breast cancer imaging, analyzing possible challenges and new perspectives related to the widespread adoption of these new tools.
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Affiliation(s)
- Maurizio Cè
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy,Correspondence: Maurizio Cè, Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy.
| | - Elena Caloro
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Maria E. Pellegrino
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Mariachiara Basile
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | - Adriana Sorce
- Postgraduate School in Diagnostic and Interventional Radiology, University of Milan, 20122 Milan, Italy
| | | | - Giancarlo Oliva
- Department of Radiology, ASST Fatebenefratelli Sacco, 20121 Milan, Italy
| | - Michaela Cellina
- Department of Radiology, ASST Fatebenefratelli Sacco, 20121 Milan, Italy
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14
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Maes-Carballo M, Mignini L, Martín-Díaz M, Bueno-Cavanillas A, Khan KS. Clinical practice guidelines and consensus for the screening of breast cancer: A systematic appraisal of their quality and reporting. Eur J Cancer Care (Engl) 2021; 31:e13540. [PMID: 34951075 DOI: 10.1111/ecc.13540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 10/20/2021] [Accepted: 12/02/2021] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Clinical practice guidelines (CPGs) and consensus statements (CSs) are being promoted to provide high-quality healthcare guidance. This systematic review has assessed the breast cancer (BC) screening CPGs and CSs quality and reporting. METHODS A search of bibliographic databases (MEDLINE, Embase, Web of Science, Scopus and CDSR), 12 guideline databases and 51 professional society websites was performed without language restrictions from January 2017 to June 2020, following prospective registration (Prospero no.: CRD42020203807). AGREE II (% of maximum score) and RIGHT (% of total 35 items) appraised quality and reporting individually, extracting data in duplicate; reviewer agreement was 98% and 93%, respectively. RESULTS Forty guidances with median overall quality and reporting 51% (interquartile range [IQR] 39-63) and 48% (IQR 35-65), respectively. Twenty-two (55%) and 20 (50%) did not reach the minimum standards (scores <50%). The guidances that deployed systematic reviews had better quality (74.2% vs. 46.9%; p = 0.001) and reporting (80.5% vs. 42.6%; p = 0.001). Guidances reporting a tool referral scored better (AGREE II: 72.8% vs. 43.1%, p = 0.002; RIGHT: 75.0% vs. 46.9%, p = 0.004). CONCLUSION BC screening CPGs and CSs suffered poor quality and reporting. More than half did not reach the minimum standards. They would improve if systematic reviews were used to underpin the recommendations made.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Breast Cancer Unit, Complexo Hospitalario Universitario de Ourense, Ourense, Spain.,Department of General Surgery, Hospital Público de Verín, Ourense, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | | | | | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain.,Instituto de Investigación Biosanitaria, IBS, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Spain
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15
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Ward AV, Anderson SM, Sartorius CA. Advances in Analyzing the Breast Cancer Lipidome and Its Relevance to Disease Progression and Treatment. J Mammary Gland Biol Neoplasia 2021; 26:399-417. [PMID: 34914014 PMCID: PMC8883833 DOI: 10.1007/s10911-021-09505-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 12/08/2021] [Indexed: 11/25/2022] Open
Abstract
Abnormal lipid metabolism is common in breast cancer with the three main subtypes, hormone receptor (HR) positive, human epidermal growth factor 2 (HER2) positive, and triple negative, showing common and distinct lipid dependencies. A growing body of studies identify altered lipid metabolism as impacting breast cancer cell growth and survival, plasticity, drug resistance, and metastasis. Lipids are a class of nonpolar or polar (amphipathic) biomolecules that can be produced in cells via de novo synthesis or acquired from the microenvironment. The three main functions of cellular lipids are as essential components of membranes, signaling molecules, and nutrient storage. The use of mass spectrometry-based lipidomics to analyze the global cellular lipidome has become more prevalent in breast cancer research. In this review, we discuss current lipidomic methodologies, highlight recent breast cancer lipidomic studies and how these findings connect to disease progression and therapeutic development, and the potential use of lipidomics as a diagnostic tool in breast cancer. A better understanding of the breast cancer lipidome and how it changes during drug resistance and tumor progression will allow informed development of diagnostics and novel targeted therapies.
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Affiliation(s)
- Ashley V Ward
- Cancer Biology Graduate Program, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Steven M Anderson
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - Carol A Sartorius
- Department of Pathology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA.
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16
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Ho PJ, Wong FY, Chay WY, Lim EH, Lim ZL, Chia KS, Hartman M, Li J. Breast cancer risk stratification for mammographic screening: A nation-wide screening cohort of 24,431 women in Singapore. Cancer Med 2021; 10:8182-8191. [PMID: 34708579 PMCID: PMC8607242 DOI: 10.1002/cam4.4297] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 08/10/2021] [Accepted: 08/26/2021] [Indexed: 12/19/2022] Open
Abstract
Background Breast cancer incidence is increasing in Asia. However, few women in Singapore attend routine mammography screening. We aim to identify women at high risk of breast cancer who will benefit most from regular screening using the Gail model and information from their first screen (recall status and mammographic density). Methods In 24,431 Asian women (50–69 years) who attended screening between 1994 and 1997, 117 developed breast cancer within 5 years of screening. Cox proportional hazard models were used to study the associations between risk classifiers (Gail model 5‐year absolute risk, recall status, mammographic density), and breast cancer occurrence. The efficacy of risk stratification was evaluated by considering sensitivity, specificity, and the proportion of cancers identified. Results Adjusting for information from first screen attenuated the hazard ratios (HR) associated with 5‐year absolute risk (continuous, unadjusted HR [95% confidence interval]: 2.3 [1.8–3.1], adjusted HR: 1.9 [1.4–2.6]), but improved the discriminatory ability of the model (unadjusted AUC: 0.615 [0.559–0.670], adjusted AUC: 0.703 [0.653–0.753]). The sensitivity and specificity of the adjusted model were 0.709 and 0.622, respectively. Thirty‐eight percent of all breast cancers were detected in 12% of the study population considered high risk (top five percentile of the Gail model 5‐year absolute risk [absolute risk ≥1.43%], were recalled, and/or mammographic density ≥50%). Conclusion The Gail model is able to stratify women based on their individual breast cancer risk in this population. Including information from the first screen can improve prediction in the 5 years after screening. Risk stratification has the potential to pick up more cancers.
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Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Wen Yee Chay
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Singapore
| | - Zi Lin Lim
- Genome Institute of Singapore, Singapore, Singapore
| | - Kee Seng Chia
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
| | - Jingmei Li
- Genome Institute of Singapore, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine National University of Singapore, Singapore, Singapore
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17
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Maes-Carballo M, Moreno-Asencio T, Martín-Díaz M, Mignini L, Bueno-Cavanillas A, Khan KS. Shared decision making in breast cancer screening guidelines: a systematic review of their quality and reporting. Eur J Public Health 2021; 31:873-883. [PMID: 34148093 DOI: 10.1093/eurpub/ckab084] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Shared decision making (SDM) is a key component of evidence-based and patient-centred care. The aim of this study is to systematically review the quality of SDM proposals in clinical practice guidelines (CPGs) and consensus statements (CSs) concerning breast cancer (BC) screening. METHODS Guidances were identified, without language restrictions, using a prospectively planned systematic search (MEDLINE, EMBASE, Web of Science, Scopus and guideline websites) from January 2010 to August 2020. Duplicate data extraction used a 31-item SDM quality assessment tool; reviewer agreement was 98%. RESULTS SDM appeared only in 38 (49.4%) (33/68 CPGs, 4/9 CSs) documents (overall compliance with the quality tool: mean 5.74, IQR 3-8). CPGs and CSs specifically mentioning the term SDM (n = 12) had higher quality (mean 6.8, IQR 4-9 vs. mean 2.1, IQR 0-3; P = 0.001). No differences were found in mean quality comparing CPGs with CSs (3 vs. 1.6; P = 0.634), use of systematic review (4.2 vs. 2.9; P = 0.929) and publication in a journal (4 vs. 1.9; P = 0.094). Guidances with SDM were more recently reported than those without it (mean 41 vs. 57 months; P = 0.042). CONCLUSION More than half of all the guidelines did not meet SDM quality criteria. Those that explored it were more recently reported. There is an urgent need for promoting SDM in guidances concerning BC screening issued by institutions, professional associations and medical journals.
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Affiliation(s)
- Marta Maes-Carballo
- Department of General Surgery, Complexo Hospitalario de Ourense, Ourense, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,Department of General Surgery, Hospital Público de Verín, Ourense, Spain
| | | | | | | | - Aurora Bueno-Cavanillas
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Instituto de Investigación Biosanitaria IBS, Granada, Spain
| | - Khalid Saeed Khan
- Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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18
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Grimm LJ, Neely B, Hou R, Selvakumaran V, Baker JA, Yoon SC, Ghate SV, Walsh R, Litton TP, Devalapalli A, Kim C, Soo MS, Hyslop T, Hwang ES, Lo JY. Mixed-Methods Study to Predict Upstaging of DCIS to Invasive Disease on Mammography. AJR Am J Roentgenol 2021; 216:903-911. [PMID: 32783550 PMCID: PMC10729920 DOI: 10.2214/ajr.20.23679] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND. The incidence of ductal carcinoma in situ (DCIS) has steadily increased, as have concerns regarding overtreatment. Active surveillance is a novel treatment strategy that avoids surgical excision, but identifying patients with occult invasive disease who should be excluded from active surveillance is challenging. Radiologists are not typically expected to predict the upstaging of DCIS to invasive disease, though they might be trained to perform this task. OBJECTIVE. The purpose of this study was to determine whether a mixed-methods two-stage observer study can improve radiologists' ability to predict upstaging of DCIS to invasive disease on mammography. METHODS. All cases of DCIS calcifications that underwent stereotactic biopsy between 2010 and 2015 were identified. Two cohorts were randomly generated, each containing 150 cases (120 pure DCIS cases and 30 DCIS cases upstaged to invasive disease at surgery). Nine breast radiologists reviewed the mammograms in the first cohort in a blinded fashion and scored the probability of upstaging to invasive disease. The radiologists then reviewed the cases and results collectively in a focus group to develop consensus criteria that could improve their ability to predict upstaging. The radiologists reviewed the mammograms from the second cohort in a blinded fashion and again scored the probability of upstaging. Statistical analysis compared the performances between rounds 1 and 2. RESULTS. The mean AUC for reader performance in predicting upstaging in round 1 was 0.623 (range, 0.514-0.684). In the focus group, radiologists agreed that upstaging was better predicted when an associated mass, asymmetry, or architectural distortion was present; when densely packed calcifications extended over a larger area; and when the most suspicious features were focused on rather than the most common features. Additionally, radiologists agreed that BI-RADS descriptors do not adequately characterize risk of invasion, and that microinvasive disease and smaller areas of DCIS will have poor prediction estimates. Reader performance significantly improved in round 2 (mean AUC, 0.765; range, 0.617-0.852; p = .045). CONCLUSION. A mixed-methods two-stage observer study identified factors that helped radiologists significantly improve their ability to predict upstaging of DCIS to invasive disease. CLINICAL IMPACT. Breast radiologists can be trained to better predict upstaging of DCIS to invasive disease, which may facilitate discussions with patients and referring providers.
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Affiliation(s)
- Lars J Grimm
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Benjamin Neely
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - Rui Hou
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Vignesh Selvakumaran
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Jay A Baker
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Sora C Yoon
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Sujata V Ghate
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Ruth Walsh
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Tyler P Litton
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
- Present address: Greensboro Imaging, Greensboro, NC
| | - Amrita Devalapalli
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
- Present address: Mecklenburg Radiology, Charlotte, NC
| | - Connie Kim
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Mary Scott Soo
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
| | - Terry Hyslop
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC
| | - E Shelley Hwang
- Department of Surgery, Duke University Medical Center, Durham, NC
| | - Joseph Y Lo
- Department of Diagnostic Radiology, Duke University Medical Center, 2301 Erwin Rd, Box 3808, Durham, NC 27710
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19
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Szucs Z, Joseph J, Larkin TJ, Xie B, Bohndiek SE, Brindle KM, Neves AA. Multi-modal imaging of high-risk ductal carcinoma in situ of the breast using C2Am: a targeted cell death imaging agent. Breast Cancer Res 2021; 23:25. [PMID: 33596961 PMCID: PMC7891030 DOI: 10.1186/s13058-021-01404-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) is a non-invasive form of early breast cancer, with a poorly understood natural history of invasive transformation. Necrosis is a well-recognized adverse prognostic feature of DCIS, and non-invasive detection of its presence and spatial extent could provide information not obtainable by biopsy. We describe here imaging of the distribution and extent of comedo-type necrosis in a model of human DCIS using C2Am, an imaging agent that binds to the phosphatidylserine exposed by necrotic cells. METHODS We used an established xenograft model of human DCIS that mimics the histopathological features of the disease. Planar near-infrared and optoacoustic imaging, using fluorescently labeled C2Am, were used to image non-invasively the presence and extent of lesion necrosis. RESULTS C2Am showed specific and sensitive binding to necrotic areas in DCIS tissue, detectable both in vivo and ex vivo. The imaging signal generated in vivo using near-infrared (NIR) fluorescence imaging was up to 6-fold higher in DCIS lesions than in surrounding fat pad or skin tissue. There was a correlation between the C2Am NIR fluorescence (Pearson R = 0.783, P = 0.0125) and optoacoustic signals (R > 0.875, P < 0.022) in the DCIS lesions in vivo and the corresponding levels of cell death detected histologically. CONCLUSIONS C2Am is a targeted multi-modal imaging agent that could complement current anatomical imaging methods for detecting DCIS. Imaging the presence and spatial extent of necrosis may give better prognostic information than that obtained by biopsy alone.
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Affiliation(s)
- Zoltan Szucs
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK
| | - James Joseph
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK
- Department of Physics, University of Cambridge, Cambridge, UK
- Present address: University of Dundee, School of Science and Engineering, Dundee, UK
| | - Tim J Larkin
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK
| | - Bangwen Xie
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK
| | - Sarah E Bohndiek
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK
- Department of Physics, University of Cambridge, Cambridge, UK
| | - Kevin M Brindle
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK.
- Department of Biochemistry, University of Cambridge, Cambridge, UK.
| | - André A Neves
- Cancer Research UK Cambridge Institute, Li Ka Shing Centre, University of Cambridge, Robinson Way, Cambridge, CB2 0RE, UK.
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20
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Schoenborn NL, Pinheiro A, Kistler CE, Schonberg MA. Association between Breast Cancer Screening Intention and Behavior in the Context of Screening Cessation in Older Women. Med Decis Making 2021; 41:240-244. [PMID: 33435829 DOI: 10.1177/0272989x20979108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nancy L Schoenborn
- Department of Medicine, Division of Geriatric Medicine and Gerontology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Adlin Pinheiro
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline, MA, USA
| | - Christine E Kistler
- Division of Geriatric Medicine and Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Mara A Schonberg
- Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Brookline, MA, USA
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21
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Nowak SA, Parker AM, Radhakrishnan A, Schoenborn N, Pollack CE. Using an Agent-based Model to Examine Deimplementation of Breast Cancer Screening. Med Care 2021; 59:e1-e8. [PMID: 33165149 PMCID: PMC8455059 DOI: 10.1097/mlr.0000000000001442] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the potential impact of provider social networks and experiences with patients on deimplementation of breast cancer screening. RESEARCH DESIGN We constructed the Breast Cancer-Social network Agent-based Model (BC-SAM), which depicts breast cancer screening decisions, incidence, and progression among 10,000 women ages 40 and over and the screening recommendations of their providers over a 30-year period. The model has patient and provider modules that each incorporate social network influences. Patients and providers were connected in a network, which represented patient-patient peer connections, provider-provider peer connections, connections between providers and patients they treat, and friend/family relationships between patients and providers. We calibrated provider decisions in the model using data from the CanSNET national survey of primary care physicians in the United States, which we fielded in 2016. RESULTS First, assuming that providers' screening recommendations for women ages 50-74 remain unchanged but their recommendations for screening among younger (below 50 y old) and older (75+ y old) women decrease, we observed a decline in predicted screening rates for women ages 50-74 due to spillover effects. Second, screening rates for younger and older women were slow to respond to changes in provider recommendations; a 78% decline in provider recommendations to older women over 30 years resulted in an estimated 23% decline in patient screening in that group. Third, providers' experiences with unscreened patients, friends, and family members modestly increased screening recommendations over time (7 percentage points). Finally, we found that provider peer effects can have a substantial impact on population screening rates and can entrench existing practices. CONCLUSION Modeling cancer screening as a complex social system demonstrates a range of potential effects and may help target future interventions designed to reduce overscreening.
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Affiliation(s)
- Sarah A Nowak
- Larner College of Medicine, University of Vermont, Burlington, VT
| | | | | | | | - Craig E Pollack
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Iqbal U, Celi LA, Li YCJ. How Can Artificial Intelligence Make Medicine More Preemptive? J Med Internet Res 2020; 22:e17211. [PMID: 32780024 PMCID: PMC7448175 DOI: 10.2196/17211] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 06/05/2020] [Accepted: 06/25/2020] [Indexed: 12/21/2022] Open
Abstract
In this paper we propose the idea that Artificial intelligence (AI) is ushering in a new era of "Earlier Medicine," which is a predictive approach for disease prevention based on AI modeling and big data. The flourishing health care technological landscape is showing great potential-from diagnosis and prescription automation to the early detection of disease through efficient and cost-effective patient data screening tools that benefit from the predictive capabilities of AI. Monitoring the trajectories of both in- and outpatients has proven to be a task AI can perform to a reliable degree. Predictions can be a significant advantage to health care if they are accurate, prompt, and can be personalized and acted upon efficiently. This is where AI plays a crucial role in "Earlier Medicine" implementation.
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Affiliation(s)
- Usman Iqbal
- Master Program in Global Health & Development, PhD Program in Global Health & Health Security, College of Public Health, Taipei Medical University, Taipei, Taiwan.,International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan
| | - Leo Anthony Celi
- Laboratory for Computational Physiology, Massachusetts Institute of Technology, Cambridge, MA, United States.,Division of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States.,Department of Biostatistics, Harvard TH Chan School of Public Health, Harvard University, Boston, MA, United States
| | - Yu-Chuan Jack Li
- International Center for Health Information Technology, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.,Department of Dermatology, Taipei Municipal Wan-Fang Hospital, Taipei, Taiwan.,International Medical Informatics Association, Geneva, Switzerland
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23
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O'Keefe JR, Wilkinson JM, Spuur KM. Current practice in mammographic imaging of the augmented breast in Australia. J Med Radiat Sci 2020; 67:102-110. [PMID: 31981297 PMCID: PMC7276184 DOI: 10.1002/jmrs.374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/22/2019] [Accepted: 11/27/2019] [Indexed: 11/25/2022] Open
Abstract
AIM This study seeks to document the imaging series used in contemporary Australian practice for imaging the augmented breast, with a secondary focus on differences in practice and opinion between BreastScreen Australia and diagnostic imaging services. METHODS A SurveyMonkey link was distributed through the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) and was assessable during December 2017 and January 2018. The questionnaire investigated: years of experience, facility type and location, image acquisition systems, appointment times, patients imaged per week, technique and imaging series used, use of limited compression views, rationale for variation in imaging series and the use of ultrasound. Descriptive statistics were produced for all variables with chi-squared tests used for comparisons between categorical variables. RESULTS The most frequently used series was the eight-image Eklund ID technique 64% and 59% (submuscular) and 68% and 58% (subglandular) for BSA and diagnostic services, respectively. Eighteen different combinations of projections were reported with eight combinations common to both subglandular and submuscular imaging. The majority of participants attributed imaging series preferences to dose reduction and radiologist preference. CONCLUSION This research has demonstrated varied approaches to the routine imaging of women with breast implants and identified the need for the establishment of dedicated evidence-based imaging protocols to ensure that regardless of which setting a woman attends that they receive standardised imaging with minimal dose and maximum breast coverage. This is a reassurance that is not applicable to current practice.
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Affiliation(s)
- Jacquelyn R O'Keefe
- Faculty of Science, School of Dentistry & Health SciencesCharles Sturt UniversityWagga WaggaNew South WalesAustralia
| | - Jenny Maree Wilkinson
- Faculty of Science, School of Dentistry & Health SciencesCharles Sturt UniversityWagga WaggaNew South WalesAustralia
| | - Kelly Maree Spuur
- Faculty of Science, School of Dentistry & Health SciencesCharles Sturt UniversityWagga WaggaNew South WalesAustralia
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Low-Value Clinical Practices: Knowledge and Beliefs of Spanish Surgeons and Anesthetists. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103556. [PMID: 32438657 PMCID: PMC7277874 DOI: 10.3390/ijerph17103556] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVES: To know the frequency and causes of low value surgical practices, according to the opinion of surgeons and anesthetists, and to determine their degree of knowledge about the Spanish "Choosing wisely" initiative. METHODS: Cross-sectional observational study, based on a self-administered online questionnaire through an opportunistic sample of 370 surgeons and anesthetists from three Spanish regions, contacted through Scientific Societies. The survey took part between July and December 2017. RESULTS: A patient profile requesting unnecessary practices was identified (female, 51-65 years old and unaffiliated disease). The frequency of requests was weekly or daily for 50.0% of the professionals, of whom 15.1% acknowledged succumbing to these pressures. To dissuade the patient, clinical reasons (47%) were considered the most effective. To increase control and safety in the case was the main reason to indicate them. The greatest responsibility for overuse was attributed to physicians, defensive medicine and mass media. Assessing professionals' knowledge on unnecessary practices, an average of 5 correct answers out of 7 was obtained. Some 64.1% of the respondents were unaware of the Spanish "Choosing wisely" initiative. CONCLUSIONS: Low value surgical practices are perceived as a frequent problem, which requires an approach entailing intervention with patients and the media as well as professionals. Increase awareness on unnecessary surgical practices, and how to avoid them remain essential.
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Grimm LJ, Destounis SV, Rahbar H, Soo MS, Poplack SP. Ductal Carcinoma In Situ Biology, Language, and Active Surveillance: A Survey of Breast Radiologists' Knowledge and Opinions. J Am Coll Radiol 2020; 17:1252-1258. [PMID: 32278849 DOI: 10.1016/j.jacr.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/05/2020] [Accepted: 03/06/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To understand how breast radiologists perceive ductal carcinoma in situ (DCIS). MATERIALS AND METHODS A 19-item survey was developed by the Society of Breast Imaging Patient Care and Delivery Committee and distributed to all Society of Breast Imaging members. The survey queried respondents' demographics, knowledge of DCIS biology, language used to discuss a new diagnosis of DCIS, and perspectives on active surveillance for DCIS. Five-point Likert scales (1 = strongly disagree, 3 = neutral, 5 = strongly agree) were used. RESULTS There were 536 responses for a response rate of 41%. There was agreement that DCIS is the primary driver of overdiagnosis in breast cancer screening (median 4), and respondents provided mean and median overdiagnosis estimates of 29.7% and 25% for low-grade DCIS as well as 4.2% and 0% for high-grade DCIS, respectively. Responses varied in how to describe DCIS but most often used the word "cancer" with a qualifier such as "early" (32%) or "pre-invasive" (25%). Respondents disagreed (median 2) with removing the word "carcinoma" from DCIS. Finally, there was agreement that current standard of care therapy for some forms of DCIS is overtreatment (median 4) and that active surveillance as an alternative management strategy should be studied (mean 4), but felt that ultrasound (median 4) and MRI (median 4) should be used to exclude women with occult invasive disease before active surveillance. CONCLUSIONS Breast radiologists' opinions about DCIS biology, language, and active surveillance are not homogenous, but general trends exist that can be used to guide research, education, and advocacy efforts.
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Affiliation(s)
- Lars J Grimm
- Department of Radiology, Duke University Medical Center, Durham, North Carolina.
| | | | - Habib Rahbar
- Clinical Director of Breast Imaging, Seattle Cancer Care Alliance; Department of Radiology, University of Washington School of Medicine, Seattle, Washington
| | - Mary Scott Soo
- Department of Radiology, Duke University Medical Center, Durham, North Carolina
| | - Steven P Poplack
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St Louis, Saint Louis, Missouri
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I. Mohammed S, Utturkar S, Lee M, Yang HH, Cui Z, Atallah Lanman N, Zhang G, Ramos Cardona XE, Mittal SK, Miller MA. Ductal Carcinoma In Situ Progression in Dog Model of Breast Cancer. Cancers (Basel) 2020; 12:cancers12020418. [PMID: 32053966 PMCID: PMC7072653 DOI: 10.3390/cancers12020418] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/25/2020] [Accepted: 02/06/2020] [Indexed: 12/12/2022] Open
Abstract
The mechanisms that drive ductal carcinoma in situ (DCIS) progression to invasive cancer are not clear. Studying DCIS progression in humans is challenging and not ethical, thus necessitating the characterization of an animal model that faithfully resembles human disease. We have characterized a canine model of spontaneous mammary DCIS and invasive cancer that shares histologic, molecular, and diagnostic imaging characteristics with DCIS and invasive cancer in women. The purpose of the study was to identify markers and altered signaling pathways that lead to invasive cancer and shed light on early molecular events in breast cancer progression and development. Transcriptomic studies along the continuum of cancer progression in the mammary gland from healthy, through atypical ductal hyperplasia (ADH), DCIS, and invasive carcinoma were performed using the canine model. Gene expression profiles of preinvasive DCIS lesions closely resemble those of invasive carcinoma. However, certain genes, such as SFRP2, FZD2, STK31, and LALBA, were over-expressed in DCIS compared to invasive cancer. The over-representation of myoepithelial markers, epithelial-mesenchymal transition (EMT), canonical Wnt signaling components, and other pathways induced by Wnt family members distinguishes DCIS from invasive. The information gained may help in stratifying DCIS as well as identify actionable targets for primary and tertiary prevention or targeted therapy.
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Affiliation(s)
- Sulma I. Mohammed
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
- Correspondence: ; Tel.: +1-765-494-9948; Fax: +1-765-494-9830
| | - Sagar Utturkar
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
| | - Maxwell Lee
- High Dimension Data Analysis Group, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20852, USA; (M.L.); (H.H.Y.)
| | - Howard H. Yang
- High Dimension Data Analysis Group, Center for Cancer Research, National Cancer Institute, Bethesda, MD 20852, USA; (M.L.); (H.H.Y.)
| | - Zhibin Cui
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
| | - Nadia Atallah Lanman
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
| | - GuangJun Zhang
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
| | - Xavier E. Ramos Cardona
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
| | - Suresh K. Mittal
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
| | - Margaret A. Miller
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN 47907, USA; (Z.C.); (N.A.L.); (G.Z.); (X.E.R.C.); (S.K.M.); (M.A.M.)
- Center for Cancer Research, Purdue University, West Lafayette, IN 47907, USA;
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Fichtali K, Bititi A, Elghanmi A, Ghazi B. Serum Lipidomic Profiling in Breast Cancer to Identify Screening, Diagnostic, and Prognostic Biomarkers. Biores Open Access 2020; 9:1-6. [PMID: 32042507 PMCID: PMC6945794 DOI: 10.1089/biores.2018.0022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Breast cancer is the major mortality cause of women worldwide. In the course of management of breast cancer, the identification of a biomarker is important in enhancing our knowledge on cancer pathology, predicting the response to treatment, and selecting the patients who are more favorable to receive certain treatments. These biomarkers have a prognostic value. In addition to traditional breast cancer prognosis factors such as the tumor size and grade, the axillary lymph node micrometastasis, and biomarkers such as HER2/neu, newly discovered biomarkers have been discovered. Some of these factors are genetic signature in tissue or in peripheral blood. Lipid profil, a simple and accessible biological examination, has been a novel path on the prediction of breast cancer risk of occurrence and recurrence in many studies. The main goal of our review is to evaluate lipid profile and breast cancer risk with an emphasis on the prognosis value of lipid profiles in breast cancer patient management.
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Affiliation(s)
- Karima Fichtali
- Cheikh Khalifa International Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Amine Bititi
- Cheikh Khalifa International Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Adil Elghanmi
- Cheikh Khalifa International Hospital, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
| | - Bouchra Ghazi
- National Laboratory of Reference, Faculty of Medicine, Mohammed VI University of Health Sciences (UM6SS), Casablanca, Morocco
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Helvie MA. Perspectives on the Overdiagnosis of Breast Cancer Associated with Mammographic Screening. JOURNAL OF BREAST IMAGING 2019; 1:278-282. [PMID: 38424804 DOI: 10.1093/jbi/wbz059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/03/2019] [Indexed: 03/02/2024]
Abstract
Overdiagnosis of breast cancer refers to the screen detection and diagnosis of breast cancer that would not have progressed to symptomatic cancer during a woman's lifetime. Screening mammography, like all screening tests, will result in some overdiagnosis that is attributable to competing causes of death occurring during the lead time (the time period between asymptomatic screen detection and clinical detection) and detection of very indolent cancer. The primary harm of overdiagnosis relates to subsequent (unnecessary) treatment. Importantly, overdiagnosis concerns must be balanced with the lifesaving and morbidity benefits of screening mammography and the prevention of some invasive cancer by detection and treatment of ductal carcinoma in situ. Reasonable estimates of overdiagnosis of women aged 40-80 years are in the order of 1%-10%, with lower values when overdiagnosis is restricted to invasive cancer and among younger women. Prospective identification of an overdiagnosed invasive cancer is not currently possible. Delaying screening until age 50 years or screening biennially rather than annually will not substantially reduce the amount of overdiagnosis of invasive cancer. The clinical significance of overdiagnosis will continue to be minimized as advances in personalized medicine further reduce treatment-associated morbidity.
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Affiliation(s)
- Mark A Helvie
- Michigan Medicine - University of Michigan, Department of Radiology, Ann Arbor, MI
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Lei C, Wei W, Liu Z, Xiong Q, Yang C, Yang M, Zhang L, Zhu T, Zhuang X, Liu C, Liu Z, Tian J, Wang K. Mammography-based radiomic analysis for predicting benign BI-RADS category 4 calcifications. Eur J Radiol 2019; 121:108711. [PMID: 31677544 DOI: 10.1016/j.ejrad.2019.108711] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 10/11/2019] [Indexed: 02/05/2023]
Abstract
PURPOSE We developed and validated a radiomic model based on mammography and assessed its value for predicting the pathological diagnosis of Breast Imaging Reporting and Data System (BI-RADS) category 4 calcifications. MATERIALS AND METHODS Patients with a total of 212 eligible calcifications were recruited (159 cases in the primary cohort and 53 cases in the validation cohort). In total, 8286 radiomic features were extracted from the craniocaudal (CC) and mediolateral oblique (MLO) images. Machine learning was used to select features and build a radiomic signature. The clinical risk factors were selected from the independent clinical factors through logistic regression analyses. The radiomic nomogram incorporated the radiomic signature and an independent clinical risk factor. The diagnostic performance of the radiomic model and the radiologists' empirical prediction model was evaluated by the area under the receiver operating characteristic curve (AUC). The differences between the various AUCs were compared with DeLong's test. RESULTS Six radiomic features and the menopausal state were included in the radiomic nomogram, which discriminated benign calcifications from malignant calcifications with an AUC of 0.80 in the validation cohort. The difference between the classification results of the radiomic nomogram and that of radiologists was significant (p < 0.05). Particularly for patients with calcifications that are negative on ultrasounds but can be detected by mammography (MG+/US- calcifications), the identification ability of the radiomic nomogram was very strong. CONCLUSIONS The mammography-based radiomic nomogram is a potential tool to distinguish benign calcifications from malignant calcifications.
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Affiliation(s)
- Chuqian Lei
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, 510080, China
| | - Wei Wei
- School of Electronics and Information, Xi'an Polytechnic University, Xi'an, 710000, China; Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, 710126, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Zhenyu Liu
- CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China
| | - Qianqian Xiong
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China; Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, 510080, China
| | - Ciqiu Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Mei Yang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Liulu Zhang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Teng Zhu
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China
| | - Xiaosheng Zhuang
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China; Shantou University Medical College, Shantou, 515041, Guangdong, China
| | - Chunling Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou, 510080, China
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou, 510080, China
| | - Jie Tian
- Engineering Research Center of Molecular and Neuro Imaging of Ministry of Education, School of Life Science and Technology, Xidian University, Xi'an, 710126, China; CAS Key Laboratory of Molecular Imaging, Institute of Automation, Chinese Academy of Sciences, Beijing, 100190, China; University of Chinese Academy of Sciences, Beijing, 100190, China.
| | - Kun Wang
- Department of Breast Cancer, Cancer Center, Guangdong Provincial People's Hospital & Guangdong Academy of Medical Sciences, 510080, China; The Second School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, China.
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Bellanger M, Zeinomar N, Tehranifar P, Terry MB. Are Global Breast Cancer Incidence and Mortality Patterns Related to Country-Specific Economic Development and Prevention Strategies? J Glob Oncol 2019; 4:1-16. [PMID: 30085889 PMCID: PMC6223528 DOI: 10.1200/jgo.17.00207] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Purpose There remains considerable international variation in breast cancer incidence and mortality, but a comprehensive examination of rates by country level economic, development and cancer prevention policies is lacking. Materials and Methods We compared GLOBOCAN 2012 age-specific breast cancer incidence and mortality rates for 177 countries by using development and policy data available from the WHO Global Cancer Country Profiles data base. We classified each country on the basis of gross national income per capita from the World Development Indicators data base, as follows: low-income country (LIC), lower-middle–income country (LMIC), upper-middle–income country (UMIC), and high-income country (HIC). Results There were 1,651,326 breast cancer cases and 516,868 breast cancer deaths estimated in 2012. Approximately three quarters of all breast cancer cases and 60% of the breast cancer deaths were in women from HICs and UMICs. Age and country-level income explained approximately 60% of the international variation in breast cancer incidence and mortality in women of all ages (adjusted R2 = 58% and 60%, respectively). Economic development indicators additionally increased the overall variation in incidence and mortality by approximately 5%. In women younger than age 50 years, country-level income explained 68% of incidence and 59% of mortality; economic development indicators additionally increased this percentage by approximately 4%. Country-level cancer prevention policy indicators contributed little to explanation of the overall variation in incidence and mortality after analysis accounted for age and country-level income; however, an overall resource summary index of greater economic development and cancer prevention policies was related to lower mortality within each major income level. Conclusion Although breast cancer incidence increases with higher income levels in all ages, women in the poorest countries bear a relatively higher burden of breast cancer mortality, particularly women younger than age 50 years.
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Affiliation(s)
- Martine Bellanger
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Nur Zeinomar
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Parisa Tehranifar
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
| | - Mary Beth Terry
- Martine Bellanger, Ecole des Hautes Etudes en Sante Publique - University Sorbonne Paris Cite, Paris, France; Nur Zeinomar, Prisa Tehranifar, and Mary Beth Terry, Columbia University; Parisa Tehranifar and Mary Beth Terry, Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; and Martine Bellanger, Nur Zeinomar, Parisa Tehranifar, and Mary Beth Terry, International Breast Cancer and Nutrition Project, Lafayette, IN
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Salikhanov I, Crape B, Howie P. Cost- Effectiveness of Mammography Screening Program in a Resource-Limited Post-Soviet Country of Kazakhstan. Asian Pac J Cancer Prev 2019; 20:3153-3160. [PMID: 31653167 PMCID: PMC6982668 DOI: 10.31557/apjcp.2019.20.10.3153] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 09/27/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To conduct cost effectiveness and benefit-cost analyses of the organized mammography-screening program in the Republic of Kazakhstan comparing women who developed breast cancer in screened and unscreened scenario. METHODS 389,352 screened women were included in the study. Among these, 895 women were further diagnosed with breast cancer. Outcomes measures include life years saved, quality-adjusted life years, incremental cost-effectiveness ratio, and value of statistical life year. Sensitivity analyses were performed to assess uncertainty. RESULTS Compared to no screening scenario, an organized mammography yielded an additional 1,253 life years and 790 quality-adjusted life years in 2016. The incremental cost-effectiveness ratio was equal to 3,157 USD per one QALY saved, which is two times less than the GDP per capita in Kazakhstan in 2016. Sensitivity analysis showed that the mammography remains cost-effective in the majority of the scenarios. CONCLUSION Mammography screening in Kazakhstan was found to be highly cost-effective, associated with treatment cost savings, and can be an efficient use of limited resources in Kazakhstan.
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Affiliation(s)
- Islam Salikhanov
- Nazarbayev University, School of Medicine, Nur-Sultan, Kazakhstan.
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Screening outcome for consecutive examinations with digital breast tomosynthesis versus standard digital mammography in a population-based screening program. Eur Radiol 2019; 29:6991-6999. [DOI: 10.1007/s00330-019-06264-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
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Rodrigues DCN, Freitas-Junior R, Rahal RMS, Correa RDS, Peixoto JE, Ribeiro NV, Ferreira NC, Soares LR. Difficult Access and Poor Productivity: Mammography Screening in Brazil. Asian Pac J Cancer Prev 2019; 20:1857-1864. [PMID: 31244310 PMCID: PMC7021592 DOI: 10.31557/apjcp.2019.20.6.1857] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Factors that may hamper access to mammographic screening in any given region include socioeconomic
limitations and the geographical distribution and quality of the mammography machines. This study evaluated access
to breast cancer screening within the Brazilian National Health Service (SUS), the geographical distribution of
mammography equipment and the number of mammograms performed in Brazil. Methods: This ecological study
evaluated the availability of mammography machines within the SUS, those available for Brazil as a whole, its macroregions,
states and the Federal District in 2016. The number of mammography machines required for breast cancer
screening was calculated and compared to the number of machines available. The expected number of mammograms was
compared with the actual number performed. Machines were georeferenced based on their location and the municipal
seat, according to healthcare region, with 60 km being defined as the maximum distance for an individual to travel for
a mammogram. Results: In 2016, there were 4,628 mammography machines in Brazil. Of these, 4,492 were in use
and 2,113 (47%) were available to the SUS. Considering the number of mammograms required as a function of the
number clinically indicated, 2,068 machines would be required for breast cancer screening in Brazil. The network of
machines available would be capable of producing 14,279,654 exams; however, only 4,073,079 exams were performed,
representing 29% of the total capacity of production in the country in 2016. Regarding the maximum distance of 60
km to access a mammogram, only relatively small areas of Brazil were found not to meet this indicator. Conclusion:
These results suggest that the difficulty of the Brazilian population in accessing breast cancer screening through the
SUS is not associated with the number of machines available or with the geographical location of the equipment but
rather with the insufficient number of mammograms performed.
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Affiliation(s)
- Danielle Cristina Netto Rodrigues
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Ruffo Freitas-Junior
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Rosemar Macedo Sousa Rahal
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Rosangela da Silveira Correa
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - João Emílio Peixoto
- Brazilian Network for Breast Research, Service for Quality Control in Ionizing Radiation, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Noely Vicente Ribeiro
- Institute of Social and Environmental Studies (IESA), Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Leonardo Ribeiro Soares
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
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Salerno S, Laghi A, Cantone MC, Sartori P, Pinto A, Frija G. Overdiagnosis and overimaging: an ethical issue for radiological protection. Radiol Med 2019; 124:714-720. [PMID: 30900132 DOI: 10.1007/s11547-019-01029-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/11/2019] [Indexed: 02/06/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to analyse the key factors that influence the overimaging using X-ray such as self-referral, defensive medicine and duplicate imaging studies and to emphasize the ethical problem that derives from it. MATERIALS AND METHODS In this study, we focused on the more frequent sources of overdiagnosis such as the total-body CT, proposed in the form of screening in both public and private sector, the choice of the most sensitive test for each pathology such as pulmonary embolism, ultrasound investigations mostly of the thyroid and of the prostate and MR examinations, especially of the musculoskeletal system. RESULTS The direct follow of overdiagnosis and overimaging is the increase in the risk of contrast media infusion, radiant damage, and costs in the worldwide healthcare system. The theme of the costs of overdiagnosis is strongly related to inappropriate or poorly appropriate imaging examination. CONCLUSIONS We underline the ethical imperatives of trust and right conduct, because the major ethical problems in radiology emerge in the justification of medical exposures of patients in the practice. A close cooperation and collaboration across all the physicians responsible for patient care in requiring imaging examination is also important, balancing possible ionizing radiation disadvantages and patient benefits in terms of care.
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Affiliation(s)
- Sergio Salerno
- Department of Diagnostic Radiology, University of Palermo, Policlinico Via del Vespro 127, 90127, Palermo, Italy.
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza-University of Rome, Via di Grottarossa 1035, 00189, Rome, Italy
| | - Marie-Claire Cantone
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Via Pascal 36, 20133, Milan, Italy
| | - Paolo Sartori
- Department of Radiology, SS Giovanni e Paolo Hospital, Castello 6777, 30122, Venice, Italy
| | - Antonio Pinto
- Department of Radiology, CTO Hospital, Azienda Ospedaliera dei Colli, Naples, Italy
| | - Guy Frija
- Department of Diagnostic Radiology, Hopital Européen Georges Pompidou Paris APHP, Université Paris-Descartes, Paris, France
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Diendéré G, Dansokho SC, Rocque R, Julien AS, Légaré F, Côté L, Mahmoudi S, Jacob P, Casais NA, Pilote L, Grad R, Giguère AMC, Witteman HO. How often do both core competencies of shared decision making occur in family medicine teaching clinics? CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2019; 65:e64-e75. [PMID: 30765371 PMCID: PMC6515489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To assess how often risk communication and values clarification occur in routine family medicine practice and to explore factors associated with their occurrence. DESIGN Qualitative and quantitative cross-sectional study. SETTING Five university-affiliated family medicine teaching clinics across Quebec. PARTICIPANTS Seventy-one health professionals (55% physicians, 35% residents, 10% nurses or dietitians) and 238 patients (76% women; age range 16 to 82 years old). MAIN OUTCOME MEASURES The presence or absence of risk communication and values clarification during visits in which decisions were made was determined. Factors associated with the primary outcome (both competencies together) were identified. The OPTION5 (observing patient involvement in decision making) instrument was used to validate the dichotomous outcome. RESULTS The presence of risk communication and values clarification during visits was associated with OPTION5 scores (area under the curve of 0.80, 95% CI 0.75 to 0.86, P < .001). Both core competencies of shared decision making occurred in 150 of 238 (63%) visits (95% CI 54% to 70%). Such an occurrence was more likely when the visit included discussion about beginning something new, treatment options, or postponing a decision, as well as when health professionals preferred a collaborative decision-making style and when the visit included more decisions or was longer. Alone, risk communication occurred in 203 of 238 (85%) visits (95% CI 82% to 96%) and values clarification in 162 of 238 (68%) visits (95% CI 61% to 75%). CONCLUSION Health professionals in family medicine are making an effort to engage patients in shared decision making in routine daily practice, especially when there is time to do so. The greatest potential for improvement might lie in values clarification; that is, discussing what matters to patients and families.
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Affiliation(s)
- Gisèle Diendéré
- Clinical research coordinator at the Jewish General Hospital in Montreal, Que
| | - Selma Chipenda Dansokho
- Research associate in the Research Unit of the Office of Education and Professional Development at Laval University in Quebec city, Que
| | - Rhéa Rocque
- Doctoral student in psychology at Laval University
| | - Anne-Sophie Julien
- Biostatistician in the Clinical Research Platform of the Research Centre of the CHU de Québec in Quebec city
| | - France Légaré
- Practising family physician and Full Professor in the Department of Family and Emergency Medicine at Laval University, Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Scientific Co-director of the Canadian Cochrane Network Site at Laval University, and a researcher at the Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL)
| | - Luc Côté
- Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development in the Faculty of Medicine at Laval University
| | - Sonia Mahmoudi
- Medical student in the Faculty of Medicine at Laval University
| | | | - Natalia Arias Casais
- Consultant with the Pan American Health Organization and the World Health Organization in Washington, DC
| | - Laurie Pilote
- Oncologist in the Division of Radiation Oncology in the Department of Medicine at the CHU de Québec-Laval University
| | - Roland Grad
- Family physician in the Herzl Family Practice Centre in Montreal, and Associate Professor in the Department of Family Medicine and Director of the Clinician Scholar Program in the Department of Family Medicine at McGill University in Montreal
| | - Anik M C Giguère
- Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, the Centre d'excellence sur le vieillissement de Québec at the Research Centre of the CHU de Québec, and the CERSSPL-UL
| | - Holly O Witteman
- Associate Professor in the Department of Family and Emergency Medicine and a researcher in the Office of Education and Professional Development at Laval University, Population Health and Optimal Health Practices at the Research Centre of the CHU de Québec, the Ottawa Hospital Research Institute in Ontario, and the CERSSPL-UL.
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Narayan AK, Elkin EB, Lehman CD, Morris EA. Quantifying performance thresholds for recommending screening mammography: a revealed preference analysis of USPSTF guidelines. Breast Cancer Res Treat 2018; 172:463-468. [PMID: 30128821 DOI: 10.1007/s10549-018-4917-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/06/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE During ongoing controversies about mammography screening, many investigators have stated that performance improvements in screening mammography may mitigate concerns about harms. However, there have been few attempts to quantify performance improvements required to recommend mammography screening. Based on USPSTF benchmarks, we utilized revealed preference methods to ascertain quantitative thresholds at which screening mammography would be recommended beyond biennial screening in women 50 and older. METHODS Benefits of routine screening mammography (breast cancer deaths averted) were from published USPSTF meta-analyses. Potential harms (10-year cumulative probability of at least one false-positive) were from published Breast Cancer Surveillance Consortium estimates. We identified the implicit threshold (benefit/harm ratio) to recommend biennial screening starting at age 50. Using this threshold, we ascertained reductions of false-positives required to recommend more frequent screening and screening initiation under age 50 using revealed preference analyses. RESULTS Using USPSTF implied benefit/harm ratio, routine biennial screening would be recommended starting at 40 if false-positives declined by at least 62%. Reductions of false-positive proportions of 74% would be required to recommend annual screening starting at 40 and reductions of false-positive proportions of 31% would be required to support annual screening starting at 50. CONCLUSIONS Using USPSTF revealed preferences, 31-74% reductions in false-positives would be required to recommend mammography screening beyond biennial screening starting at age 50. Widespread implementation of tomosynthesis and reducing recall rates to the lower end of recommended recall rates (5-12%) would provide support for expanding screening beyond biennial screening in women age 50.
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Affiliation(s)
- Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St. Wang 219H, Boston, MA, 02114, USA.
| | - Elena B Elkin
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | | | - Elizabeth A Morris
- Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Gao Y, Heller SL, Moy L. Male Breast Cancer in the Age of Genetic Testing: An Opportunity for Early Detection, Tailored Therapy, and Surveillance. Radiographics 2018; 38:1289-1311. [PMID: 30074858 DOI: 10.1148/rg.2018180013] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
In detection, treatment, and follow-up, male breast cancer has historically lagged behind female breast cancer. On the whole, breast cancer is less common among men than among women, limiting utility of screening, yet the incidence of male breast cancer is rising, and there are men at high risk for breast cancer. While women at high risk for breast cancer are well characterized, with clearly established guidelines for screening, supplemental screening, risk prevention, counseling, and advocacy, men at high risk for breast cancer are poorly identified and represent a blind spot in public health. Today, more standardized genetic counseling and wider availability of genetic testing are allowing identification of high-risk male relatives of women with breast cancer, as well as men with genetic mutations predisposing to breast cancer. This could provide a new opportunity to update our approach to male breast cancer. This article reviews male breast cancer demographics, risk factors, tumor biology, and oncogenetics; recognizes how male breast cancer differs from its female counterpart; highlights its diagnostic challenges; discusses the implications of the widening clinical use of multigene panel testing; outlines current National Comprehensive Cancer Network guidelines (version 1, 2018) for high-risk men; and explores the possible utility of targeted screening and surveillance. Understanding the current state of male breast cancer management and its challenges is important to shape future considerations for care. Shifting the paradigm of male breast cancer detection toward targeted precision medicine may be the answer to improving clinical outcomes of this uncommon disease. ©RSNA, 2018.
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Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., S.L.H., L.M.); and the Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (L.M.)
| | - Samantha L Heller
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., S.L.H., L.M.); and the Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (L.M.)
| | - Linda Moy
- From the Department of Radiology, New York University Langone Medical Center, 160 E 34th St, New York, NY 10016 (Y.G., S.L.H., L.M.); and the Center for Advanced Imaging Innovation and Research, New York University School of Medicine, New York, NY (L.M.)
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Siedlikowski S, Ells C, Bartlett G. Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women. Public Health Rev 2018; 39:15. [PMID: 29876139 PMCID: PMC5978996 DOI: 10.1186/s40985-018-0092-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 03/29/2018] [Indexed: 12/29/2022] Open
Abstract
CONTEXT A decision to undertake screening for breast cancer often takes place within the primary care setting, but current controversies such as overdiagnosis and inconsistent screening recommendations based on evolving evidence render this a challenging process, particularly for average-risk women. Given the responsibility of primary care providers in counseling women in this decision-making process, it is important to understand their thoughts on these controversies and how they manage uncertainty in their practice. OBJECTIVE To review the perspectives and approaches of primary care providers regarding mammography decision-making with average-risk women. DESIGN AND METHODS This study is a critical interpretive review of peer-review literature that reports primary care provider perspectives on mammography screening decision-making. Ovid MEDLINE®, Ovid PsycInfo, and Scopus databases were searched with dates from 2002 to 2017 using search terms related to mammography screening, uncertainty, counseling, decision-making, and primary health care providers. RESULTS Nine articles were included following a review process involving the three authors. Using an inductive and iterative approach, data were grouped into four thematic categories: (1) perceptions on the effectiveness of screening, screening initiation age, and screening frequency; (2) factors guiding primary care providers in the screening decision-making process, including both provider and patient-related factors, (3) uncertainty faced by primary care providers regarding guidelines and screening discussions with their patients; and (4) informed decision-making with average-risk women, including factors that facilitate and hinder this process. DISCUSSION The discussion of results addresses several factors about the diversity of perspectives and practices of physicians counseling average-risk women regarding breast cancer screening. This has implications for the challenge of understanding and explaining evidence, what should be shared with average-risk women considering screening, the forms of knowledge that physicians value to guide screening decision-making, and the consent process for population-based screening initiatives. Within the data, there was little attention placed on how physicians coped with uncertainty in practice. Given the dual responsibility of physicians in caring for both individuals and the larger population, further research should probe more deeply into how they balance their duties to individual patients with those to the larger population they serve.
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Affiliation(s)
- Sophia Siedlikowski
- Department of Family Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, Suite 300, Canada, QC H3S 1Z1 Canada
| | - Carolyn Ells
- Biomedical Ethics Unit, McGill University, 3647 Peel St, Room 305, Montreal, QC H3A 1X1 Canada
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, 5858, chemin de la Côte-des-Neiges, Suite 300, Canada, QC H3S 1Z1 Canada
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Jeong KY, Kim EK, Park MH, Kim HM. Perspective on Cancer Therapeutics Utilizing Analysis of Circulating Tumor Cells. Diagnostics (Basel) 2018; 8:diagnostics8020023. [PMID: 29641512 PMCID: PMC6023425 DOI: 10.3390/diagnostics8020023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 04/03/2018] [Accepted: 04/09/2018] [Indexed: 12/19/2022] Open
Abstract
Various methods are available for cancer screening, and the methods are performed depending on the origin site of cancer. Among these methods, biopsy followed by medical imaging is the most common. After cancer progression is determined, an optimal treatment—such as surgery, chemotherapy, and/or radiation therapy—is selected. A new assay has been developed that detects circulating tumor cells (CTCs). Tracking changes in CTCs may reveal important tumoral sensitivity information or resistance patterns to specific regimens and prompt changes in therapy on a personalized basis. Characterization of CTCs at the DNA, RNA, and protein levels is important for gaining insight for clinical applications. A small number of CTCs can be analyzed to obtain genome information such as the progression of cancer including metastasis, even in a single cluster. Although many clinical studies, particularly CTC enumeration and detection of specific oncogene expression, have increased the success rate of diagnosis and predicting prognosis, there is no consensus regarding the technical approaches and various aspects of the methodology, making it difficult to standardize optimal methods for CTC analysis. However, ongoing technological advances are currently being achieved and large-scale clinical studies are being conducted. Applying CTC analysis in the clinic would be very useful for advancing diagnosis, prognosis prediction, and therapeutics.
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Affiliation(s)
- Keun-Yeong Jeong
- R&D Division, Metimedi Pharmaceuticals Co., 263, Central-ro, Yeonsu-Gu, Incheon 22006, Korea.
| | - Eun Kyung Kim
- R&D Division, Metimedi Pharmaceuticals Co., 263, Central-ro, Yeonsu-Gu, Incheon 22006, Korea.
| | - Min Hee Park
- R&D Division, Metimedi Pharmaceuticals Co., 263, Central-ro, Yeonsu-Gu, Incheon 22006, Korea.
| | - Hwan Mook Kim
- Gachon Institute of Pharmaceutical Science, Gachon University, 191, Hambangmoe-ro, Yeonsu-gu, Incheon 21936, Korea.
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Perspective on Cancer Therapeutics Utilizing Analysis of Circulating Tumor Cells. DIAGNOSTICS (BASEL, SWITZERLAND) 2018. [PMID: 29641512 DOI: 10.3390/diagnostics8020023.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Various methods are available for cancer screening, and the methods are performed depending on the origin site of cancer. Among these methods, biopsy followed by medical imaging is the most common. After cancer progression is determined, an optimal treatment-such as surgery, chemotherapy, and/or radiation therapy-is selected. A new assay has been developed that detects circulating tumor cells (CTCs). Tracking changes in CTCs may reveal important tumoral sensitivity information or resistance patterns to specific regimens and prompt changes in therapy on a personalized basis. Characterization of CTCs at the DNA, RNA, and protein levels is important for gaining insight for clinical applications. A small number of CTCs can be analyzed to obtain genome information such as the progression of cancer including metastasis, even in a single cluster. Although many clinical studies, particularly CTC enumeration and detection of specific oncogene expression, have increased the success rate of diagnosis and predicting prognosis, there is no consensus regarding the technical approaches and various aspects of the methodology, making it difficult to standardize optimal methods for CTC analysis. However, ongoing technological advances are currently being achieved and large-scale clinical studies are being conducted. Applying CTC analysis in the clinic would be very useful for advancing diagnosis, prognosis prediction, and therapeutics.
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Nguyen CP, Adang EMM. Cost-effectiveness of breast cancer screening using mammography in Vietnamese women. PLoS One 2018; 13:e0194996. [PMID: 29579131 PMCID: PMC5868837 DOI: 10.1371/journal.pone.0194996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 03/14/2018] [Indexed: 12/22/2022] Open
Abstract
Background The incidence rate of breast cancer is increasing and has become the most common cancer in Vietnamese women while the survival rate is lower than that of developed countries. Early detection to improve breast cancer survival as well as reducing risk factors remains the cornerstone of breast cancer control according to the World Health Organization (WHO). This study aims to evaluate the costs and outcomes of introducing a mammography screening program for Vietnamese women aged 45–64 years, compared to the current situation of no screening. Methods Decision analytical modeling using Markov chain analysis was used to estimate costs and health outcomes over a lifetime horizon. Model inputs were derived from published literature and the results were reported as incremental cost-effectiveness ratios (ICERs) and/or incremental net monetary benefits (INMBs). One-way sensitivity analyses and probabilistic sensitivity analyses were performed to assess parameter uncertainty. Results The ICER per life year gained of the first round of mammography screening was US$3647.06 and US$4405.44 for women aged 50–54 years and 55–59 years, respectively. In probabilistic sensitivity analyses, mammography screening in the 50–54 age group and the 55–59 age group were cost-effective in 100% of cases at a threshold of three times the Vietnamese Gross Domestic Product (GDP) i.e., US$6332.70. However, less than 50% of the cases in the 60–64 age group and 0% of the cases in the 45–49 age group were cost effective at the WHO threshold. The ICERs were sensitive to the discount rate, mammography sensitivity, and transition probability from remission to distant recurrence in stage II for all age groups. Conclusion From the healthcare payer viewpoint, offering the first round of mammography screening to Vietnamese women aged 50–59 years should be considered, with the given threshold of three times the Vietnamese GDP per capita.
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Affiliation(s)
- Chi Phuong Nguyen
- Department of Pharmaceutical Administration and Economics, Hanoi University of Pharmacy, Hanoi, Vietnam
- * E-mail:
| | - Eddy M. M. Adang
- Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Kapetas P, Clauser P, Woitek R, Pinker K, Bernathova M, Helbich TH, Baltzer PA. Virtual Touch IQ elastography reduces unnecessary breast biopsies by applying quantitative "rule-in" and "rule-out" threshold values. Sci Rep 2018; 8:3583. [PMID: 29483627 PMCID: PMC5827686 DOI: 10.1038/s41598-018-22065-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 02/10/2018] [Indexed: 11/22/2022] Open
Abstract
Our purpose was to evaluate Virtual Touch IQ (VTIQ) elastography and identify quantitative “rule-in” and “rule-out” thresholds for the probability of malignancy, which can help avoid unnecessary breast biopsies. 189 patients with 196 sonographically evident lesions were included in this retrospective, IRB-approved study. Quantitative VTIQ images of each lesion measuring the respective maximum Shear Wave Velocity (SWV) were obtained. Paired and unpaired, non-parametric statistics were applied for comparisons as appropriate. ROC-curve analysis was used to analyse the diagnostic performance of VTIQ and to specify “rule-in” and “rule-out” thresholds for the probability of malignancy. The standard of reference was either histopathology or follow-up stability for >24 months. 84 lesions were malignant and 112 benign. Median SWV of benign lesions was significantly lower than that of malignant lesions (p < 0.001). The application of a “rule-out” threshold of 1.9 m/s lead to a sensitivity of >98% with a concomitant significant (p = 0.032) reduction in false positive cases of almost 15%, whereas a “rule-in” threshold of 6.5 m/s suggested a probability of malignancy of >95%. In conclusion, VTIQ elastography accurately differentiates malignant from benign breast lesions. The application of quantitative “rule-in” and “rule-out” thresholds is feasible and allows reduction of unnecessary benign breast biopsies by almost 15%.
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Affiliation(s)
- Panagiotis Kapetas
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Ramona Woitek
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Department of Radiology, University of Cambridge, Cambridge Biomedical Campus, CB2 0QQ, Cambridge, UK
| | - Katja Pinker
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.,Memorial Sloan-Kettering Cancer Center, Molecular Imaging and Therapy Service, 301 E 55th St, 10022, New York, NY, USA
| | - Maria Bernathova
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Thomas H Helbich
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Pascal A Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial. Breast Cancer Res Treat 2018; 169:489-496. [DOI: 10.1007/s10549-018-4705-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/10/2017] [Indexed: 11/25/2022]
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44
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Age to Begin and Intervals for Breast Cancer Screening: Balancing Benefits and Harms. AJR Am J Roentgenol 2018; 210:279-284. [DOI: 10.2214/ajr.17.18730] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Chen X, Chen H, Dai M, Ai J, Li Y, Mahon B, Dai S, Deng Y. Plasma lipidomics profiling identified lipid biomarkers in distinguishing early-stage breast cancer from benign lesions. Oncotarget 2017; 7:36622-36631. [PMID: 27153558 PMCID: PMC5095026 DOI: 10.18632/oncotarget.9124] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/16/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breast cancer is very common and highly fatal in women. Current non-invasive detection methods like mammograms are unsatisfactory. Lipidomics, a promising detection method, may serve as a novel prognostic approach for breast cancer in high-risk patients. RESULTS According the predictive model, the combination of 15 lipid species had high diagnostic value. In the training set, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the combination of these 15 lipid species were 83.3%, 92.7%, 89.7%, and 87.9%, respectively. The AUC in the training set was 0.926 (95% CI 0.869-0.982). Similar results were found in the validation set, with the sensitivity, specificity, PPV and NPV at 81.0%, 94.5%, 91.9%, and 86.7%, respectively. The AUC was 0.938 (95% CI 0.889-0.986) in the validation set. METHODS Using triple quadrupole liquid chromatography electrospray ionization tandem mass spectrometry, this study was to detect global lipid profiling of a total of 194 plasma samples from 84 patients with early-stage breast cancer (stage 0-II) and 110 patients with benign breast disease included in a training set and a validation set. A binary logistic regression was used to build a predictive model for evaluating the lipid species as potential biomarkers in the diagnosis of breast cancer. CONCLUSIONS The combination of these 15 lipid species as a panel could be used as plasma biomarkers for the diagnosis of breast cancer.
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Affiliation(s)
- Xiaoli Chen
- Department of Clinical Laboratory, The Fourth Hospital Affiliated to Guangxi Medical University, Liuzhou City, Guangxi Province, China.,Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Hankui Chen
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Meiyu Dai
- Department of Clinical Laboratory, The Fourth Hospital Affiliated to Guangxi Medical University, Liuzhou City, Guangxi Province, China.,Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Junmei Ai
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Yan Li
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Brett Mahon
- Department of Pathology, Rush University Medical Center, Chicago, Illinois, USA
| | - Shengming Dai
- Department of Clinical Laboratory, The Fourth Hospital Affiliated to Guangxi Medical University, Liuzhou City, Guangxi Province, China
| | - Youping Deng
- Department of Medicine, Rush University Medical Center, Chicago, Illinois, USA.,Department of Anatomy and Cell Biology, Rush University Medical Center, Chicago, Illinois, USA.,Medical College, Wuhan University of Science and Technology, Wuhan, Hubei Province, China
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46
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Nagler RH, Franklin Fowler E, Gollust SE. Women's Awareness of and Responses to Messages About Breast Cancer Overdiagnosis and Overtreatment: Results From a 2016 National Survey. Med Care 2017; 55:879-885. [PMID: 28857962 PMCID: PMC5657609 DOI: 10.1097/mlr.0000000000000798] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Scientists, clinicians, and other experts aim to maximize the benefits of cancer screening while minimizing its harms. Chief among these harms are overdiagnosis and overtreatment. Although available data suggest that patient awareness of these harms is low, we know little about how patients respond to information about these phenomena. OBJECTIVES Using the case of breast cancer screening, this study assesses women's awareness of and reactions to statements about overdiagnosis and overtreatment. METHODS We draw on data from a 2016 population-based survey of US women aged 35-55 years that oversampled women of lower socioeconomic position (those living at or below 100% of federal poverty level) (N=429). RESULTS Results showed that women's awareness of overdiagnosis (16.5%) and overtreatment (18.0%) was low, and women under age 40 were least likely to have heard about overdiagnosis. Most women did not evaluate statements about these harms positively: <1 in 4 agreed with and found statements about overdiagnosis and overtreatment to be believable, and even fewer evaluated them as strong arguments to consider in their own mammography decision making. Women with a recent mammogram history were particularly unconvinced by overdiagnosis and overtreatment arguments. CONCLUSIONS A majority of women were unaware of 2 important harms of breast cancer screening: overdiagnosis and overtreatment. Most did not find statements about these harms to be believable and persuasive. Communication interventions, supported by evidence from health communication research, are necessary to improve patient understanding of screening's harms, promote informed decision making, and, in turn, ensure high-value care.
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Affiliation(s)
- Rebekah H Nagler
- *Hubbard School of Journalism and Mass Communication, University of Minnesota, Minneapolis, MN †Department of Government, Wesleyan University, Middletown, CT ‡Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN
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47
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Stiel L, Soret S, Montgomery S. Geographic patterns of change over time in mammography: Differences between Black and White U.S. Medicare enrollees. Cancer Epidemiol 2016; 46:57-65. [PMID: 28033538 DOI: 10.1016/j.canep.2016.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 11/18/2016] [Accepted: 11/24/2016] [Indexed: 11/18/2022]
Abstract
U.S. Black women have higher breast cancer mortality compared to White women while their rate of ever having a mammogram has become equal to or slightly surpassed that of Whites. We mapped the distribution of change in screening mammography for Black and White female Medicare enrollees ages 67-69 from 2008 to 2012 by hospital referral region across the contiguous U.S., performed cluster analysis to assess spatial autocorrelation, and examined the screening differences between these groups in 2008 and 2012 respectively. Changes in screening mammography are not consistent across the U.S.: Black and White women have increased and decreased their use of mammography in different regions and Black women's change patterns vary more widely.
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Affiliation(s)
- Laura Stiel
- Department of Social Work and Social Ecology, Loma Linda University, 1898 Business Center Drive, Suite 202, San Bernardino, CA 92408, USA.
| | - Samuel Soret
- School of Public Health, Center for Community Resilience, Loma Linda University, 24951 North Circle Drive, Loma Linda, CA 92350, USA
| | - Susanne Montgomery
- School of Behavioral Health, Loma Linda University, 11065 Campus Street, Loma Linda, CA 92350, USA
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48
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Rahbar H, McDonald ES, Lee JM, Partridge SC, Lee CI. How Can Advanced Imaging Be Used to Mitigate Potential Breast Cancer Overdiagnosis? Acad Radiol 2016; 23:768-73. [PMID: 27017136 DOI: 10.1016/j.acra.2016.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 02/08/2023]
Abstract
Radiologists, as administrators and interpreters of screening mammography, are considered by some to be major contributors to the potential harms of screening, including overdiagnosis and overtreatment. In this article, we outline current efforts within the breast imaging community toward mitigating screening harms, including the widespread adoption of tomosynthesis and potentially adjusting screening frequency and thresholds for image-guided breast biopsy. However, the emerging field of breast radiomics may offer the greatest promise for reducing overdiagnosis by identifying imaging-based biomarkers strongly associated with tumor biology, and therefore helping prevent the harms of unnecessary treatment for indolent cancers.
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49
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Breast cancer screening with digital breast tomosynthesis. Breast Cancer 2016; 24:32-41. [DOI: 10.1007/s12282-016-0699-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 04/13/2016] [Indexed: 11/26/2022]
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