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Kerlikowske K, Chen S, Bissell MCS, Lee CI, Tice JA, Sprague BL, Miglioretti DL. Population Attributable Risk of Advanced-Stage Breast Cancer by Race and Ethnicity. JAMA Oncol 2024; 10:167-175. [PMID: 38060241 PMCID: PMC10704341 DOI: 10.1001/jamaoncol.2023.5242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/31/2023] [Indexed: 12/08/2023]
Abstract
Importance Advanced-stage breast cancer rates vary by race and ethnicity, with Black women having a 2-fold higher rate than White women among regular screeners. Clinical risk factors that explain a large proportion of advanced breast cancers by race and ethnicity are unknown. Objective To evaluate the population attributable risk proportions (PARPs) for advanced-stage breast cancer (prognostic pathologic stage IIA or higher) associated with clinical risk factors among routinely screened premenopausal and postmenopausal women by race and ethnicity. Design, Setting, and Participants This cohort study used data collected prospectively from Breast Cancer Surveillance Consortium community-based breast imaging facilities from January 2005 to June 2018. Participants were women aged 40 to 74 years undergoing 3 331 740 annual (prior screening within 11-18 months) or biennial (prior screening within 19-30 months) screening mammograms associated with 1815 advanced breast cancers diagnosed within 2 years of screening examinations. Data analysis was performed from September 2022 to August 2023. Exposures Heterogeneously or extremely dense breasts, first-degree family history of breast cancer, overweight/obesity (body mass index >25.0), history of benign breast biopsy, and screening interval (biennial vs annual) stratified by menopausal status and race and ethnicity (Asian or Pacific Islander, Black, Hispanic/Latinx, White, other/multiracial). Main Outcomes and Measures PARPs for advanced breast cancer. Results Among 904 615 women, median (IQR) age was 57 (50-64) years. Of the 3 331 740 annual or biennial screening mammograms, 10.8% were for Asian or Pacific Islander women; 9.5% were for Black women; 5.3% were for Hispanic/Latinx women; 72.0% were for White women; and 2.0% were for women of other races and ethnicities, including those who were Alaska Native, American Indian, 2 or more reported races, or other. Body mass index PARPs were larger for postmenopausal vs premenopausal women (30% vs 22%) and highest for postmenopausal Black (38.6%; 95% CI, 32.0%-44.8%) and Hispanic/Latinx women (31.8%; 95% CI, 25.3%-38.0%) and premenopausal Black women (30.3%; 95% CI, 17.7%-42.0%), with overall prevalence of having overweight/obesity highest in premenopausal Black (84.4%) and postmenopausal Black (85.1%) and Hispanic/Latinx women (72.4%). Breast density PARPs were larger for premenopausal vs postmenopausal women (37% vs 24%, respectively) and highest among premenopausal Asian or Pacific Islander (46.6%; 95% CI, 37.9%-54.4%) and White women (39.8%; 95% CI, 31.7%-47.3%) whose prevalence of dense breasts was high (62%-79%). For premenopausal and postmenopausal women, PARPs were small for family history of breast cancer (5%-8%), history of breast biopsy (7%-12%), and screening interval (2.1%-2.3%). Conclusions and Relevance In this cohort study among routinely screened women, the proportion of advanced breast cancers attributed to biennial vs annual screening was small. To reduce the number of advanced breast cancer diagnoses, primary prevention should focus on interventions that shift patients with overweight and obesity to normal weight.
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Affiliation(s)
- Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
| | - Shuai Chen
- Department of Public Health Sciences, University of California, Davis
| | - Michael C. S. Bissell
- Department of Public Health Sciences, University of California, Davis
- PicnicHealth, San Francisco, California
| | - Christoph I. Lee
- Department of Radiology, University of Washington, Fred Hutchinson Cancer Center, Seattle
| | - Jeffrey A. Tice
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco
| | - Brian L. Sprague
- Departments of Surgery and Radiology, University of Vermont, Burlington
| | - Diana L. Miglioretti
- Department of Public Health Sciences, University of California, Davis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
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Kerlikowske K, Chen S, Golmakani MK, Sprague BL, Tice JA, Tosteson ANA, Rauscher GH, Henderson LM, Buist DSM, Lee JM, Gard CC, Miglioretti DL. Cumulative Advanced Breast Cancer Risk Prediction Model Developed in a Screening Mammography Population. J Natl Cancer Inst 2022; 114:676-685. [PMID: 35026019 PMCID: PMC9086807 DOI: 10.1093/jnci/djac008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Estimating advanced breast cancer risk in women undergoing annual or biennial mammography could identify women who may benefit from less or more intensive screening. We developed an actionable model to predict cumulative 6-year advanced cancer (prognostic pathologic stage II or higher) risk according to screening interval. METHODS We included 931 186 women aged 40-74 years in the Breast Cancer Surveillance Consortium undergoing 2 542 382 annual (prior mammogram within 11-18 months) or 752 049 biennial (prior within 19-30 months) screening mammograms. The prediction model includes age, race and ethnicity, body mass index, breast density, family history of breast cancer, and prior breast biopsy subdivided by menopausal status and screening interval. We used fivefold cross-validation to internally validate model performance. We defined higher than 95th percentile as high risk (>0.658%), higher than 75th percentile to 95th or less percentile as intermediate risk (0.380%-0.658%), and 75th or less percentile as low to average risk (<0.380%). RESULTS Obesity, high breast density, and proliferative disease with atypia were strongly associated with advanced cancer. The model is well calibrated and has an area under the receiver operating characteristics curve of 0.682 (95% confidence interval = 0.670 to 0.694). Based on women's predicted advanced cancer risk under annual and biennial screening, 69.1% had low or average risk regardless of screening interval, 12.4% intermediate risk with biennial screening and average risk with annual screening, and 17.4% intermediate or high risk regardless of screening interval. CONCLUSION Most women have low or average advanced cancer risk and can undergo biennial screening. Intermediate-risk women may consider annual screening, and high-risk women may consider supplemental imaging in addition to annual screening.
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Affiliation(s)
- Karla Kerlikowske
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Shuai Chen
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - Brian L Sprague
- Department of Surgery and Radiology, University of Vermont, Burlington, VT, USA
| | - Jeffrey A Tice
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Garth H Rauscher
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington, and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Charlotte C Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
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Hophan SL, Odnokoz O, Liu H, Luo Y, Khan S, Gradishar W, Zhou Z, Badve S, Torres MA, Wan Y. Ductal Carcinoma In Situ of Breast: From Molecular Etiology to Therapeutic Management. Endocrinology 2022; 163:bqac027. [PMID: 35245349 PMCID: PMC8962444 DOI: 10.1210/endocr/bqac027] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Indexed: 11/19/2022]
Abstract
Ductal carcinoma in situ (DCIS) makes up a majority of noninvasive breast cancer cases. DCIS is a neoplastic proliferation of epithelial cells within the ductal structure of the breast. Currently, there is little known about the progression of DCIS to invasive ductal carcinoma (IDC), or the molecular etiology behind each DCIS lesion or grade. The DCIS lesions can be heterogeneous in morphology, genetics, cellular biology, and clinical behavior, posing challenges to our understanding of the molecular mechanisms by which approximately half of all DCIS lesions progress to an invasive status. New strategies that pinpoint molecular mechanisms are necessary to overcome this gap in understanding, which is a barrier to more targeted therapy. In this review, we will discuss the etiological factors associated with DCIS, as well as the complexity of each nuclear grade lesion. Moreover, we will discuss the possible molecular features that lead to progression of DCIS to IDC. We will highlight current therapeutic management and areas for improvement.
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Affiliation(s)
- Shelby Lynn Hophan
- Department of Obstetrics and Gynecology, Department of Pharmacology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Olena Odnokoz
- Department of Pharmacology and Chemical Biology, Winship Cancer Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Huiping Liu
- Department of Pharmacology, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Yuan Luo
- Department of Preventive Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Seema Khan
- Department of Surgery, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - William Gradishar
- Department of Medicine, The Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Zhuan Zhou
- Department of Surgery, UT Southwestern Medical Center, Dallas, TX 75390, USA
| | - Sunil Badve
- Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Mylin A Torres
- Department of Hematology and Oncology, Winship Cancer Center, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Yong Wan
- Department of Pharmacology and Chemical Biology, Winship Cancer Center, Emory University School of Medicine, Atlanta, GA 30322, USA
- Department of Hematology and Oncology, Winship Cancer Center, Emory University School of Medicine, Atlanta, GA 30322, USA
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Rosenberg V, Bareket-Samish A, Chodick G, Siegelmann-Danieli N. Hormone-Replacement Therapy and Its Association with Breast Cancer Subtypes: A Large Retrospective Cohort Study. Int J Womens Health 2021; 13:1207-1216. [PMID: 34887685 PMCID: PMC8651048 DOI: 10.2147/ijwh.s311696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose The study examined trends in breast cancer incidence, mammography testing rates, hormone-replacement therapy (HRT) use and breast cancer subtypes in a large Israeli health maintenance organization during 2000-2014. Methods Annual rates of mammography tests and HRTs use were analyzed in women age ≥45. Annual incidence rates of breast cancer were analyzed in women age ≥20. Estimated annual percentage changes were used to test changes in incidence rates. Invasive breast cancer subtypes were approximated by treatments received. We compared annual rates and duration of HRTs use between women diagnosed with breast cancer and those who were not, as well as HRT use between subtypes of invasive breast cancer. Results We identified 14,092 breast cancer cases (88% invasive, 12% in situ). The age-adjusted incidence rate of invasive breast cancer peaked in 2005, consistent with increased mammography screening that year, and decreased thereafter. HRT use decreased from 13.2% in 2002 to 4.6% in 2014. The subtypes distribution of 7771 patients diagnosed with invasive breast cancer during 2007-2014 was: luminal A and B without HER2 over-expression (HR+/HER2-), 69.7%; Luminal B with HER2 over-expression (HR+/HER2+), 8.9%; Hormone receptor-negative HER2 enriched (HR-/HER2+), 5.4%; triple negative (HR-/HER2-), 10.0%; unknown, 6.0%. Overall, in women age ≥45 diagnosed with invasive breast cancer, 76-86% did not have HRT exposure vs 14-24% who were current (within 1 year before the breast cancer diagnosis), recent (within 2-5 years), or past users (>5 years). Current/recent HRT use was statistically significantly higher in luminal vs non-luminal/unknown breast cancer subtypes (13.9% vs 8.9%, respectively; p < 0.001). Conclusion Our results show a decrease in breast cancer incidence that parallels the global and local decrease in HRT use. Yet, our results imply that current/recent HRT exposure may contribute to the incidence of luminal breast cancer tumors in particular. The magnitude of the effect supports findings from population-based studies.
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Affiliation(s)
- Vered Rosenberg
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel
| | | | - Gabriel Chodick
- Maccabi Institute for Research and Innovation, Maccabi Healthcare Services, Tel Aviv, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nava Siegelmann-Danieli
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Professional Medicine, Maccabi Healthcare Services, Tel Aviv, Israel
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5
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Houghton SC, Hankinson SE. Cancer Progress and Priorities: Breast Cancer. Cancer Epidemiol Biomarkers Prev 2021; 30:822-844. [PMID: 33947744 PMCID: PMC8104131 DOI: 10.1158/1055-9965.epi-20-1193] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/13/2020] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Affiliation(s)
- Serena C Houghton
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts.
| | - Susan E Hankinson
- Department of Biostatistics and Epidemiology, University of Massachusetts Amherst, Amherst, Massachusetts
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KDM3B-ETF1 fusion gene downregulates LMO2 via the WNT/β-catenin signaling pathway, promoting metastasis of invasive ductal carcinoma. Cancer Gene Ther 2021; 29:215-224. [PMID: 33828234 DOI: 10.1038/s41417-021-00301-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 01/11/2021] [Accepted: 01/25/2021] [Indexed: 11/08/2022]
Abstract
Breast cancer is the most common malignancy for women, with invasive ductal carcinoma being the largest subtype of breast cancers, accounting for 75-80% of cases. However, the underlying mechanism of invasive ductal carcinoma remains unclear. In this study, we investigate the possible effects KDM3B-ETF1 fusion gene has on breast cancer cell metastasis, invasion and its downstream signaling mediators as revealed from RNA sequence data analysis. As predicted, KDM3B-ETF1 expression was increased in breast cancer tissues and cells. Overexpression of KDM3B-ETF1 in cancer cell lines promoted the growth and invasion of breast cancer cells, while KDM3B-ETF1 knockdown showed the opposite effects on malignant cell growth and invasion both in vivo and in vitro as evidenced by cell counting kit-8, Transwell assay and tumor xenograft in nude mice. On the contrary, LIM Domain Only 2 (LMO2) expression was significantly reduced in breast cancer tissues and cells. According to chromatin immunoprecipitation and Western blot analysis, KDM3B-ETF1 targets LMO2 and reduced the expression of LMO2, leading to an increase in WNT/β-catenin signaling pathway and thus promoting invasion. In conclusion, fusion gene KDM3B-ETF1 inhibits LMO2, activates the Wnt/β-catenin signaling pathway that leads to increased breast cancer cell invasion and metastasis, providing a novel insight into developing therapeutic strategies. These results provide novel insights into the molecular mechanism of invasive ductal carcinomas, which may lead to potential therapeutic targets.
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7
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Gender Disparity in Breast Cancer: A Veteran Population-Based Comparison. Clin Breast Cancer 2021; 21:e471-e478. [PMID: 33619003 DOI: 10.1016/j.clbc.2021.01.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 01/14/2021] [Accepted: 01/19/2021] [Indexed: 11/21/2022]
Abstract
BACKGROUND Male breast cancer (MBC) comprises <1% of all cancers and continues to rise. Because of rarity, there is paucity in the literature; therefore, management of MBC is generalized from female breast cancer (FBC). METHODS Data from 152 VA Medical Centers were used to analyze the database of Veteran patient with breast cancer diagnosed between 1998 and 2016 using biostatistical software (SAS 9.3). Our primary objective is to compare patient's demographics, breast cancer characteristics, and outcomes for male and female Veterans. FINDING In total, 8864 patients' records were reviewed;1528 MBC were compared with 7336 FBC with a mean follow up time of 5.5 years (SD 4.17). The mean age at diagnosis was 68.6 years and 57.3 years for MBC and FBC, respectively (P < .0001). Higher numbers of MBC patients (95%) were >50 years of age compared to FBC patients (72%). More MBC patients (16.8 vs. 9.1% and 9 vs. 4%) presented with higher disease stage (III and IV, respectively). Estrogen receptor-positive tumors were more common in MBC (59 versus 52%). Hormonal treatment was received by 27% of MBC versus 19% FBC; chemotherapy 21.3% versus 41.5% and radiation 23.5% versus 60.9%. Forty-two percent MBC and 20% FBC Veterans died during study. Male patients had higher death rate 1.285 (95% CI: 1.150, 1.434, P < .0001) compared to females after adjusting data for age, race, stage, and grade. INTERPRETATION To the best of our knowledge, this is the largest comparison series of MBC and FBC to date in the Veterans population. The higher mortality rate in MBC patients may be due to late presentation, higher stage at the time of diagnosis and/or tumor biology. Veteran's exposures to hazardous materials during their military deployments as an additional factor for worse prognosis need further investigation.
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8
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Wang Y, Chen K, Yang Y, Tan L, Chen L, Zhu L, Su F, Liu X, Li S. Incidence and survival outcomes of early male breast cancer: a population-based comparison with early female breast cancer. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:536. [PMID: 31807518 DOI: 10.21037/atm.2019.10.04] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Male breast cancer (MBC) is a rare malignancy. We aimed to analyze the incidence trends, clinicopathological characteristics, and survival outcomes in early MBC comparison with early female breast cancer (FBC). Methods We included eligible MBC and FBC patients with stage I-II disease in the Surveillance, Epidemiology, and End Results (SEER) database from 2000-2015. Joinpoint regression was used to evaluate the trends in age-adjusted incidence. A one-to-four propensity score matching (PSM) analysis was performed to reduce bias in a retrospective study. Survival outcomes were evaluated using Kaplan-Meier analyses with the log-rank test and Cox proportional hazards regression analysis. Results Trends in the age-adjusted incidence rates of early MBC were stable [2000-2015, annual percentage change (APC) =0.50, 95% confidence interval (CI): -0.1 to 1.1, P=0.102]; however, the incidence of early FBC changed significantly over the time period (2000-2015, APC = 0.30, 95% CI: 0.0 to 0.6, P=0.045). In the matched cohort, unmarried status, higher grade, larger tumor size, and advanced lymph node (LN) status were associated with a higher risk of breast cancer death and death of any causes both in early MBC and FBC patients. The hormone receptor (HR) status was as a prognostic factor in FBC patients, but not in MBC. Early MBC had worse breast cancer-specific survival (BCSS) and overall survival (OS) than early FBC in stage I, stage II and HR-positive subgroup of patients. Conclusions The biological behavior, clinicopathological features, and clinical outcomes of early MBC are different from that of FBC. Further studies on individualized treatment approaches in MBC are needed.
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Affiliation(s)
- Yan Wang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Kai Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Yaping Yang
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Luyuan Tan
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Lili Chen
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Liling Zhu
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Fengxi Su
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
| | - Xue Liu
- College of Basic Medicine, Jining Medical University, Jining 272067, China
| | - Shunrong Li
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China.,Department of Breast Surgery, Breast Tumor Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510120, China
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Chapitre 3 : Hormonothérapie ménopausique et cancer du sein. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 41 Suppl 1:S58-S67. [DOI: 10.1016/j.jogc.2019.02.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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10
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Théberge I, Vandal N, Guertin MH, Perron L. The mammography screening detection of ductal carcinoma in situ and invasive breast cancer according to women's characteristics: is it the same? Breast Cancer Res Treat 2018; 174:525-535. [PMID: 30564969 DOI: 10.1007/s10549-018-05095-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 12/08/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Detection of ductal carcinoma in situ (DCIS) has increased with the mammography dissemination. Given the potential role of DCIS as a precursor of invasive breast cancer (IBC), we aimed to assess whether women's characteristics have a different effect on the DCIS compared to IBC detection rate. METHODS This study included 3,609,569 screening mammograms performed from 2002 to 2015 in our organized breast cancer screening program, which actively invites women 50-69 years of age. The association between women's characteristics and the DCIS detection rate, the IBC detection rate and the odds ratio of DCIS among screen-detected cancers was assessed by logistic regression and generalized estimating equations with independent correlation matrix and sandwich estimator. RESULTS A total of 4173 DCIS and 15,136 IBC were screen-detected. Increasing women's age, current hormone replacement therapy use and higher body mass index were less associated with the DCIS than with IBC detection rates (p value for the odds of DCIS among screen-detected cancers of, respectively, < 0.0001, 0.0244 and < 0.0001). In contrast, having a previous breast aspiration or biopsy and increasing breast density were more strongly associated with DCIS than with IBC detection rates (p value of, respectively, 0.0050 and < 0.0001). CONCLUSION The results suggest that some women's characteristics could be playing a role in the initiation and other in the progression from in situ to invasive breast cancer. These characteristics can also affect the screening sensitivity, and this effect may differ depending on whether screen-detected cases were DCIS or IBC.
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Affiliation(s)
- Isabelle Théberge
- Institut national de santé publique du Québec, 945, Av. Wolfe, Quebec City, G1V 5B3, Canada. .,Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec City, Canada.
| | - Nathalie Vandal
- Institut national de santé publique du Québec, 945, Av. Wolfe, Quebec City, G1V 5B3, Canada
| | - Marie-Hélène Guertin
- Institut national de santé publique du Québec, 945, Av. Wolfe, Quebec City, G1V 5B3, Canada
| | - Linda Perron
- Institut national de santé publique du Québec, 945, Av. Wolfe, Quebec City, G1V 5B3, Canada.,Département de médecine sociale et préventive, Faculté de Médecine, Université Laval, Quebec City, Canada.,Département de santé publique et médecine préventive, CHU de Québec-Université Laval, Hôpital Saint-François d'Assise, Quebec City, Canada
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11
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Salagame U, Banks E, O’Connell DL, Egger S, Canfell K. Menopausal Hormone Therapy use and breast cancer risk by receptor subtypes: Results from the New South Wales Cancer Lifestyle and EvaluAtion of Risk (CLEAR) study. PLoS One 2018; 13:e0205034. [PMID: 30403669 PMCID: PMC6221262 DOI: 10.1371/journal.pone.0205034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/18/2018] [Indexed: 12/31/2022] Open
Abstract
Breast cancer risk is increased with current Menopausal Hormone Therapy (MHT) use, with higher risks reported for ER+ (Estrogen Receptor positive), and ER+/PR+ (Estrogen and Progesterone Receptor positive) breast cancers than those of ER- and ER-/PR- status, respectively. There is limited evidence to suggest MHT use is associated with the specific subtype characterised as ER+/PR+/HER2- (Estrogen and Progesterone Receptor positive and Human Epidermal growth factor Receptor2 negative) status. This study aims to investigate the MHT-breast cancer relationship for breast cancer tumor receptor subtypes defined by ER expression alone, by ER and PR expression only and by joint expression of ER, PR, and HER2. Analyses compared 399 cancer registry-verified breast cancer cases with receptor status information and 324 cancer-free controls. We used multinomial logistic regression to estimate adjusted odds ratios (aORs) and 95% Confidence Intervals (CI) for current and past versus never MHT use, for subgroups defined by tumor receptor expression. Current, but not past, use of MHT was associated with an elevated risk of ER+ breast cancer (aOR = 2.04, 95%CI: 1.28-3.24) and ER+/PR+ breast cancer (aOR = 2.29, 1.41-3.72). Current MHT use was also associated with an elevated risk of the ER+/PR+/HER2- subtype (aOR = 2.30, 1.42-3.73). None of the other subtypes based on ER, ER/PR or ER/PR/HER2 expression were significantly associated with current MHT use in this analysis. Current, but not past, use of MHT increases the risk of breast cancer, with consistently higher risks reported for ER+ and ER+/PR+ subtypes and mounting evidence regarding the specific ER+/PR+/HER2- subtype. Our findings contribute to quantification of the effects of MHT, and support efforts to articulate the receptor-mediated mechanisms by which MHT increases the risk of breast cancer.
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Affiliation(s)
- Usha Salagame
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australia
- Sax Institute, Sydney, New South Wales, Australia
| | - Dianne L. O’Connell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
| | - Sam Egger
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales, Australia
| | - Karen Canfell
- Cancer Research Division, Cancer Council NSW, Woolloomooloo, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
- Prince of Wales Clinical School, UNSW, Sydney, Australia
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12
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Santen RJ, Yue W. Cause or prevention of breast cancer with estrogens: analysis from tumor biologic data, growth kinetic model and Women's Health Initiative study. Climacteric 2018; 22:3-12. [PMID: 30380950 DOI: 10.1080/13697137.2017.1388364] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The existing medical literature suggests that estrogens may cause breast cancer but, paradoxically, can also prevent this neoplasm under specific circumstances. Appropriate interpretation of this complex data requires an understanding of emerging concepts of tumor biology. A substantial body of data, including animal models and epidemiologic studies, suggests that estrogens contribute to the development of breast cancer. Additionally, pre-clinical experiments indicate that the responsible mechanisms include both estrogen receptor α-dependent and -independent effects (ERα-dependent and ERα-independent effects). We recently developed two models to describe the growth kinetics of occult breast tumors, one based on autopsy studies and tumor doubling time and the other, computer-based. Validation of the models involved comparison of the predicted incidence of breast cancer with the actual incidence in population-based studies. Utilization of these models allowed us to determine that 16 years on average are required for tumors to undergo the 30 doubling times necessary for the occult tumors to reach the threshold for clinical detection. These models suggest that menopausal hormone therapy with estrogen plus a progestogen in the Women's Health Initiative (WHI) study accelerated the doubling time of occult, pre-existing tumors from 200 to 150 days and thus, increased the rate of tumor diagnosis. Based on estrogen-induced apoptosis data, the model accurately predicted the prevention of diagnosed breast cancer in the estrogen-alone arm of the WHI. Notably, pre-clinical studies demonstrated that conjugated equine estrogen, as used in the WHI, has unique, pro-apoptotic properties compared to the anti-apoptotic effects of estradiol, a finding providing an explanation for the reduction in breast cancer with conjugated equine estrogen.
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Affiliation(s)
- R J Santen
- a Division of Endocrinology and Metabolism , University of Virginia Health Science System , Charlottesville , VA , USA
| | - W Yue
- a Division of Endocrinology and Metabolism , University of Virginia Health Science System , Charlottesville , VA , USA
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13
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Baeyens-Fernández JA, Molina-Portillo E, Pollán M, Rodríguez-Barranco M, Del Moral R, Arribas-Mir L, Sánchez-Cantalejo Ramírez E, Sánchez MJ. Trends in incidence, mortality and survival in women with breast cancer from 1985 to 2012 in Granada, Spain: a population-based study. BMC Cancer 2018; 18:781. [PMID: 30068302 PMCID: PMC6090958 DOI: 10.1186/s12885-018-4682-1] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 07/19/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The incidence of breast cancer has increased since the 1970s. Despite favorable trends in prognosis, the role of changes in clinical practice and the introduction of screening remain controversial. We examined breast cancer trends to shed light on their determinants. METHODS Data were obtained for 8502 new cases of breast cancer in women between 1985 and 2012 from a population-based cancer registry in Granada (southern Spain), and for 2470 breast cancer deaths registered by the Andalusian Institute of Statistics. Joinpoint regression analyses of incidence and mortality rates were obtained. Observed and net survival rates were calculated for 1, 3 and 5 years. The results are reported here for overall survival and survival stratified by age group and tumor stage. RESULTS Overall, age-adjusted (European Standard Population) incidence rates increased from 48.0 cases × 100,000 women in 1985-1989 to 83.4 in 2008-2012, with an annual percentage change (APC) of 2.5% (95%CI, 2.1-2.9) for 1985-2012. The greatest increase was in women younger than 40 years (APC 3.5, 95%CI, 2.4-4.8). For 2000-2012 the incidence trend increased only for stage I tumors (APC 3.8, 95%CI, 1.9-5.8). Overall age-adjusted breast cancer mortality decreased (APC - 1, 95%CI, - 1.4 - - 0.5), as did mortality in the 50-69 year age group (APC - 1.3, 95%CI, - 2.2 - - 0.4). Age-standardized net survival increased from 67.5% at 5 years in 1985-1989 to 83.7% in 2010-2012. All age groups younger than 70 years showed a similar evolution. Five-year net survival rates were 96.6% for patients with tumors diagnosed in stage I, 88.2% for stage II, 62.5% for stage III and 23.3% for stage IV. CONCLUSIONS Breast cancer incidence is increasing - a reflection of the evolution of risk factors and increasing diagnostic pressure. After screening was introduced, the incidence of stage I tumors increased, with no decrease in the incidence of more advanced stages. Reductions were seen for overall mortality and mortality in the 50-69 year age group, but no changes were found after screening implementation. Survival trends have evolved favorably except for the 70-84 year age group and for metastatic tumors.
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Affiliation(s)
- José Antonio Baeyens-Fernández
- Departamento de Urgencias y Emergencias, Área de Gestión Sanitaria Noreste, Hospital Regional de Baza, Carretera de Murcia s/n, 18800 Baza, Spain
| | - Elena Molina-Portillo
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - Marina Pollán
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
- Environmental and Cancer Epidemiology Department, National Center of Epidemiology - Instituto de Salud Carlos III, Madrid, Spain
| | - Miguel Rodríguez-Barranco
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - Rosario Del Moral
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
- Department of Radiotherapy and Oncology, Virgen de las Nieves University Hospital, Granada, Spain
| | - Lorenzo Arribas-Mir
- Centro de Salud La Chana, Área de Gestión Sanitaria Granada-Metropolitano, Granada, Spain
- Department of Epidemiology and Public Health, University of Granada, Granada, Spain
| | - Emilio Sánchez-Cantalejo Ramírez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
| | - María-José Sánchez
- Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
- Public Health and Epidemiology CIBER Network (CIBERESP), Madrid, Spain
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14
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Zanetti R, Ponti A, Rosso S, Ricceri F, Pitarella S, Segnan N. The Beginning of a Decline in Breast Cancer Incidence in Italy? TUMORI JOURNAL 2018; 94:293-6. [DOI: 10.1177/030089160809400301] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The incidence of invasive breast cancer in Turin, Italy, showed a statistically significant decrease during 1999–2003 overall (estimated annual percent change -2.6; 95% CL -8.52; -0.78) and in women aged over 50, similar to the recently documented trend in American data. This represents the first demonstration of a decline in breast cancer incidence in the early years of this decade outside the United States. In our population, the drop in the usage of hormone replacement therapy which occurred after 2002 is unlikely to be at the origin of this declining incidence trend, which is largely explained by a screening effect. This observation may be relevant to other geographical areas where organized or spontaneous screening reached a plateau after an increase in the preceding years.
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Affiliation(s)
| | - Antonio Ponti
- Unità di Valutazione dello Screening Mammografico, CPO, Turin, Italy
| | | | | | - Sabina Pitarella
- Unità di Valutazione dello Screening Mammografico, CPO, Turin, Italy
| | - Nereo Segnan
- Unità di Epidemiologia dei Tumori, Centro per l'Epidemiologia e la Prevenzione Oncologica, CPO, Turin, Italy
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15
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Kerlikowske K, Gard CC, Tice JA, Ziv E, Cummings SR, Miglioretti DL. Risk Factors That Increase Risk of Estrogen Receptor-Positive and -Negative Breast Cancer. J Natl Cancer Inst 2016; 109:2898140. [PMID: 28040694 DOI: 10.1093/jnci/djw276] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 09/17/2016] [Accepted: 10/19/2016] [Indexed: 12/15/2022] Open
Abstract
Background Risk factors may differentially influence development of estrogen receptor (ER)-positive vs -negative breast cancer. We examined associations with strong, prevalent risk factors by ER subtype. Methods Of 1 279 443 women age 35 to 74 years participating in the Breast Cancer Surveillance Consortium, 14 969 developed ER-positive and 3617 developed ER-negative invasive breast cancer. We calculated hazard ratios (HRs) using Cox regression and compared ER subtype hazard ratios at representative ages or by menopausal status using Wald tests. All statistical tests were two-sided. Results For women age 40 years, compared with no prior biopsy, ER-positive vs ER-negative HRs were 1.53 (95% CI = 1.30 to 1.81) vs 1.26 (95% CI = 0.90 to 1.76) for nonproliferative disease, 1.63 (95% CI = 1.23 to 2.17) vs 1.41 (95% CI = 0.78 to 2.57) for proliferative disease without atypia, and 4.47 (95% CI = 2.88 to 6.96) vs 0.20 (95% CI = 0.02 to 2.51) for proliferative disease with atypia. Benign disease proliferation risk was stronger for ER-positive than ER-negative cancer for women age 35 years (Wald P = .04), age 40 years (Wald P = .04), and age 50 years (Wald P = .06). Among pre/perimenopausal women, body mass index (BMI) had a stronger association with ER-negative than ER-positive cancer (obese II/III vs. normal weight: HR = 1.52, 95% CI = 1.19 to 1.94; vs 1.21, 95% CI = 1.08 to 1.36). Increasing BMI similarly increased ER-positive and ER-negative cancer risk among postmenopausal hormone users (Wald P = .15) and nonusers (Wald P = .08). Associations with ER subtype varied by race/ethnicity across all ages (P < .001) and by family history of breast cancer and breast density for specific ages. Conclusions Strength of risk factor associations differed by ER subtype. Separate risk models for ER subtypes may improve identification of women for targeted prevention strategies.
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Affiliation(s)
- Karla Kerlikowske
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Charlotte C Gard
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Jeffrey A Tice
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Elad Ziv
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Steven R Cummings
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
| | - Diana L Miglioretti
- Affiliations of authors: Departments of Medicine and Epidemiology and Biostatistics (KK, JAT, EZ) and General Internal Medicine Section, Department of Veterans Affairs (KK), University of California, San Francisco, San Francisco, CA; Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM (CCG); San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA (SRC); Department of Public Health Sciences, University of California, Davis, Davis, CA (DLM); Group Health Research Institute, Group Health Cooperative, Seattle, WA (DLM)
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Alvarado M, Ozanne E, Esserman L. Overdiagnosis and overtreatment of breast cancer. Am Soc Clin Oncol Educ Book 2016:e40-5. [PMID: 24451829 DOI: 10.14694/edbook_am.2012.32.301] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Breast cancer is the most common cancer in women. Through greater awareness, mammographic screening, and aggressive biopsy of calcifications, the proportion of low-grade, early stage cancers and in situ lesions among all breast cancers has risen substantially. The introduction of molecular testing has increased the recognition of lower risk subtypes, and less aggressive treatments are more commonly recommended for these subtypes. Mammographically detected breast cancers are much more likely to have low-risk biology than symptomatic tumors found between screenings (interval cancers) or that present as clinical masses. Recognizing the lower risk associated with these lesions and the ability to confirm the risk with molecular tests should safely enable the use of less aggressive treatments. Importantly, ductal carcinoma in situ (DCIS) lesions, or what have been called stage I cancers, in and of themselves are not life-threatening. In situ lesions have been treated in a manner similar to that of invasive cancer, but there is little evidence to support that this practice has improved mortality. It is also being recognized that DCIS lesions are heterogeneous, and a substantial proportion of them may in fact be precursors of more indolent invasive cancers. Increasing evidence suggests that these lesions are being overtreated. The introduction of molecular tests should be able to help usher in a change in approach to these lesions. Reclassifying these lesions as part of the spectrum of high-risk lesions enables the use of a prevention approach. Learning from the experience with active surveillance in prostate cancer should empower the introduction of new approaches, with a focus on preventing invasive cancer, especially given that there are effective, United States Food and Drug Administration (FDA)-approved breast cancer preventive interventions.
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Affiliation(s)
- Michael Alvarado
- From the Department of Surgery, University of California, San Francisco
| | - Elissa Ozanne
- From the Department of Surgery, University of California, San Francisco
| | - Laura Esserman
- From the Department of Surgery, University of California, San Francisco
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17
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Colditz GA, Bohlke K. Preventing breast cancer now by acting on what we already know. NPJ Breast Cancer 2015; 1:15009. [PMID: 28721366 PMCID: PMC5515195 DOI: 10.1038/npjbcancer.2015.9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 06/19/2015] [Indexed: 11/12/2022] Open
Abstract
The age-specific rate of breast cancer rises rapidly through premenopausal years and significantly more slowly after menopause. Reproductive factors affect cell proliferation and the accumulation of genetic changes. Lifetime risk of breast cancer is linearly related to the length of the interval from menarche to first birth. Lifestyle changes that accompany industrialization, together with shifting reproductive patterns, drive up incidence rates. Prevention must begin early in the life as almost one-quarter of cases are diagnosed before age 50 in high-income countries. This requires greater emphasis on prevention across the life course to address the global burden of breast cancer.
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Affiliation(s)
- Graham A Colditz
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, MO, USA
- Siteman Cancer Center, Washington University in St Louis, St Louis, MO, USA
| | - Kari Bohlke
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, MO, USA
- Siteman Cancer Center, Washington University in St Louis, St Louis, MO, USA
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18
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Bias in Observational Studies of the Association between Menopausal Hormone Therapy and Breast Cancer. PLoS One 2015; 10:e0124076. [PMID: 25938446 PMCID: PMC4418576 DOI: 10.1371/journal.pone.0124076] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 03/03/2015] [Indexed: 11/19/2022] Open
Abstract
Background During the period 1985-2000 the breast cancer incidence rates increased 50% in the age group invited to mammography screening in Norway and Sweden. Simultaneously, use of hormone replacement treatment therapy (HT) increased 5 times. Several influential observational studies showed that HT was associated with 50% to 100% increased risk of breast cancer and most for those using combined (estrogen plus progestin) hormone replacement therapy (CHT). In contrast, the randomized WHI trial reported that CHT increased the risk by 10% for those not having previously used hormones and 24% when including previous users in the analyses. In another randomized trial, estrogen use only was not associated with any increased risk at all. After the WHI trial was published in 2003, use of HT dropped 70% within 5 years in Norway and Sweden while breast cancer rates were essentially unchanged. After 2008, HT use has dropped further and breast cancer incidence rates have started increasing again. The study objective is to calculate and to explain potential bias in the observational study design. Methods and Findings Here we use data from the randomized WHI trial and analyze these data as done in the observational studies to calculate the magnitude of the potential biases in the observational study design. Time varying effect of hormones and categorization of the follow-up time may increase the hazard ratio for long-term users from 1.10 to 1.48. Selective retrospective reporting of hormone use may further increase the hazard ratio to 1.68. Conclusions We suggest that the mechanism causing higher hazard ratio of breast cancer (compared to the observational studies) is the time-varying effect of CHT on the breast cancer risk and selective retrospective reporting of hormone use. Other risk factors for the increase in breast cancer risk in the age group 50-69 years should be considered, for example, overdiagnosis.
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Gangnon RE, Sprague BL, Stout NK, Alagoz O, Weedon-Fekjær H, Holford TR, Trentham-Dietz A. The contribution of mammography screening to breast cancer incidence trends in the United States: an updated age-period-cohort model. Cancer Epidemiol Biomarkers Prev 2015; 24:905-12. [PMID: 25787716 DOI: 10.1158/1055-9965.epi-14-1286] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/18/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The impact of screening mammography on breast cancer incidence is difficult to disentangle from cohort- and age-related effects on incidence. METHODS We developed an age-period-cohort model of ductal carcinoma in situ (DCIS) and invasive breast cancer incidence in U.S. females using cancer registry data. Five functions were included in the model to estimate stage-specific effects for age, premenopausal birth cohorts, postmenopausal birth cohorts, period (for all years of diagnosis), and a mammography period effect limited to women ages ≥ 40 years after 1982. Incidence with and without the mammography period effect was calculated. RESULTS More recent birth cohorts have elevated underlying risk compared with earlier cohorts for both pre- and postmenopausal women. Comparing models with and without the mammography period effect showed that overall breast cancer incidence would have been 23.1% lower in the absence of mammography in 2010 (95% confidence intervals, 18.8-27.4), including 14.7% (9.5-19.3) lower for invasive breast cancer and 54.5% (47.4-59.6) lower for DCIS. Incidence of distant-staged breast cancer in 2010 would have been 29.0% (13.1-48.1) greater in the absence of mammography screening. CONCLUSIONS Mammography contributes to markedly elevated rates of DCIS and early-stage invasive cancers, but also contributes to substantial reductions in the incidence of metastatic breast cancer. IMPACT Mammography is an important tool for reducing the burden of breast cancer, but future work is needed to identify risk factors accounting for increasing underlying incidence and to distinguish between indolent and potentially lethal early-stage breast cancers that are detected via mammography.
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Affiliation(s)
- Ronald E Gangnon
- Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, Wisconsin. Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin. Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin
| | - Brian L Sprague
- Department of Surgery and Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School, Boston, Massachusetts
| | - Oguz Alagoz
- Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin. Department of Industrial and System Engineering, University of Wisconsin, Madison, Wisconsin
| | - Harald Weedon-Fekjær
- Oslo Center for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | | | - Amy Trentham-Dietz
- Department of Population Health Sciences, University of Wisconsin, Madison, Wisconsin. Carbone Cancer Center, University of Wisconsin, Madison, Wisconsin.
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Lee E, Luo J, Su YC, Lewinger JP, Schumacher FR, Van Den Berg D, Wu AH, Bernstein L, Ursin G. Hormone metabolism pathway genes and mammographic density change after quitting estrogen and progestin combined hormone therapy in the California Teachers Study. Breast Cancer Res 2014; 16:477. [PMID: 25499601 PMCID: PMC4318222 DOI: 10.1186/s13058-014-0477-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2013] [Accepted: 11/11/2014] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Mammographic density (MD) is a strong biomarker of breast cancer risk. MD increases after women start estrogen plus progestin therapy (EPT) and decreases after women quit EPT. A large interindividual variation in EPT-associated MD change has been observed, but few studies have investigated genetic predictors of the EPT-associated MD change. Here, we evaluate the association between polymorphisms in hormone metabolism pathway genes and MD changes when women quit EPT. METHODS We collected mammograms before and after women quit EPT and genotyped 405 tagging single nucleotide polymorphisms (SNPs) in 30 hormone metabolism pathway genes in 284 non-Hispanic white participants of the California Teachers Study (CTS). Participants were ages 49 to 71 years at time of mammography taken after quitting EPT. We assessed percent MD using a computer-assisted method. MD change was calculated by subtracting MD of an 'off-EPT' mammogram from MD of an 'on-EPT' (that is baseline) mammogram. Linear regression analysis was used to investigate the SNP-MD change association, adjusting for the baseline 'on-EPT' MD, age and BMI at time of baseline mammogram, and time interval and BMI change between the two mammograms. An overall pathway and gene-level summary was obtained using the adaptive rank truncated product (ARTP) test. We calculated 'P values adjusted for correlated tests (P(ACT))' to account for multiple testing within a gene. RESULTS The strongest associations were observed for rs7489119 in SLCO1B1, and rs5933863 in ARSC. SLCO1B1 and ARSC are involved in excretion and activation of estrogen metabolites of EPT, respectively. MD change after quitting was 4.2% smaller per minor allele of rs7489119 (P = 0.0008; P(ACT) = 0.018) and 1.9% larger per minor allele of rs5933863 (P = 0.013; P(ACT) = 0.025). These individual SNP associations did not reach statistical significance when we further used Bonferroni correction to consider the number of tested genes. The pathway level summary ARTP P value was not statistically significant. CONCLUSIONS Data from this longitudinal study of EPT quitters suggest that genetic variation in two hormone metabolism pathway genes, SLCO1B1 and ARSC, may be associated with change in MD after women stop using EPT. Larger longitudinal studies are needed to confirm our findings.
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Affiliation(s)
- Eunjung Lee
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90089, USA.
| | - Jianning Luo
- Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA.
| | - Yu-Chen Su
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90089, USA.
| | - Juan Pablo Lewinger
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90089, USA.
| | - Fredrick R Schumacher
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90089, USA.
| | - David Van Den Berg
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90089, USA.
| | - Anna H Wu
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90089, USA.
| | - Leslie Bernstein
- Department of Population Sciences, Beckman Research Institute, City of Hope, 1500 East Duarte Road, Duarte, CA, 91010, USA.
| | - Giske Ursin
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California/Norris Comprehensive Cancer Center, 1441 Eastlake Avenue, Los Angeles, CA, 90089, USA.
- Department of Nutrition, University of Oslo, PB 1046 Blindern, 0317, Oslo, Norway.
- Cancer Registry of Norway, PB 5313 Majorstuen, 0304, Oslo, Norway.
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Jewett PI, Gangnon RE, Trentham-Dietz A, Sprague BL. Trends of postmenopausal estrogen plus progestin prevalence in the United States between 1970 and 2010. Obstet Gynecol 2014; 124:727-733. [PMID: 25198271 PMCID: PMC4172523 DOI: 10.1097/aog.0000000000000469] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate long term trends in estrogen-progestin prevalence for the U.S. female population by year and age. METHODS We integrated data on oral estrogen-progestin use from the National Health and Nutrition Examination Survey 1999-2010 with data from the National Prescription Audit 1970-2003. Distributions of estrogen-progestin by age from the National Health and Nutrition Examination Survey were applied to the prescription data, and calibration and interpolation procedures were used to generate estrogen-progestin prevalence estimates by single year of age and single calendar year for 1970-2010. RESULTS Estimated prevalence of oral estrogen-progestin was below 0.5% in the 1970s, began to rise in the early 1980s, and almost tripled between 1990 and the late 1990s. The age-adjusted prevalence for women aged 45-64 years peaked at 13.5% in 1999 with highest use among 57-year-old women (23.2%). Prevalence of estrogen-progestin use declined dramatically in the early 2000s with only 2.7% of women aged 45-64 years using estrogen-progestin in 2010, which is comparable to prevalence levels in the mid-1980s. CONCLUSION The dramatic rise and fall of estrogen-progestin use over the past 40 years provides an illuminating case study of prescription practices before, during, and after the development of evidence regarding benefits and harms. LEVEL OF EVIDENCE : II.
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Affiliation(s)
- Patricia I. Jewett
- Department of Population Health Science, University of Wisconsin, Madison, WI 53726
- University of Wisconsin Carbone Cancer Center, Madison, WI 53726
| | - Ronald E. Gangnon
- Department of Population Health Science, University of Wisconsin, Madison, WI 53726
- Department of Biostatistics and Medical Informatics, University of Madison, WI 53726
- University of Wisconsin Carbone Cancer Center, Madison, WI 53726
| | - Amy Trentham-Dietz
- Department of Population Health Science, University of Wisconsin, Madison, WI 53726
- University of Wisconsin Carbone Cancer Center, Madison, WI 53726
| | - Brian L. Sprague
- Department of Surgery and Vermont Cancer Center, University of Vermont, Burlington, VT 05401
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RETIRED: Managing Menopause Chapter 3 Menopausal Hormone Therapy and Breast Cancer. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2014. [DOI: 10.1016/s1701-2163(15)30459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Santen RJ, Stuenkel CA, Burger HG, Manson JE. Competency in Menopause Management: Whither Goest the Internist? J Womens Health (Larchmt) 2014; 23:281-5. [DOI: 10.1089/jwh.2014.4746] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Affiliation(s)
- Richard J. Santen
- Division of Endocrinology and Metabolism, University of Virginia Health Sciences System, Charlottesville, Virginia
| | - Cynthia A. Stuenkel
- Division of Endocrinology, Diabetes and Metabolism, University of California at San Diego, La Jolla, California
| | - Henry G. Burger
- Prince Henry's Institute for Medical Research, Monash University, Melbourne, Australia
| | - JoAnn E. Manson
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Munsell MF, Sprague BL, Berry DA, Chisholm G, Trentham-Dietz A. Body mass index and breast cancer risk according to postmenopausal estrogen-progestin use and hormone receptor status. Epidemiol Rev 2014; 36:114-36. [PMID: 24375928 PMCID: PMC3873844 DOI: 10.1093/epirev/mxt010] [Citation(s) in RCA: 255] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2013] [Indexed: 12/20/2022] Open
Abstract
To assess the joint relationships among body mass index, menopausal status, and breast cancer according to breast cancer subtype and estrogen-progestin medication use, we conducted a meta-analysis of 89 epidemiologic reports published in English during 1980-2012 identified through a systematic search of bibliographic databases. Pooled analysis yielded a summary risk ratio of 0.78 (95% confidence interval (CI): 0.67, 0.92) for hormone receptor-positive premenopausal breast cancer associated with obesity (body mass index (weight (kg)/height (m)(2)) ≥30 compared with <25). Obesity was associated with a summary risk ratio of 1.39 (95% CI: 1.14, 1.70) for receptor-positive postmenopausal breast cancer. For receptor-negative breast cancer, the summary risk ratios of 1.06 (95% CI: 0.70, 1.60) and 0.98 (95% CI: 0.78, 1.22) associated with obesity were null for both premenopausal and postmenopausal women, respectively. Elevated postmenopausal breast cancer risk ratios associated with obesity were limited to women who never took estrogen-progestin therapy, with risk ratios of 1.42 (95% CI: 1.30, 1.55) among never users and 1.18 (95% CI: 0.98, 1.42) among users; too few studies were available to examine this relationship according to receptor subtype. Future research is needed to confirm whether obesity is unrelated to receptor-negative breast cancer in populations of postmenopausal women with low prevalence of hormone medication use.
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Affiliation(s)
| | | | | | | | - Amy Trentham-Dietz
- Correspondence to Dr. Amy Trentham-Dietz, University of Wisconsin, 610 Walnut Street, WARF Room 307, Madison, WI 53726 (e-mail: )
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Román M, Rué M, Sala M, Ascunce N, Baré M, Baroja A, De la Vega M, Galcerán J, Natal C, Salas D, Sánchez-Jacob M, Zubizarreta R, Castells X. Trends in detection of invasive cancer and ductal carcinoma in situ at biennial screening mammography in Spain: a retrospective cohort study. PLoS One 2013; 8:e83121. [PMID: 24376649 PMCID: PMC3871523 DOI: 10.1371/journal.pone.0083121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Breast cancer incidence has decreased in the last decade, while the incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world. The phenomenon has been attributed to the widespread adaption of screening mammography. The aim of the study was to evaluate the temporal trends in the rates of screen detected invasive cancers and DCIS, and to compare the observed trends with respect to hormone replacement therapy (HRT) use along the same study period. METHODS Retrospective cohort study of 1,564,080 women aged 45-69 years who underwent 4,705,681 screening mammograms from 1992 to 2006. Age-adjusted rates of screen detected invasive cancer, DCIS, and HRT use were calculated for first and subsequent screenings. Poisson regression was used to evaluate the existence of a change-point in trend, and to estimate the adjusted trends in screen detected invasive breast cancer and DCIS over the study period. RESULTS The rates of screen detected invasive cancer per 100.000 screened women were 394.0 at first screening, and 229.9 at subsequent screen. The rates of screen detected DCIS per 100.000 screened women were 66.8 at first screen and 43.9 at subsequent screens. No evidence of a change point in trend in the rates of DCIS and invasive cancers over the study period were found. Screen detected DCIS increased at a steady 2.5% per year (95% CI: 1.3; 3.8), while invasive cancers were stable. CONCLUSION Despite the observed decrease in breast cancer incidence in the population, the rates of screen detected invasive cancer remained stable during the study period. The proportion of DCIS among screen detected breast malignancies increased from 13% to 17% throughout the study period. The rates of screen detected invasive cancer and DCIS were independent of the decreasing trend in HRT use observed among screened women after 2002.
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MESH Headings
- Aged
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Early Detection of Cancer/trends
- Female
- Hormone Replacement Therapy/statistics & numerical data
- Humans
- Incidence
- Mammography
- Mass Screening/statistics & numerical data
- Middle Aged
- Retrospective Studies
- Spain/epidemiology
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Affiliation(s)
- Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
| | - Montse Rué
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA)-University of Lleida, Lleida, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nieves Ascunce
- Navarra Breast Cancer Screening Programme, Public Health Institute, Pamplona, Navarra, Spain
| | - Marisa Baré
- Oficina Tècnica de Cribratge, Corporació Sanitaria Parc Taulí-Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
| | - Araceli Baroja
- La Rioja Breast Cancer Screening Programme, Fundacion Rioja Salud, Logroño, La Rioja, Spain
| | - Mariola De la Vega
- Dirección General de Programas Asistenciales, Consejería de Sanidad, Servicio Canario de Salud, Tenerife, Santa Cruz de Tenerife, Spain
| | - Jaume Galcerán
- Foundation Society for Cancer Research and Prevention, Pere Virgili Health Research Institute, Reus, Tarragona, Spain
| | - Carmen Natal
- Program & Analysis Unit, Health Office, Oviedo, Principado de Asturias, Spain
| | - Dolores Salas
- General Directorate Public Health & Centre for Public Health Research, Valencia, Comunidad Valenciana, Spain
| | - Mercedes Sánchez-Jacob
- Servicio de Promoción de la Salud y Programas Preventivos, Consejería de Sanidad, Valladolid, Castilla y León, Spain
| | - Raquel Zubizarreta
- Galician Breast Cancer Screening Programme, Public Health & Planning Directorate, Health Office, Santiago de Compostela, La Coruña, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
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Ductal carcinoma in situ: what the pathologist needs to know and why. Int J Breast Cancer 2013; 2013:914053. [PMID: 23476791 PMCID: PMC3580892 DOI: 10.1155/2013/914053] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2012] [Revised: 12/19/2012] [Accepted: 01/02/2013] [Indexed: 11/26/2022] Open
Abstract
Ductal carcinoma in situ is a proliferation of malignant epithelial cells confined to the ductolobular system of the breast. It is considered a pre-cursor lesion for invasive breast cancer and when identified patients are treated with some combination of surgery, +/− radiation therapy, and +/adjuvant tamoxifen. However, no good biomarkers exist that can predict with accuracy those cases of DCIS destined to progress to invasive disease or once treated those patients that are likely to suffer a recurrence; thus, in the era of screening mammography it seems likely that many patients with DCIS are overtreated. This paper details the parameters that should be included in a pathology report for a case of DClS with some explanations as to their importance for good clinical decision making.
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A sustained decline in postmenopausal hormone use: results from the National Health and Nutrition Examination Survey, 1999-2010. Obstet Gynecol 2012; 120:595-603. [PMID: 22914469 DOI: 10.1097/aog.0b013e318265df42] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Short-term declines in postmenopausal hormone use were observed after the Women's Health Initiative trial results in 2002. Although concerns about the trial's generalizability have been expressed, long-term trends in hormone use in a nationally representative sample have not been reported. We sought to evaluate national trends in the prevalence of hormone use and to assess variation by type of formulation and patient characteristics. METHODS We examined postmenopausal hormone use during 1999-2010 using cross-sectional data from 10,107 women aged 40 years and older in the National Health and Nutrition Examination Survey. RESULTS In 1999-2000, the prevalence of oral postmenopausal hormone use was 22.4% (95% confidence interval [CI] 19.0-25.8) overall, 13.3% (95% CI 11.0-15.5) for estrogen only, and 8.3% (95% CI 6.2-10.4) for estrogen plus progestin. A sharp decline in use of all formulations occurred in 2003-2004, when the overall prevalence decreased to 11.9% (95% CI 9.6-14.2). This decline was initially limited to non-Hispanic whites; use among non-Hispanic blacks and Hispanics did not decline substantially until 2005-2006. Hormone use continued to decline through 2009-2010 across all patient demographic groups, with the current prevalence now at 4.7% (95% CI 3.3-6.1) overall, 2.7% (95% CI 1.9-3.4) for estrogen only, and 1.7% (95% CI 0.7-2.7) for estrogen plus progestin. Patient characteristics currently associated with hormone use include history of hysterectomy, non-Hispanic white race or ethnicity, and income. CONCLUSION Postmenopausal hormone use in the United States has declined in a sustained fashion to low levels across a wide variety of patient subgroups.
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Abstract
Breast cancer is the leading cause of cancer death for women worldwide. While breast cancer incidence is lower for many ethnic minority women than for white women, stage at diagnosis and survival are often worse. These disparities are most marked for African-American women, but are also present for Asians, Latinas, Native Americans and Hawaiians. The etiology of ethnic disparities in breast cancer is multifactorial, including differences in tumor characteristics, genetics, access to care and insurance, prevalence of risk factors, screening participation and processes of care, such as timeliness of diagnosis and quality of communication and treatment. This review will examine what is known regarding ethnic differences in all of these areas, what questions remain, and where researchers and policy makers should focus their future efforts.
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Affiliation(s)
- Leah S Karliner
- University of California, San Francisco, and Medical Effectiveness Research Center for Diverse Populations, San Francisco, CA, USA.
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Rath MG, Heil J, Domschke C, Topic Z, Schneider S, Sinn HP, Marme F, Scharf A, Schneeweiss A, Sohn C, Rom J. Predictors of resectability in breast-conserving therapy. Arch Gynecol Obstet 2012; 286:1023-31. [DOI: 10.1007/s00404-012-2401-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2011] [Accepted: 05/29/2012] [Indexed: 11/29/2022]
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Burger HG, MacLennan AH, Huang KE, Castelo-Branco C. Evidence-based assessment of the impact of the WHI on women's health. Climacteric 2012; 15:281-7. [DOI: 10.3109/13697137.2012.655564] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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31
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Warner E. An Ounce of Breast Cancer Prevention—Let's Try for a Pound. Cancer Epidemiol Biomarkers Prev 2012; 21:705-6. [DOI: 10.1158/1055-9965.epi-12-0312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Ellen Warner
- Author's Affiliation: Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada
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Missaoui N, Landolsi H, Jaidaine L, Ben Abdelkader A, Yaacoubi MT, Hmissa S. Breast cancer in central Tunisia: an earlier age at diagnosis and incidence increase over a 15-year period. Breast J 2012; 18:289-91. [PMID: 22487378 DOI: 10.1111/j.1524-4741.2012.01242.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Colditz GA, Wei EK. Preventability of cancer: the relative contributions of biologic and social and physical environmental determinants of cancer mortality. Annu Rev Public Health 2012; 33:137-56. [PMID: 22224878 PMCID: PMC3631776 DOI: 10.1146/annurev-publhealth-031811-124627] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Whereas models of cancer disparities and variation in cancer burden within population groups now specify multiple levels of action from biologic processes to individual risk factors and social and physical contextual factors, approaches to estimating the preventable proportion of cancer use more traditional direct models often from single exposures to cancer at specific organ sites. These approaches are reviewed, and the strengths and limitations are presented. The need for additional multilevel data and approaches to estimation of preventability are identified. International or regional variation in cancer may offer the most integrated exposure assessment over the life course. For the four leading cancers, which account for 50% of incidence and mortality, biologic, social, and physical environments play differing roles in etiology and potential prevention. Better understanding of the interactions and contributions across these levels will help refine prevention strategies.
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Affiliation(s)
- Graham A Colditz
- Alvin J. Siteman Cancer Center and Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri 63108, USA.
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34
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Sainani KL. Communicating Risks Clearly: Absolute Risk and Number Needed to Treat. PM R 2012; 4:220-2. [DOI: 10.1016/j.pmrj.2012.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2012] [Accepted: 01/13/2012] [Indexed: 11/16/2022]
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Buist DSM, Walker R, Bowles EJA, Carney PA, Taplin SH, Onega T, Kerlikowske K, Clinton W, Miglioretti DL. Screening mammography use among current, former, and never hormone therapy users may not explain recent declines in breast cancer incidence. Cancer Epidemiol Biomarkers Prev 2012; 21:720-7. [PMID: 22301831 DOI: 10.1158/1055-9965.epi-11-1115] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Screening mammography and invasive breast cancer and ductal carcinoma in situ (DCIS) rates recently declined in the United States; screening mammography declines among former hormone therapy (HT) users may be an important contributor. We longitudinally examined women and compared mammography use and cancer rates by HT use [current, former, and never users of estrogen + progestin (EPT) and estrogen only (ET)]. METHODS We studied 163,490 unique women aged 50-79 years enrolled in Group Health (Washington State) between 1994-2009. Electronic data identified HT dispensing, mammography use and incident breast cancer diagnosis. We calculated age-adjusted screening compliance as a time-varying variable (screened-within-the-past-26 months, yes/no). RESULTS Before 2002, screening compliance differed significantly by HT with current EPT users having the highest rates (83%) followed by former EPT (77%), current ET (77%), former ET (72%), and never users (56%). After 2002, screening was high (∼81%) among current and former EPT and ET users and significantly increased among never users (∼62%). Invasive breast cancer rates significantly decreased over the whole study period (P(trend) ≤ 0.05) for all HT users, except EPT current users (P(trend) = 0.68); DCIS rates did not change in any group. CONCLUSIONS Differential screening mammography rates by HT use do not explain invasive breast cancer incidence declines. Our data suggest discontinuing HT has an immediate effect on breast cancer rates, lending support to the mechanism that cessation leads to tumor regression. IMPACT Studies examining the influence of a changing exposure in relation to outcomes should account for varying exposures, individuals' characteristics, as well as screening methods and frequency.
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Affiliation(s)
- Diana S M Buist
- Group Health Research Institute, Group Health Cooperative, Seattle, WA 98101, USA.
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Weedon-Fekjær H, Bakken K, Vatten LJ, Tretli S. Understanding recent trends in incidence of invasive breast cancer in Norway: age-period-cohort analysis based on registry data on mammography screening and hormone treatment use. BMJ 2012; 344:e299. [PMID: 22290099 PMCID: PMC3268754 DOI: 10.1136/bmj.e299] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To quantify the separate contributions of menopausal hormone treatment and mammography screening activities on trends in incidence of invasive breast cancer between 1987 and 2008. DESIGN Population study using aggregated data analysed by an extended age-period-cohort model. SETTING Norway. Population Norwegian women aged 30-90 between 1987 and 2008, including 50,102 newly diagnosed cases of invasive breast cancer. Main outcomes measures Attributable proportions of mammography screening and hormone treatment to recent incidence of invasive breast cancer, and the remaining variation in incidence after adjustment for mammography screening and hormone treatment. RESULTS The incidence of invasive breast cancer in Norway increased steadily until 2002, levelled off, and then declined from 2006. All non-linear changes in incidence were explained by use of hormone treatment and mammography screening activities, with about similar contributions of each factor. In 2002, when the incidence among women aged 50-69 was highest, an estimated 23% of the cases in that age group could be attributed to mammography screening and 27% to use of hormone treatment. CONCLUSIONS Changes in incidence trends of invasive breast cancer since the early 1990s may be fully attributed to mammography screening and hormone treatment, with about similar contributions of each factor.
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Affiliation(s)
- Harald Weedon-Fekjær
- Department of Etiological Research, Cancer Registry of Norway, Institute of Population-based Cancer Research, PO Box 5313 Majorstuen, 0304 Oslo, Norway.
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Liu L, Zhang J, Wu AH, Pike MC, Deapen D. Invasive breast cancer incidence trends by detailed race/ethnicity and age. Int J Cancer 2012; 130:395-404. [PMID: 21351091 PMCID: PMC3196818 DOI: 10.1002/ijc.26004] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Accepted: 02/07/2011] [Indexed: 01/07/2023]
Abstract
Racial/ethnic disparities in breast cancer incidence may contain important evidence for understanding and control of the disease. Monitoring the incidence trends of breast cancer by race/ethnicity allows identification of high risk groups and development of targeted prevention programs. Using population-based cancer registry data from the Los Angeles Cancer Surveillance Program, we examined the invasive female breast cancer incidence trends among the diverse racial/ethnic populations in Los Angeles County, California, from 1972 to 2007. Age-adjusted incidence rates (AAIRs) and age-specific incidence rates (ASIRs) were calculated and examined respectively for non-Hispanic (NH) white, black, Hispanic, Chinese, Filipina, Japanese and Korean women by calendar year and time period. Rising trends of AAIRs were found in all racial/ethnic groups during the 1980s and 1990s. The breast cancer risk increased more substantially in Japanese and Filipinas than in Chinese and Koreans. During 2000-2007, the trends of AAIRs declined significantly among NH white women and slightly in blacks, remained unchanged for Hispanics and continued to rise significantly among all Asian subgroups. The patterns of ASIRs by race/ethnicity changed dramatically over time. By 2000-2007, younger Hispanic women had the lowest breast cancer risk, replacing the Chinese and Koreans who formerly had the lowest risk. Rapidly increasing breast cancer incidence trends among Asian-Americans underline the importance of behavioral and lifestyle changes as a result of acculturation on the development of the disease. The unique trends of breast cancer incidence by race/ethnicity suggest the need for targeted breast cancer control programs for different racial/ethnic populations.
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Affiliation(s)
- Lihua Liu
- Los Angeles Cancer Surveillance Program, Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA.
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Stahl MS, Prichard J, Stark A. Adiposity and Risk of Proliferative Diseases of the Breast Prior to the Diagnosis of Invasive Breast Cancer: Results from a Pilot Study. Breast J 2012; 18:191-4. [DOI: 10.1111/j.1524-4741.2011.01213.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Skaane P. Controversies in mammography screening: let us not ignore science in this never-ending debate. Acta Radiol 2011; 52:1061-3. [PMID: 22144424 DOI: 10.1258/ar.2011.11a010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Per Skaane
- Department of Radiology, Section Mammography, Oslo University Hospital, Ullevaal, University of Oslo, Norway
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Hofvind S, Sakshaug S, Ursin G, Graff-Iversen S. Breast cancer incidence trends in Norway--explained by hormone therapy or mammographic screening? Int J Cancer 2011; 130:2930-8. [PMID: 21732346 DOI: 10.1002/ijc.26280] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Accepted: 06/16/2011] [Indexed: 11/09/2022]
Abstract
A decline in breast cancer incidence has been observed in several countries after 2002. Reduced use of menopausal hormonal therapy (HT), as a consequence of the publication of results from the Women's Health Initiative, has been argued to be the main reason. In Norway, the governmentally funded Norwegian Breast Cancer Screening Program (NBCSP) was implemented during the same time period as the increased use of HT. This study investigated trends in breast cancer incidence by use of HT and introduction of the screening program. We obtained rates of breast cancer from the Cancer Registry of Norway and sales data of HT preparations from the Norwegian Institute of Public Health. Mammography rates were estimated from published reports. Breast cancer incidence rates increased steadily from 1956 to the end of the 20th century, particularly in women aged 55-69 during 1996-2002 residing in the counties where the NBCSP was first introduced. The rates declined after 2002-2003. HT use increased in 1987-2001, peaking around year 2000. In particular, sales of combined estrogen and progestogen preparations declined after 2002. Among women aged 55-59, rates of hormone receptor positive breast cancers peaked in 2000-2003. No such trend was seen in other age groups. In conclusion, the interpretation of breast cancer incidence trends in Norway from 1987 to 2009 is complicated because the NBCSP was introduced during a period with increasing HT use. Both factors likely contributed to the observed trends, and the role of each may vary across age groups.
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Fenton JJ, Abraham L, Taplin SH, Geller BM, Carney PA, D'Orsi C, Elmore JG, Barlow WE. Effectiveness of computer-aided detection in community mammography practice. J Natl Cancer Inst 2011; 103:1152-61. [PMID: 21795668 DOI: 10.1093/jnci/djr206] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Computer-aided detection (CAD) is applied during screening mammography for millions of US women annually, although it is uncertain whether CAD improves breast cancer detection when used by community radiologists. METHODS We investigated the association between CAD use during film-screen screening mammography and specificity, sensitivity, positive predictive value, cancer detection rates, and prognostic characteristics of breast cancers (stage, size, and node involvement). Records from 684 956 women who received more than 1.6 million film-screen mammograms at Breast Cancer Surveillance Consortium facilities in seven states in the United States from 1998 to 2006 were analyzed. We used random-effects logistic regression to estimate associations between CAD and specificity (true-negative examinations among women without breast cancer), sensitivity (true-positive examinations among women with breast cancer diagnosed within 1 year of mammography), and positive predictive value (breast cancer diagnosed after positive mammograms) while adjusting for mammography registry, patient age, time since previous mammography, breast density, use of hormone replacement therapy, and year of examination (1998-2002 vs 2003-2006). All statistical tests were two-sided. RESULTS Of 90 total facilities, 25 (27.8%) adopted CAD and used it for an average of 27.5 study months. In adjusted analyses, CAD use was associated with statistically significantly lower specificity (OR = 0.87, 95% confidence interval [CI] = 0.85 to 0.89, P < .001) and positive predictive value (OR = 0.89, 95% CI = 0.80 to 0.99, P = .03). A non-statistically significant increase in overall sensitivity with CAD (OR = 1.06, 95% CI = 0.84 to 1.33, P = .62) was attributed to increased sensitivity for ductal carcinoma in situ (OR = 1.55, 95% CI = 0.83 to 2.91; P = .17), although sensitivity for invasive cancer was similar with or without CAD (OR = 0.96, 95% CI = 0.75 to 1.24; P = .77). CAD was not associated with higher breast cancer detection rates or more favorable stage, size, or lymph node status of invasive breast cancer. CONCLUSION CAD use during film-screen screening mammography in the United States is associated with decreased specificity but not with improvement in the detection rate or prognostic characteristics of invasive breast cancer.
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Affiliation(s)
- Joshua J Fenton
- Department of Family and Community Medicine and Center for Healthcare Policy and Research, University of California, Davis, Sacramento, CA 95817, USA.
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Salagame U, Canfell K, Banks E. An epidemiological overview of the relationship between hormone replacement therapy and breast cancer. Expert Rev Endocrinol Metab 2011; 6:397-409. [PMID: 30754116 DOI: 10.1586/eem.11.31] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Large-scale randomized clinical trials and observational studies have consistently found that use of hormone replacement therapy (HRT) increases the risk of breast cancer. More recently, ecological studies have shown correlations between dramatic reductions in use of HRT in many countries, and declines in the rates of breast cancer in older women. Meta-analyses of data from the trials and observational studies show that the increase in breast cancer risk is greater for combined estrogen-progestin therapies compared with estrogen alone; that for both types of preparation, breast cancer risk increases with duration of use; and that the risks decrease relatively quickly after cessation of use. For both estrogen-only and combined therapies, the risk of breast cancer is higher if therapy is initiated close to the time of the menopause, relative to the risks in women starting HRT later. Most drug regulatory authorities currently recommend that HRT be prescribed only to fully informed women who have moderate-to-severe menopausal symptoms, for the shortest duration possible; and it is recommended that the need for therapy be reviewed at least every 6-12 months.
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Affiliation(s)
- Usha Salagame
- a Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, Australia
| | - Karen Canfell
- a Cancer Epidemiology Research Unit, Cancer Council NSW, Sydney, Australia
- c
| | - Emily Banks
- b National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, 0200 Australia
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Ozanne EM, Shieh Y, Barnes J, Bouzan C, Hwang ES, Esserman LJ. Characterizing the impact of 25 years of DCIS treatment. Breast Cancer Res Treat 2011; 129:165-73. [PMID: 21390494 DOI: 10.1007/s10549-011-1430-5] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 02/26/2011] [Indexed: 11/29/2022]
Abstract
The significant increase in the detection and treatment of ductal carcinoma in situ (DCIS) since the introduction of screening mammography has not been accompanied by the anticipated reduction in invasive breast cancer (IBC) incidence. The prevalence of DCIS requires a reexamination of the population level effects of detecting and treating DCIS. To further our understanding of the possible impact of DCIS diagnosis and treatment on IBC incidence in the U.S., we simulated breast cancer incidence over 25 years under various assumptions regarding the baseline incidence of IBC and the progression of DCIS to IBC. The simulations demonstrate a tradeoff between the expected increased incidence of IBC absent any DCIS detection and treatment and the rate of progression of DCIS to IBC. Our analyses indicate that a high progression of DCIS to IBC implies a significant increase in incidence of IBC over what is observed had we not detected and treated DCIS. Conversely, if we assume that there would not have been a significant increase over and above the observed incidence evident in SEER, then our model indicates that the rate of DCIS progression to clinically significant IBC is low. Given the tradeoff illustrated by our model, we must reevaluate the assumption that DCIS is a short-term obligate precursor of invasive cancer and instead focus on further exploration of the true natural history of DCIS.
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Affiliation(s)
- Elissa M Ozanne
- Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Silverman BG, Siegelmann-Danieli N, Braunstein R, Kokia ES. Trends in breast cancer incidence associated with reductions in the use of hormone replacement therapy. Cancer Epidemiol 2011; 35:11-6. [DOI: 10.1016/j.canep.2010.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2010] [Revised: 11/17/2010] [Accepted: 11/22/2010] [Indexed: 10/18/2022]
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Daubisse-Marliac L, Delafosse P, Boitard J, Poncet F, Grosclaude P, Colonna M. Breast cancer incidence and time trend in France from 1990 to 2007: a population-based study from two French cancer registries. Ann Oncol 2011; 22:329-34. [DOI: 10.1093/annonc/mdq396] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Martins E, Freitas R, Curado MP, Freitas NMA, Silva CMB, Oliveira JC. Prevalence of breast cancer in the city of Goiânia, Goiás, Brazil, between 1988 and 2002. SAO PAULO MED J 2011; 129:309-14. [PMID: 22069129 PMCID: PMC10868936 DOI: 10.1590/s1516-31802011000500005] [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: 10/01/2010] [Revised: 04/25/2011] [Accepted: 05/02/2011] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Studies have shown increased prevalence rates for breast cancer, relating to higher incidence, longer survival and breast cancer prevention programs among populations. The aim here was to analyze the annual prevalence of breast cancer in Goiânia over a 15-year period. DESIGN AND SETTING This was a cross-sectional study on women with breast cancer diagnosed in Goiânia, Goiás, Brazil, from 1988 to 2002. METHODS The breast cancer cases were identified in the database of the Population-Based Cancer Registry of Goiânia. The 15-year period was stratified into three five-year periods. The cases were followed up for five years, and the mortality database was used to exclude deaths. The population of the official census was used as the denominator for rate calculations. RESULTS The coefficient of breast cancer prevalence in Goiania was 22.87/100,000 in 1988 and 220.22/100,000 women in 2002. The analyses for periods showed that in the first period, the rate was 19.39/100,000 and that it was 44.79/100,000 in the last period. For the fifteen years analyzed, the prevalence rate for breast cancer was 127.24/100,000 women. The annual percentage change was 27.07 (P < 0.001; 95% confidence interval, CI: 20.79-33.67) from 1988 to 1992 and 9.39 (P < 0.001; 95% CI: 8.52-10.25) from 1992 to 2002. CONCLUSION There was an increase in the breast cancer prevalence rate in the city of Goiânia between 1988 and 2002, possibly relating to the improvement in the screening and treatment of breast cancer.
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Affiliation(s)
- Edesio Martins
- MHSc. Epidemiologist, Postgraduate Program on Health Sciences, School of Medicine, Universidade Federal de Goiás (UFG) and Population-Based Cancer Registry of Goiânia, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.
| | - Ruffo Freitas
- MD, PhD. Gynecologist and Mastologist, Gynecology and Breast Service of Hospital Araújo Jorge, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.
| | - Maria Paula Curado
- MD, PhD. Senior researcher at the International Prevention Research Institute, Lyon, France, and Population-Based Cancer Registry of Goiânia, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.
| | - Nilceana Maya Aires Freitas
- MD, PhD. Radiotherapist, Radiotherapy Service of Hospital Araújo Jorge, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.
| | - Carleane Maciel Bandeira Silva
- Technician at the Population-Based Cancer Registry of Goiânia, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.
| | - José Carlos Oliveira
- MD, PhD. Head of Head and Neck Surgery Service of Hospital Araújo Jorge and Population-Based Cancer Registry of Goiânia, Associação de Combate ao Câncer de Goiás (ACCG), Goiânia, Goiás, Brazil.
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Age-Specific Spatio-Temporal Patterns of Female Breast Cancer Mortality in Spain (1975–2005). Ann Epidemiol 2010; 20:906-16. [DOI: 10.1016/j.annepidem.2010.07.102] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 07/16/2010] [Accepted: 07/19/2010] [Indexed: 11/17/2022]
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Nelson HD, Tyne K, Naik A, Bougatsos C, Chan BK, Humphrey L. Screening for breast cancer: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2010. [PMID: 19920273 DOI: 10.1059/0003-4819-151-10-200911170-00009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND This systematic review is an update of evidence since the 2002 U.S. Preventive Services Task Force recommendation on breast cancer screening. PURPOSE To determine the effectiveness of mammography screening in decreasing breast cancer mortality among average-risk women aged 40 to 49 years and 70 years or older, the effectiveness of clinical breast examination and breast self-examination, and the harms of screening. DATA SOURCES Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews (through the fourth quarter of 2008), MEDLINE (January 2001 to December 2008), reference lists, and Web of Science searches for published studies and Breast Cancer Surveillance Consortium for screening mammography data. STUDY SELECTION Randomized, controlled trials with breast cancer mortality outcomes for screening effectiveness, and studies of various designs and multiple data sources for harms. DATA EXTRACTION Relevant data were abstracted, and study quality was rated by using established criteria. DATA SYNTHESIS Mammography screening reduces breast cancer mortality by 15% for women aged 39 to 49 years (relative risk, 0.85 [95% credible interval, 0.75 to 0.96]; 8 trials). Data are lacking for women aged 70 years or older. Radiation exposure from mammography is low. Patient adverse experiences are common and transient and do not affect screening practices. Estimates of overdiagnosis vary from 1% to 10%. Younger women have more false-positive mammography results and additional imaging but fewer biopsies than older women. Trials of clinical breast examination are ongoing; trials for breast self-examination showed no reductions in mortality but increases in benign biopsy results. LIMITATION Studies of older women, digital mammography, and magnetic resonance imaging are lacking. CONCLUSION Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women. False-positive mammography results and additional imaging are common. No benefit has been shown for clinical breast examination or breast self-examination.
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Affiliation(s)
- Heidi D Nelson
- Oregon Health & Science University, Veterans Affairs Medical Center, Portland, OR 97239-3098, USA.
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Sprague BL, Trentham-Dietz A, Remington PL. The contribution of postmenopausal hormone use cessation to the declining incidence of breast cancer. Cancer Causes Control 2010; 22:125-34. [PMID: 21080050 DOI: 10.1007/s10552-010-9682-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 10/29/2010] [Indexed: 11/29/2022]
Abstract
The striking decline in United States breast cancer incidence since 2002 has been widely attributed to a reduction in postmenopausal hormone use, yet very little analysis has been conducted to quantify the contribution of changes in hormone use to the declining trend. We used literature-based estimates of the relative risk and the changing prevalence of hormone use to estimate the impact of hormone use on the decline in breast cancer incidence between 2002 and 2003 among women aged 40-79. For the base case of a 44% decline in hormone use and a relative risk for current use of 1.5, we estimated that 43% of the decline in incidence was attributable to hormone use. By exploring a range of parameter values, we found that high, unlikely values of the relative risk (i.e., ≥ 2.25) and/or the percent decline in hormone use (i.e., ≥ 75%) would be required to account for 100% of the observed decline in breast cancer incidence. We conclude that hormone use is unlikely to account for more than half of the observed decline in breast cancer incidence between 2002 and 2003. Further efforts are needed to quantify the potential contributions of other factors, such as the plateau in screening mammography utilization.
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Affiliation(s)
- Brian L Sprague
- Department of Surgery, University of Vermont, Burlington, VT 05401, USA.
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Farhat GN, Walker R, Buist DSM, Onega T, Kerlikowske K. Changes in invasive breast cancer and ductal carcinoma in situ rates in relation to the decline in hormone therapy use. J Clin Oncol 2010; 28:5140-6. [PMID: 21060026 DOI: 10.1200/jco.2010.29.5121] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
PURPOSE To assess trends in invasive breast cancer and ductal carcinoma in situ (DCIS) incidence in association with changes in hormone therapy (HT) use in regular mammography screeners. METHODS We included 2,071,814 screening mammography examinations performed between January 1997 and December 2006 on 696,385 women age 40 to 79 years; 9,586 breast cancers were diagnosed within 12 months of a screening examination. We calculated adjusted annual rates (mammogram level) for prevalent HT use, incident invasive breast cancer (overall and by tumor histology and estrogen receptor [ER] status), and incident DCIS. RESULTS After a precipitous decrease in HT use in 2002, the incidence of invasive breast cancer decreased significantly in 2002 to 2006 among women age 50 to 69 years (P(trend(2002-2006)) = .005) and 70 to 79 years (P(trend(2002-2006)) = .003) but not in women age 40 to 49 years (P(trend(2002-2006)) = .45). DCIS rates significantly decreased in women age 50 to 69 years after 2002 (P(trend(2002-2006)) = .02). Invasive ductal tumors significantly declined in women age 50 to 69 years and 70 to 79 years in 2002 to 2006. In women age 50 to 69 years, invasive lobular and ER-positive cancer rates declined steadily in 2002 to 2005 (P(trend(2002-2005)) = .02 and .03, respectively), but an elevated rate in 2006 rendered the overall trend nonsignificant (P(trend(2002-2006)) = .89 and .91, respectively). CONCLUSION In parallel to the sharp decline in HT use in women undergoing regular mammography screening, invasive breast cancer rates decreased in women age 50 to 69 and 70 to 79 years after 2002, and DCIS rates decreased in women age 50 to 69 years, consistent with evidence that HT cessation reduces breast cancer risk. However, the decrease in incidence may have started to level off in 2006; this finding has not been uniformly reported in other populations, warranting further investigation.
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Affiliation(s)
- Ghada N Farhat
- San Francisco Coordinating Center, California Pacific Medical Center Research Institute, San Francisco, CA, USA
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