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Al-Balas M, Al-Balas H, Al-Amer Z, Ashour L, Obiedat M. Awareness, Knowledge, and Current Practice of Breast Cancer Among Surgeons in Jordan. JCO Glob Oncol 2024; 10:e2300472. [PMID: 38905578 DOI: 10.1200/go.23.00472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 04/06/2024] [Accepted: 04/23/2024] [Indexed: 06/23/2024] Open
Abstract
PURPOSE Breast cancer (BC) is the most prevalent cancer in Jordan. De-escalation in treatment reflects a paradigm shift in BC treatment. More tailored strategies and the adoption of a multidisciplinary approach are essential to apply recent changes in management. In the era of breast surgery fellowship, adopting well-structured training is essential to apply recent therapeutic guidelines and meet patients' expectations. METHODS A cross-sectional study using a customized, self-reported questionnaire was used. Data collection occurred anonymously using a link via WhatsApp in the period between February 2023 and April 2023. RESULTS A total of 89 surgeons were involved in this study, and only 14 (15.7%) completed a subspecialty in breast surgery. About 58.4% considered the age of 40 years as the starting point for screening, and 84.3% reported that mammogram screening is associated with improved BC survival. Only 10.1% and 28.1% acknowledged the applicability of both tomosynthesis and breast magnetic resonance imaging in screening, respectively. A significant difference in the mean knowledge score about BC is observed between general surgeon and those with subspecialty. Varying levels of awareness concerning different risk factors and their correlation with the likelihood of BC occurrence observed. Although 56.2% of participants could offer breast conserving surgery and consider it oncological safe, only 48.3% defined it correctly. Of the participants, 61.8% and 76.4% stated that sentinel lymph node biopsy can be safely applied in clinically negative or suspicious axillary nodes, respectively, with <50% of surgeon performing it in their practice. CONCLUSION More efforts are required to enhance the knowledge and practice of surgeons in the field of breast surgery. Adopting national guidelines can facilitate the acceptance and improvement of current practices among surgeons in Jordan.
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Affiliation(s)
- Mahmoud Al-Balas
- Department of General Surgery, Urology and Anesthesia, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Hamzeh Al-Balas
- Department of General Surgery, Urology and Anesthesia, Faculty of Medicine, The Hashemite University, Zarqa, Jordan
| | - Zain Al-Amer
- Faculty of Medicine, Mu'tah University, Mu'tah, Jordan
| | - Laith Ashour
- Faculty of Medicine, Al-Balqa Applied University, Al-Salt, Jordan
| | - Mufleh Obiedat
- Endocrine and General Surgery, Jordanian Royal Medical Services, Amman, Jordan
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2
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Van Poppel H, Hogenhout R, Albers P, van den Bergh RCN, Barentsz JO, Roobol MJ. A European Model for an Organised Risk-stratified Early Detection Programme for Prostate Cancer. Eur Urol Oncol 2021; 4:731-739. [PMID: 34364829 DOI: 10.1016/j.euo.2021.06.006] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/10/2021] [Accepted: 06/23/2021] [Indexed: 11/16/2022]
Abstract
CONTEXT Overdiagnosis as the argument to stop prostate cancer (PCa) screening is less valid since the introduction of new technologies such as risk calculators (RCs) and magnetic resonance imaging (MRI). These new technologies result in fewer unnecessary biopsy procedures and fewer cases of both overdiagnosis and underdetection. Therefore, we can now adequately respond to the growing and urgent need for a structured risk assessment to detect PCa early. OBJECTIVE To provide expert discussion on the existing evidence for a previously published risk-stratified strategy regarding an organised population-based early detection programme for PCa. EVIDENCE ACQUISITION The proposed algorithm for early detection of PCa emerged from expert consensus by the authors based on available evidence derived from a nonsystematic review of the current literature using Medline/PubMed, Cochrane Library database, ClinicalTrials.gov, ISRCTN Registry, and the European Association of Urology guidelines on PCa. EVIDENCE SYNTHESIS Although not confirmed by the highest level of evidence, current literature and guidelines point towards an algorithm for early detection of PCa that starts with risk-based prostate-specific antigen (PSA) testing, followed by multivariable risk stratification with RCs. All men who are classified to be at intermediate and high risk are then offered prostate MRI. The combined data from RCs and MRI results can be used to select men for prostate biopsy. Low-risk men return to a risk-based safety net that includes individualised PSA-interval tests and, if necessary, repeated MRI. Depending on local availability, the use of the different risk stratification tools may be adapted. CONCLUSIONS We present a risk-stratified algorithm for an organised population-based early detection programme for clinically significant PCa. Although the proposed strategy has not yet been analysed prospectively, it exploits and may even improve the most important available benefits of "PSA-only" screening studies, while at the same time reduces unnecessary biopsies and overdiagnosis by using new risk stratification tools. PATIENT SUMMARY This paper presents a personalised strategy that enables selective early detection of prostate cancer by combining prostate-specific antigen (interval) testing' prediction models (risk calculators), and magnetic resonance imaging scans. This will likely lead to reduced prostate cancer-related morbidity and mortality, while reducing the need for prostate biopsy and limiting overdiagnosis.
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Affiliation(s)
- Hendrik Van Poppel
- Department of Development and Regeneration, University Hospital KU Leuven, Leuven, Belgium.
| | - Renée Hogenhout
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Peter Albers
- Department of Urology, Heinrich-Heine University Medical Faculty, Düsseldorf, Germany; Division of Personalized Early Detection of Prostate Cancer, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | | | - Jelle O Barentsz
- Department of Medical Imaging, Radboudumc, Nijmegen, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus University Medical Center, Rotterdam, The Netherlands
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Armaroli P, Riggi E, Basu P, Anttila A, Ponti A, Carvalho AL, Dillner J, Elfström MK, Giordano L, Lönnberg S, Ronco G, Senore C, Soerjomataram I, Tomatis M, Vale DB, Jarm K, Sankaranarayanan R, Segnan N. Performance indicators in breast cancer screening in the European Union: A comparison across countries of screen positivity and detection rates. Int J Cancer 2020; 147:1855-1863. [PMID: 32159224 DOI: 10.1002/ijc.32968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 01/19/2023]
Abstract
Comparable performance indicators for breast cancer screening in the European Union (EU) have not been previously reported. We estimated adjusted breast cancer screening positivity rate (PR) and detection rates (DR) to investigate variation across EU countries. For the age 50-69 years, the adjusted EU-pooled PR for initial screening was 8.9% (cross-programme variation range 3.2-19.5%) while DR of invasive cancers was 5.3/1,000 (range 3.8-7.4/1,000) and DR of ductal carcinoma in situ (DCIS) was 1.3/1,000 (range 0.7-2.7/1,000). For subsequent screening, the adjusted EU-pooled PR was 3.6% (range 1.4-8.4%), the DR was 4.0/1,000 (range 2.2-5.8/1,000) and 0.8/1,000 (range 0.5-1.3/1,000) for invasive and DCIS, respectively. Adjusted performance indicators showed remarkable heterogeneity, likely due to different background breast cancer risk and awareness between target populations, and also different screening protocols and organisation. Periodic reporting of the screening indicators permits comparison and evaluation of the screening activities between and within countries aiming to improve the quality and the outcomes of screening programmes. Cancer Screening Registries would be a milestone in this direction and EU Screening Reports provide a fundamental contribution to building them.
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Affiliation(s)
- Paola Armaroli
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Emilia Riggi
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Ahti Anttila
- Mass Screening Registry, Finish Cancer Registry, Helsinki, Finland
| | - Antonio Ponti
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Andre L Carvalho
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Miriam K Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Livia Giordano
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Stefan Lönnberg
- Mass Screening Registry, Finish Cancer Registry, Helsinki, Finland
| | - Gugliemo Ronco
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Senore
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Mariano Tomatis
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Diama B Vale
- Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, Brazil
| | - Katja Jarm
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Nereo Segnan
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
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4
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Muratov S, Canelo-Aybar C, Tarride JE, Alonso-Coello P, Dimitrova N, Borisch B, Castells X, Duffy SW, Fitzpatrick P, Follmann M, Giordano L, Hofvind S, Lebeau A, Quinn C, Torresin A, Vialli C, Siesling S, Ponti A, Giorgi Rossi P, Schünemann H, Nyström L, Broeders M. Monitoring and evaluation of breast cancer screening programmes: selecting candidate performance indicators. BMC Cancer 2020; 20:795. [PMID: 32831048 PMCID: PMC7444070 DOI: 10.1186/s12885-020-07289-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 08/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the scope of the European Commission Initiative on Breast Cancer (ECIBC) the Monitoring and Evaluation (M&E) subgroup was tasked to identify breast cancer screening programme (BCSP) performance indicators, including their acceptable and desirable levels, which are associated with breast cancer (BC) mortality. This paper documents the methodology used for the indicator selection. METHODS The indicators were identified through a multi-stage process. First, a scoping review was conducted to identify existing performance indicators. Second, building on existing frameworks for making well-informed health care choices, a specific conceptual framework was developed to guide the indicator selection. Third, two group exercises including a rating and ranking survey were conducted for indicator selection using pre-determined criteria, such as: relevance, measurability, accurateness, ethics and understandability. The selected indicators were mapped onto a BC screening pathway developed by the M&E subgroup to illustrate the steps of BC screening common to all EU countries. RESULTS A total of 96 indicators were identified from an initial list of 1325 indicators. After removing redundant and irrelevant indicators and adding those missing, 39 candidate indicators underwent the rating and ranking exercise. Based on the results, the M&E subgroup selected 13 indicators: screening coverage, participation rate, recall rate, breast cancer detection rate, invasive breast cancer detection rate, cancers > 20 mm, cancers ≤10 mm, lymph node status, interval cancer rate, episode sensitivity, time interval between screening and first treatment, benign open surgical biopsy rate, and mastectomy rate. CONCLUSION This systematic approach led to the identification of 13 BCSP candidate performance indicators to be further evaluated for their association with BC mortality.
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Affiliation(s)
- Sergei Muratov
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Carlos Canelo-Aybar
- Iberoamerican Cochrane Center, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau-CIBERESP), Barcelona, Spain
| | - Nadya Dimitrova
- European Commission, Joint Research Centre, Via E. Fermi 2749 - TP 127, I-21027, Ispra, VA, Italy.
| | - Bettina Borisch
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | | | - Patricia Fitzpatrick
- National Screening Service, Dublin, Ireland
- UCD School of Public Health, Physiotherapy & Sports Science, Dublin, Ireland
| | | | - Livia Giordano
- CPO-Piedmont - AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Annette Lebeau
- University Medical Center Hamburg-Eppendorf and Private Group Practice for Pathology, Hamburg, Germany
| | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland
| | | | - Claudia Vialli
- European Commission, Joint Research Centre, Via E. Fermi 2749 - TP 127, I-21027, Ispra, VA, Italy
| | - Sabine Siesling
- Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, Netherlands
- University of Twente, Enschede, Netherlands
| | - Antonio Ponti
- CPO-Piedmont - AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Lennarth Nyström
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Mireille Broeders
- Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands.
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Mizzi D, Zarb F, Dennis A. A retrospective audit of the first screening round of the Maltese breast screening programme. Radiography (Lond) 2017; 23:60-66. [DOI: 10.1016/j.radi.2016.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 09/23/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022]
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Presence, characteristics and equity of access to breast cancer screening programmes in 27 European countries in 2010 and 2014. Results from an international survey. Prev Med 2016; 91:250-263. [PMID: 27527575 DOI: 10.1016/j.ypmed.2016.08.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 10/21/2022]
Abstract
The European Union Council Recommendation of 2 December 2003 on cancer screening suggests the implementation of organised, population-based breast cancer screening programmes based on mammography every other year for women aged 50 to 69years, ensuring equal access to screening, taking into account potential needs for targeting particular socioeconomic groups. A European survey on coverage and participation, and key organisational and policy characteristics of the programmes, targeting years 2010 and 2014, was undertaken in 2014. Overall, 27 countries contributed to this survey, 26 of the 28 European Union member states (92.9%) plus Norway. In 2014, 25 countries reported an ongoing population-based programme, one country reported a pilot programme and another was planning a pilot. In eight countries, the target age range was broader than that proposed by the Council Recommendation, and in three countries the full range was not covered. Fifteen countries reported not reaching some vulnerable populations, such as immigrants, prisoners and people without health insurance, while 22 reported that participation was periodically monitored by socioeconomic variables (e.g. age and territory). Organised, population-based breast cancer screening programmes based on routine mammograms are in place in most EU member states. However, there are still differences in the way screening programmes are implemented, and participation by vulnerable populations should be encouraged.
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7
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Broeders M, Paci E. The Balance Sheet of Benefits and Harms of Breast Cancer Population-Based Screening in Europe: Outcome Research, Practice and Future Challenges. WOMENS HEALTH 2015; 11:883-90. [DOI: 10.2217/whe.15.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Breast cancer screening programs are still object of harsh debate. In 2012, the Independent UK Panel reviewed the benefits and harms of mammography screening based on randomized trials and the EUROSCREEN Working Group reviewed European observational outcome studies. The conclusion was that screening programs should continue, while acknowledging that harms, such as the occurrence of false-positive results and overdiagnosis, can have a negative impact on a woman's life. Information on the balance sheet of the benefits and harms of breast cancer screening should help women and their physicians to make an informed choice. The future challenge for breast screening programs is to assess the feasibility, acceptability, effectiveness and impact of risk-based screening in order to maximize benefit-to-harm ratios.
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Affiliation(s)
- Mireille Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Reference Centre for Screening, Nijmegen, The Netherlands
| | - Eugenio Paci
- Epidemiologist, Formerly at the Institute for Cancer Research and Prevention, Florence, Italy
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Performance indicators evaluation of the population-based breast cancer screening programme in Northern Portugal using the European Guidelines. Cancer Epidemiol 2015; 39:783-9. [PMID: 26315486 DOI: 10.1016/j.canep.2015.08.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2015] [Revised: 08/08/2015] [Accepted: 08/12/2015] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To evaluate the first 10 years of operation of the population-based breast cancer screening programme implemented in the Northern Region of Portugal, using selected recommended standard performance indicators. METHODS Data from women aged 50-69 screened with two-view mammography, biennially, in the period 2000-2009, were included. Main performance indicators were compared with the recommended levels of the European Guidelines. RESULTS A total of 202,039 screening examinations were performed, 71,731 (35.5%) in the initial screening and 130,308 (64.5%) in the subsequent screening. Coverage rate by examination reached 74.3% of the target population, in the last period evaluated. Recall rates were 8.1% and 2.4% and cancer detection rates were 4.4/1000 and 2.9/1000 respectively, for initial and subsequent screenings. The breast cancer detection rate, expressed as a multiple of the background expected incidence was 3.1 in initial screen and 2.2 in subsequent screen. The incidence of invasive interval cancers met the desirable recommended levels both the first and second years since last screening examination, in the initial and subsequent screenings. Invasive tumours <15mm were 50.4% and 53.8% of the invasive cancers detected in initial and subsequent screenings. Less favourable size, grading and biomarkers expression were found in interval cancers compared to screen-detected cancers. CONCLUSIONS Breast cancer screening programme in the Northern Region of Portugal was well accepted by the population. Most of the performance indicators were consistent with the desirable levels of the European Guidelines, which indicate an effective screening programme. Future research should verify the consistency of some of these results by using updated information from a larger population.
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Ponti A, Lynge E, James T, Májek O, von Euler-Chelpin M, Anttila A, Fitzpatrick P, Mano MP, Kawai M, Scharpantgen A, Fracheboud J, Hofvind S, Vidal C, Ascunce N, Salas D, Bulliard JL, Segnan N, Kerlikowske K, Taplin S. International variation in management of screen-detected ductal carcinoma in situ of the breast. Eur J Cancer 2014; 50:2695-704. [PMID: 25149183 PMCID: PMC4275301 DOI: 10.1016/j.ejca.2014.07.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 07/16/2014] [Accepted: 07/18/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ductal carcinoma in situ (DCIS) incidence has grown with the implementation of screening and its detection varies across International Cancer Screening Network (ICSN) countries. The aim of this survey is to describe the management of screen-detected DCIS in ICSN countries and to evaluate the potential for treatment related morbidity. METHODS We sought screen-detected DCIS data from the ICSN countries identified during 2004-2008. We adopted standardised data collection forms and analysis and explored DCIS diagnosis and treatment processes ranging from pre-operative diagnosis to type of surgery and radiotherapy. RESULTS Twelve countries contributed data from a total of 15 screening programmes, all from Europe except the United States of America and Japan. Among women aged 50-69 years, 7,176,050 screening tests and 5324 screen-detected DCIS were reported. From 21% to 93% of DCIS had a pre-operative diagnosis (PO); 67-90% of DCIS received breast conservation surgery (BCS), and in 41-100% of the cases this was followed by radiotherapy; 6.4-59% received sentinel lymph node biopsy (SLNB) only and 0.8-49% axillary dissection (ALND) with 0.6% (range by programmes 0-8.1%) being node positive. Among BCS patients 35% received SLNB only and 4.8% received ALND. Starting in 2006, PO and SLNB use increased while ALND remained stable. SLNB and ALND were associated with larger size and higher grade DCIS lesions. CONCLUSIONS Variation in DCIS management among screened women is wide and includes lymph node surgery beyond what is currently recommended. This indicates the presence of varying levels of overtreatment and the potential for its reduction.
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Affiliation(s)
- Antonio Ponti
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ted James
- Department of Surgery, University of Vermont, Burlington, VT, USA
| | - Ondřej Májek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | | | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Helsinki, Finland
| | | | - Maria Piera Mano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Masaaki Kawai
- Department of Surgical Oncology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | | | | | | | - Carmen Vidal
- Cancer Detection and Control Programme, Catalan Institute of Oncology, Barcelona, Spain
| | - Nieves Ascunce
- Breast Cancer Screening Programme, Instituto de Salud Pública, Navarra, Spain
| | - Dolores Salas
- General Directorate Research and Public Health and Centre for Public Health Research, Valencia, Spain
| | | | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Karla Kerlikowske
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Stephen Taplin
- Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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10
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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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Ascunce N, Delfrade J, Salas D, Zubizarreta R, Ederra M. Programas de detección precoz de cáncer de mama en España: características y principales resultados. Med Clin (Barc) 2013; 141:13-23. [DOI: 10.1016/j.medcli.2012.03.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 03/14/2012] [Accepted: 03/15/2012] [Indexed: 10/28/2022]
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12
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Giordano L, Von Karsa L, Tomatis M, Majek O, De Wolf C, Lancucki L, Hofvind S, Nystrom L, Segnan N, Ponti A. Mammographic Screening Programmes in Europe: Organization, Coverage and Participation. J Med Screen 2012; 19 Suppl 1:72-82. [PMID: 22972813 DOI: 10.1258/jms.2012.012085] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
- Livia Giordano
- Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | - Lawrence Von Karsa
- European Cancer Network (ECN) for Screening and Prevention, Quality Assurance Group, Section of Early Detection and Prevention, International, Agency for Research on Cancer, Lyon, France
| | - Mariano Tomatis
- Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | - Ondrej Majek
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Chris De Wolf
- Swiss Federation of Breast Cancer Screening, Bern, Switzerland
| | | | - Solveig Hofvind
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Lennarth Nystrom
- Department of Public Health and Clinical Medicine, Umeá University, Umeá, Sweden
| | - Nereo Segnan
- Cancer Epidemiology Unit, Department of Cancer Screening, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | - Antonio Ponti
- Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
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13
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Hofvind S, Ponti A, Patnick J, Ascunce N, Njor S, Broeders M, Giordano L, Frigerio A, Törnberg S. False-Positive Results in Mammographic Screening for Breast Cancer in Europe: A Literature Review and Survey of Service Screening Programmes. J Med Screen 2012; 19 Suppl 1:57-66. [PMID: 22972811 DOI: 10.1258/jms.2012.012083] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Solveig Hofvind
- Researcher, Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Antonio Ponti
- Epidemiologist, Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | | | - Nieves Ascunce
- Public Health Doctor, Navarra Breast Cancer Screening Programme. Spanish Cancer Screening Network, Public Health Institute, Pamplona, Spain
| | - Sisse Njor
- Post Doc, Centre for Epidemiology and Screening, University of Copenhagen, Copenhagen, Denmark
| | - Mireille Broeders
- Senior Epidemiologist, Department of Epidemiology, Biostatistics and HTA, Radboud University Nijmegen Medical Centre, and National Expert and Training Centre for Breast Cancer Screening, Nijmegen, The Netherlands
| | - Livia Giordano
- MD MPH, Epidemiologist, Epidemiology Unit, CPO Piemonte, AOU S. Giovanni Battista, Turin, Italy
| | - Alfonso Frigerio
- Radiologist, Regional Reference Centre for Breast Cancer Screening, AOU S. Giovanni Battista, Turin, Italy
| | - Sven Törnberg
- Oncologist and Director, Cancer Screening Unit, Oncologic Centre S3:00, Karolinska University Hospital, Stockholm, Sweden
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Jacobsen KK, von Euler-Chelpin M. Performance indicators for participation in organized mammography screening. J Public Health (Oxf) 2012; 34:272-8. [DOI: 10.1093/pubmed/fdr106] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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[Assessment of results in the early diagnosis of breast cancer program in Asturias Community]. ACTA ACUST UNITED AC 2011; 27:38-43. [PMID: 22024048 DOI: 10.1016/j.cali.2011.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Revised: 06/20/2011] [Accepted: 07/11/2011] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate and disseminate the intermediate results of a breast cancer early detection program in the Asturias Community. MATERIAL AND METHODS We report the results of screening examinations performed between 2005 and 2009, using the indicators proposed in the European Guidelines on Quality Assurance in Mammography Screening. The information sources for breast cancer cases diagnosed were the pathology information system and the information on the characteristics of the tumour from the pathology report. The classification of the diagnostic features of the program was from its own information system. RESULTS A total of 1,384 breast cancers were diagnosed in the program target population during the study period, of which 49% were diagnosed in the program, 13% were interval cancers, 17% were diagnosed in women who chose not to participate in the program, and 22% in women who for various reasons had not been invited to participate. The most advanced diagnoses were made in the group of interval cancers and the earliest diagnoses were made in the uninvited population. CONCLUSIONS When the healthcare system is directed towards the asymptomatic population to provide a measure of prevention, it must ensure that there is a favourable balance. The results of this evaluation are consistent with accepted standards and with those found in other assessments.
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Lynge E, Törnberg S, von Karsa L, Segnan N, van Delden JJM. Determinants of successful implementation of population-based cancer screening programmes. Eur J Cancer 2011; 48:743-8. [PMID: 21788130 DOI: 10.1016/j.ejca.2011.06.051] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2011] [Revised: 06/22/2011] [Accepted: 06/23/2011] [Indexed: 11/18/2022]
Abstract
To facilitate the future implementation of population-based cancer screening programmes in European countries, we summarised the experience gained from existing programmes across Europe. We listed points that citizens, advocacy groups, politicians, health planners, and health professionals should consider when planning, implementing and running population based cancer screening programmes. The list is general and is applicable to breast, cervical and colorectal cancer screening. It is based on evidence presented in the three European Union guidelines on quality assurance in cancer screening and diagnosis, supplemented with other literature and expert experience presented at a European Science Advisory Network for Health workshop. The implementation of a cancer screening programme should be divided into the following seven phases: (1) before planning, (2) planning, (3) feasibility testing, (4) piloting or trial implementation, (5) scaling up from pilot to service, (6) running of full-scale programme, and (7) sustainability. For each phase, a substantial number of specified conditions have to be met. Successful implementation of a cancer screening programme requires societal acceptance and local ownership along with the best evidence-based practise and verification of adequate performance in each phase of implementation.
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Affiliation(s)
- Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Denmark.
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Majek O, Danes J, Skovajsova M, Bartonkova H, Buresova L, Klimes D, Brabec P, Kozeny P, Dusek L. Breast cancer screening in the Czech Republic: time trends in performance indicators during the first seven years of the organised programme. BMC Public Health 2011; 11:288. [PMID: 21554747 PMCID: PMC3112123 DOI: 10.1186/1471-2458-11-288] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Accepted: 05/10/2011] [Indexed: 12/04/2022] Open
Abstract
Background The Czech Breast Cancer Screening Programme (CBCSP) was initiated in September 2002 by establishing a network of accredited centres. The aim of this article is to describe progress in the programme quality over time after the inception of the organised programme. Methods The CBCSP is monitored using an information system consisting of three principal components: 1) the national cancer registry, 2) a screening registry collecting data on all screening examinations, further assessments and final diagnoses at accredited programme centres, and 3) administrative databases of healthcare payers. Key performance indicators from the European Guidelines have been adopted for continuous monitoring. Results Breast cancer incidence in the Czech Republic has steadily been increasing, however with a growing proportion of less advanced stages. The mortality rate has recently stabilised. The screening registry includes 2,083,285 records on screening episodes between 2002 and 2008. In 2007-2008, 51% of eligible women aged 45-69 were screened. In 2008, the detection rates were 6.1 and 3.7 per 1,000 women in initial and subsequent screening respectively. Corresponding recall rates are 3.9% and 2.2%, however, it is necessary to pay attention to further assessment performed during the screening visits. Benign to malignant open biopsy ratio was 0.1. Of invasive cases detected in screening, 35.6% was less than 10 mm in diameter. Values of early performance indicators, as measured by both crude and standardized estimates, are generally improving and fulfil desirable targets set by European Guidelines. Conclusions Mammography screening in the Czech Republic underwent successful transformation from opportunistic prevention to an organised programme. Values of early indicators confirm continuous improvement in different aspects of process quality. Further stimulation of participation through invitation system is necessary to exploit the full potential of screening mammography at the population level.
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Affiliation(s)
- Ondrej Majek
- Institute of Biostatistics and Analyses, Masaryk University, Kamenice 126/3, 625 00 Brno, Czech Republic
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Population-based mammography screening below age 50: balancing radiation-induced vs prevented breast cancer deaths. Br J Cancer 2011; 104:1214-20. [PMID: 21364575 PMCID: PMC3068504 DOI: 10.1038/bjc.2011.67] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Exposure to ionizing radiation at mammography screening may cause breast cancer. Because the radiation risk increases with lower exposure age, advancing the lower age limit may affect the balance between screening benefits and risks. The present study explores the benefit-risk ratio of screening before age 50. METHODS The benefits of biennial mammography screening, starting at various ages between 40 and 50, and continuing up to age 74 were examined using micro-simulation. In contrast with previous studies that commonly used excess relative risk models, we assessed the radiation risks using the latest BEIR-VII excess absolute rate exposure-risk model. RESULTS The estimated radiation risk is lower than previously assessed. At a mean glandular dose of 1.3 mGy per view that was recently measured in the Netherlands, biennial mammography screening between age 50 and 74 was predicted to induce 1.6 breast cancer deaths per 100,000 women aged 0-100 (range 1.3-6.3 extra deaths at a glandular dose of 1-5 mGy per view), against 1121 avoided deaths in this population. Advancing the lower age limit for screening to include women aged 40-74 was predicted to induce 3.7 breast cancer deaths per 100,000 women aged 0-100 (range 2.9-14.4) at biennial screening, but would also prevent 1302 deaths. CONCLUSION The benefits of mammography screening between age 40 and 74 were predicted to outweigh the radiation risks.
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Variation in performance in low-volume mammography screening programmes: experience from Switzerland. Cancer Epidemiol 2010; 35:293-7. [PMID: 20729158 DOI: 10.1016/j.canep.2010.07.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 07/25/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Reading volume and mammography screening performance appear positively correlated. Quality and effectiveness were compared across low-volume screening programmes targeting relatively small populations and operating under the same decentralised healthcare system. Except for accreditation of 2nd readers (restrictive vs non-restrictive strategy), these organised programmes had similar screening regimen/procedures and duration, which maximises comparability. Variation in performance and its determinants were explored in order to improve mammography practice and optimise screening performance. METHODS Circa 200,000 screens performed between 1999 and 2006 (4 rounds) in 3 longest standing Swiss cantonal programmes (of Vaud, Geneva and Valais) were assessed. Indicators of quality and effectiveness were assessed according to European standards. Interval cancers were identified through linkage with cancer registries records. RESULTS Swiss programmes met most European standards of performance with a substantial, favourable cancer stage shift. Up to a two-fold variation occurred for several performance indicators. In subsequent rounds, compared with programmes (Vaud and Geneva) that applied a restrictive selection strategy for 2nd readers, proportions of in situ lesions and of small cancers (≤1cm) were one third lower and halved, respectively, and the proportion of advanced lesions (stage II+) nearly 50% higher in the programme without a restrictive selection strategy. Discrepancy in second-year proportional incidence of interval cancers appears to be multicausal. CONCLUSION Differences in performance could partly be explained by a selective strategy for second readers and a prior experience in service screening, but not by the levels of opportunistic screening and programme attendance. This study provides clues for enhancing mammography screening performance in low-volume programmes.
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Ascunce N, Salas D, Zubizarreta R, Almazán R, Ibáñez J, Ederra M. Cancer screening in Spain. Ann Oncol 2010; 21 Suppl 3:iii43-51. [DOI: 10.1093/annonc/mdq085] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Cabanes A, Vidal E, Aragonés N, Pérez-Gómez B, Pollán M, Lope V, López-Abente G. Cancer mortality trends in Spain: 1980–2007. Ann Oncol 2010; 21 Suppl 3:iii14-20. [DOI: 10.1093/annonc/mdq089] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Spadea T, Bellini S, Kunst A, Stirbu I, Costa G. The impact of interventions to improve attendance in female cancer screening among lower socioeconomic groups: a review. Prev Med 2010; 50:159-64. [PMID: 20093138 DOI: 10.1016/j.ypmed.2010.01.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2009] [Revised: 01/11/2010] [Accepted: 01/13/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To review the scientific evidence on the effectiveness of interventions to promote attendance to breast and cervical cancer screening among lower socioeconomic groups. METHODS We performed a computerized literature search looking for relevant papers published between 1997 and 2006. Papers were classified into three groups based on the type of intervention evaluated: (1) implementation of organized population screening programs; (2) different strategies of enhancing attendance within an organized program; (3) local interventions in disadvantaged populations. RESULTS The available evidence supports the hypothesis that while organized population screening programs are successful in increasing overall participation rates, they may not per se substantially reduce social inequalities. Some strategies were consistently found to enhance access to screening among lower socioeconomic groups, including cost-reducing interventions (e.g. offering free tests and eliminating geographical barriers), a greater involvement of primary-care physicians and individually tailored pro-active communication that addresses barriers to screening. CONCLUSIONS Evidence from studies suggests that the attendance of deprived women to cancer screening can be improved with organized screening programs tailored to their needs. The same may apply to the prevention of adverse outcomes of other health conditions, such as hypertension, hypercholesterolemia, and diabetes.
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Affiliation(s)
- Teresa Spadea
- Regional Epidemiology Unit, ASL TO3 Piedmont Region, Grugliasco, Italy.
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Cabanes A, Ascunce N, Vidal E, Ederra M, Barcos A, Erdozain N, Lope V, Pollán M. Decline in age at menarche among Spanish women born from 1925 to 1962. BMC Public Health 2009; 9:449. [PMID: 19961593 PMCID: PMC2796666 DOI: 10.1186/1471-2458-9-449] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Accepted: 12/04/2009] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND While the timing of reproductive events varies across populations, a downward trend in age at menarche has nevertheless been reported in most of the developed world over the past century. Given the impact of change in age at menarche on health conditions, this study sought to examine secular trends in age at menarche among women living in Navarre (Northern Spain) who participated in a population-based breast cancer screening programme. METHODS The study was based on 110545 women born from 1925 to 1962. Trends were tested using a linear regression model, in which year of birth was entered continuously as the predictor and age at menarche (years) as the response variable, using size of town and region of birth as covariates. RESULTS Among women born in Navarre between 1925 and 1962, age at menarche declined steadily from an average of 13.72 years in the 1925-1929 birth-cohorts to 12.83 years in the 1958-1962 birth-cohorts. Controlling for size of town or city of birth, age at menarche declined by an average of 0.132 years every 5 years over the period 1925-1962. This decline was greater in women born in rural versus urban settings. Trends were also different among regions of birth. CONCLUSION We report a population-based study showing a downward trend in age of onset of menarche among Spanish women born in the period 1925-1962, something that is more pronounced among women born in rural settings and varies geographically.
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Affiliation(s)
- Anna Cabanes
- Area de Epidemiología Ambiental y Cáncer, Centro Nacional de Epidemiología, Instituto de Salud Carlos III, Monforte de Lemos 5, 28029 Madrid, Spain.
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Hofvind S, Yankaskas BC, Bulliard JL, Klabunde CN, Fracheboud J. Comparing Interval Breast Cancer Rates in Norway and North Carolina: Results and Challenges. J Med Screen 2009; 16:131-9. [DOI: 10.1258/jms.2009.009012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To compare interval breast cancer rates (ICR) between a biennial organized screening programme in Norway and annual opportunistic screening in North Carolina (NC) for different conceptualizations of interval cancer. Setting Two regions with different screening practices and performance. Methods 620,145 subsequent screens (1996–2002) performed in women aged 50–69 and 1280 interval cancers were analysed. Various definitions and quantification methods for interval cancers were compared. Results ICR for one year follow-up were lower in Norway compared with NC both when the rate was based on all screens (0.54 versus 1.29 per 1000 screens), negative final assessments (0.54 versus 1.29 per 1000 screens), and negative screening assessments (0.53 versus 1.28 per 1000 screens). The rate of ductal carcinoma in situ was significantly lower in Norway than in NC for cases diagnosed in both the first and second year after screening. The distributions of histopathological tumour size and lymph node involvement in invasive cases did not differ between the two regions for interval cancers diagnosed during the first year after screening. In contrast, in the second year after screening, tumour characteristics remained stable in Norway but became prognostically more favorable in NC. Conclusion Even when applying a common set of definitions of interval cancer, the ICR was lower in Norway than in NC. Different definitions of interval cancer did not influence the ICR within Norway or NC. Organization of screening and screening performance might be major contributors to the differences in ICR between Norway and NC.
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Affiliation(s)
- Solveig Hofvind
- Department of Screening Based-research, The Cancer Registry of Norway, 0304 Oslo, Norway
| | - Bonnie C Yankaskas
- Department of Radiology, University of North Carolina at Chapel Hill, 27599, USA
| | - Jean-Luc Bulliard
- Cancer Epidemiology Unit, University Institute of Social and Preventive Medicine, Lausanne, Switzerland
| | - Carrie N Klabunde
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892–7344, USA
| | - Jacques Fracheboud
- Department of Public Health, NETB, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Age-specific breast, uterine and ovarian cancer mortality trends in Spain: Changes from 1980 to 2006. Cancer Epidemiol 2009; 33:169-75. [DOI: 10.1016/j.canep.2009.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 08/24/2009] [Accepted: 08/25/2009] [Indexed: 11/24/2022]
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Bulliard JL, Ducros C, Jemelin C, Arzel B, Fioretta G, Levi F. Effectiveness of organised versus opportunistic mammography screening. Ann Oncol 2009; 20:1199-202. [PMID: 19282467 DOI: 10.1093/annonc/mdn770] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Detailed comparison of effectiveness between organised and opportunistic mammography screening operating in the same country has seldom been carried out. PATIENTS AND METHODS Prognostic indicators, as defined in the European Guidelines, were used to evaluate screening effectiveness in Switzerland. Matching of screening programmes' records with population-based cancer registries enabled to compare indicators of effectiveness by screening and detection modality (organised versus opportunistic screening, unscreened, interval cancers). Comparisons of prognostic profile were also drawn with two Swiss regions uncovered by service screening of low and high prevalence of opportunistic screening, respectively. RESULTS Opportunistic and organised screening yielded overall little difference in prognostic profile. Both screening types led to substantial stage shifting. Breast cancer prognostic indicators were systematically more favourable in Swiss regions covered by a programme. In regions without a screening programme, the higher the prevalence of opportunistic screening, the better was the prognostic profile. CONCLUSIONS Organised screening appeared as effective as opportunistic screening. Mammography screening has strongly influenced the stage distribution of breast cancer in Switzerland, and a favourable impact on mortality is anticipated. Extension of organised mammography screening to the whole of Switzerland can be expected to further improve breast cancer prognosis in a cost-effective way.
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Affiliation(s)
- J-L Bulliard
- Cancer Epidemiology Unit, University Institute of Social and Preventive Medicine (IUMSP), Centre Hospitalier Universitaire Vaudois and University of Lausanne, Lausanne, Switzerland.
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de Gelder R, Bulliard JL, de Wolf C, Fracheboud J, Draisma G, Schopper D, de Koning HJ. Cost-effectiveness of opportunistic versus organised mammography screening in Switzerland. Eur J Cancer 2008; 45:127-38. [PMID: 19038540 DOI: 10.1016/j.ejca.2008.09.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Revised: 09/17/2008] [Accepted: 09/25/2008] [Indexed: 02/07/2023]
Abstract
BACKGROUND Various centralised mammography screening programmes have shown to reduce breast cancer mortality at reasonable costs. However, mammography screening is not necessarily cost-effective in every situation. Opportunistic screening, the predominant screening modality in several European countries, may under certain circumstances be a cost-effective alternative. In this study, we compared the cost-effectiveness of both screening modalities in Switzerland. METHODS Using micro-simulation modelling, we predicted the effects and costs of biennial mammography screening for 50-69 years old women between 1999 and 2020, in the Swiss female population aged 30-70 in 1999. A sensitivity analysis on the test sensitivity of opportunistic screening was performed. RESULTS Organised mammography screening with an 80% participation rate yielded a breast cancer mortality reduction of 13%. Twenty years after the start of screening, the predicted annual breast cancer mortality was 25% lower than in a situation without screening. The 3% discounted cost-effectiveness ratio of organised mammography screening was euro11,512 per life year gained. Opportunistic screening with a similar participation rate was comparably effective, but at twice the costs: euro22,671-24,707 per life year gained. This was mainly related to the high costs of opportunistic mammography and frequent use of imaging diagnostics in combination with an opportunistic mammogram. CONCLUSION Although data on the performance of opportunistic screening are limited, both opportunistic and organised mammography screening seem effective in reducing breast cancer mortality in Switzerland. However, for opportunistic screening to become equally cost-effective as organised screening, costs and use of additional diagnostics should be reduced.
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Affiliation(s)
- Rianne de Gelder
- Erasmus MC, Department of Public Health, Rotterdam, The Netherlands.
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Duijm LE, Groenewoud JH, Fracheboud J, van Ineveld BM, Roumen RM, de Koning HJ. Introduction of additional double reading of mammograms by radiographers: Effects on a biennial screening programme outcome. Eur J Cancer 2008; 44:1223-8. [DOI: 10.1016/j.ejca.2008.03.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2007] [Revised: 01/26/2008] [Accepted: 03/10/2008] [Indexed: 11/25/2022]
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Utilization and cost of diagnostic imaging and biopsies following positive screening mammography in the southern breast cancer screening region of the Netherlands, 2000-2005. Eur Radiol 2008; 18:2390-7. [PMID: 18491102 DOI: 10.1007/s00330-008-1043-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2007] [Revised: 03/27/2008] [Accepted: 04/21/2008] [Indexed: 10/22/2022]
Abstract
We prospectively assessed trends in utilization and costs of diagnostic services of screen-positive women in a biennial breast cancer screening program for women aged 50-75 years. All 2,062 women with suspicious findings at screening mammography in the southern region of the Netherlands between 1 January 2000 and 1 July 2005 (158,997 screens) were included. Data were collected on any diagnostic examinations, interventional procedures, and surgical consultations with two-year follow-up. We used national reimbursement rates to estimate imaging costs and percutaneous biopsy costs. Cost prices, charged by hospitals, were used to estimate open surgical biopsy costs and surgical consultation costs. The largest increase in utilization of diagnostic procedures per 100 referrals was observed for axillary ultrasound (from 3.9 in 2000 to 33.5 in 2005) and for stereotactic core biopsy (from 2.1 in 2000 to 26.8 in 2005). Per 100 referrals, the open surgical biopsy rate decreased from 34.7 (2000) to 4.6 (2005) and the number of outpatient surgical consultations fluctuated between 269.8 (2000) and 309.7 (2004). Mean costs for the diagnosis of one cancer were Euro1,501 and ranged from Euro1,223 (2002) to Euro1,647 (2003). Surgical biopsies comprised 54.1% of total diagnostic costs for women screened in 2000, but decreased to 9.9% for women screened in 2005. Imaging costs increased from 23.7 to 43.8%, percutaneous biopsy costs from 9.9 to 27.2%, and consultation costs from 12.3 to 19.1%. We conclude that diagnostic costs per screen-detected cancer remained fairly stable through the years, although huge changes in the use of different diagnostic procedures were observed.
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Kellen E, Putte GV, Van Steen A, Cloes E, Lousbergh D, Buntinx F, Van Limbergen E. Interval cancers in the beginning years of the breast cancer screening programme in the Belgian province of Limburg. Acta Clin Belg 2008; 63:179-84. [PMID: 18714848 DOI: 10.1179/acb.2008.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To assess the occurrence of interval breast cancers among those women who attended the mammography screening programme in the Belgian province of Limburg. Interval cancers are tumours that are being diagnosed before the next scheduled screening round and are related to the sensitivity and the screening interval. METHODS Biennial screening is provided to all women aged 50-69. The records of the screening programme were linked to those of the cancer registry. The interval cancer rate, expressed as a proportion of the underlying (expected) breast cancer incidence rate was calculated. The observed interval cancer incidence is the number of interval cancers per 10,000 'negative' screening tests. RESULTS The interval cancer rate in the first year was 25.37% for all cancers (ductal carcinoma in situ included) and 21.7% when the analysis was restricted to invasive tumours. Proportional incidence of interval cancer in the second year after screening was 12.02% for all cancers. CONCLUSION In conclusion, the interval cancer rates in the Belgian province of Limburg were compatible with the European guidelines. However, increasing the recall rate in our programme and systematically reviewing the interval cancers may improve the quality of the programme even further.
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Affiliation(s)
- E Kellen
- Leuven University Centre for Cancer Prevention (LUCK), Leuven, Belgium.
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Tangka FKL, Dalaker J, Chattopadhyay SK, Gardner JG, Royalty J, Hall IJE, DeGroff A, Blackman DK, Coates RJ. Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002-2003 (United States). Cancer Causes Control 2007; 17:1145-54. [PMID: 17006720 PMCID: PMC1764594 DOI: 10.1007/s10552-006-0058-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2006] [Accepted: 06/26/2006] [Indexed: 11/30/2022]
Abstract
Objective To examine the extent to which the National Breast and Cervical Cancer Early Detection Program (Program) has helped to meet the mammography screening needs of underserved women. Methods Low-income, uninsured women aged 40–64 are eligible for free mammography screening through the Program. We used data from the U.S. Census Bureau to estimate the number of women eligible for services. We obtained the number of women receiving Program-funded mammograms from the Program. We then calculated the percentage of eligible women who received mammograms through the Program. Results In 2002–2003, of all U.S. women aged 40–64, approximately 4 million (8.5%) had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 528,622 (13.2%) received a Program-funded mammogram. Rates varied substantially by race and ethnicity. The percentage of eligible women screened in each state ranged from about 2% to approximately 79%. Conclusions Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40–64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.
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Affiliation(s)
- Florence K. L. Tangka
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
- Centers for Disease Control and Prevention, DCPC, 4770 Buford Highway, NE, Mailstop K-55, Atlanta, GA 30341-3717 USA
| | - Joseph Dalaker
- Housing and Household Economic Statistics Division, U.S. Census Bureau, Washington, DC USA
| | - Sajal K. Chattopadhyay
- Office of Strategy and Innovation, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - James G. Gardner
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Janet Royalty
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ingrid J. E. Hall
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Amy DeGroff
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Donald K. Blackman
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
| | - Ralph J. Coates
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
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Boncz I, Sebestyén A, Döbrossy L, Péntek Z, Budai A, Kovács A, Dózsa C, Ember I. The organisation and results of first screening round of the Hungarian nationwide organised breast cancer screening programme. Ann Oncol 2007; 18:795-9. [PMID: 17259642 DOI: 10.1093/annonc/mdl489] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The aim of this paper is to give an overview of organisational issues of the Hungarian nationwide organised breast cancer screening programme and to provide the results of the first screening round of the programme for the years 2002-2003. PATIENTS AND METHODS Data were derived from the financial database of the National Health Insurance Fund Administration covering the period 2000-2003. Women who underwent mammography screening were included into the study. RESULTS Uptake of the organised screening programme in 2002-2003 was 45.09%, while the recall rate was 7.23%. Malignant cases represented 65.38% of total surgeries and 0.36% of total number of screened women yielding a cancer detection rate 3.6 per 1000 screened women. Malignant cases of 10.78% were identified as ductal carcinoma in situ, while 89.22% was invasive cancer. Benign to malignant ratio was 0.54 : 1. CONCLUSION There is therefore an urgent need to closely monitor performance and to review programme policies and procedures with the aim of increasing both the participation rate and the proportion of women eligible to attend screening.
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Affiliation(s)
- I Boncz
- Department of Health Policy, National Health Insurance Fund Administration, Váci út 73/A., 1139 Budapest, Hungary.
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Duijm LEM, Groenewoud JH, Roumen RMH, de Koning HJ, Plaisier ML, Fracheboud J. A decade of breast cancer screening in The Netherlands: trends in the preoperative diagnosis of breast cancer. Breast Cancer Res Treat 2007; 106:113-9. [PMID: 17219049 DOI: 10.1007/s10549-006-9468-5] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 11/25/2006] [Indexed: 11/28/2022]
Abstract
PURPOSE In a prospective, multi-institutional follow-up study we describe the trends in the preoperative pathologic confirmation of breast cancer of women who underwent breast cancer screening between 1995 and 2005. METHODS We included all women aged 50-75 years who underwent biennial screening mammography in the southern breast cancer screening region of the Netherlands between February 13, 1995 and December 22, 2004. Clinical data, breast imaging reports, biopsy results and breast surgery reports were collected of all women with a positive screening result. Follow-up lasted through the next biennial screening examination and was approximately two years for all referred women. RESULTS Of 258,900 mammographic screening examinations, 3,064 (1.2%) were positive screens. The majority of women (92%) were analyzed in four regional hospitals and workup yielded breast cancer in 1,332 women. From 1995 to 2005, the percentage of breast cancer cases that underwent percutaneous biopsy prior to surgery, increased from 42.4 to 100%. The proportion of cancers with a preoperative diagnosis of malignancy by percutaneous biopsy, increased from 27.1% in 1995 to 92.7% in 2004. Preoperative breast cancer confirmation by fine needle aspiration cytology (FNAC) gradually decreased from 91.3% to 14.5%, whereas preoperative confirmation by ultrasound guided core biopsy (USCB) or stereotactic core needle biopsy (SCNB) increased from 8.7% to 69.1% and from 0 to 17.4% respectively. CONCLUSIONS A preoperative diagnosis of breast cancer is currently obtained in more than 90% of breast cancer patients. The increase in preoperative breast cancer diagnosis through 1995-2004 is correlated with the introduction of SNCB and increased use of USCB at the expense of FNAC.
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Affiliation(s)
- Lucien E M Duijm
- Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands.
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Séradour B, Ancelle-Park R. Dépistage organisé des Cancers du Sein : peut-on comparer les résultats du programme français aux résultats internationaux ? ACTA ACUST UNITED AC 2006; 87:1009-14. [PMID: 16936624 DOI: 10.1016/s0221-0363(06)74124-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Full coverage of the national breast cancer screening programme was obtained in 2004. The new protocol was published in 2001. It changed the organisation implemented since 1994 for a better fit with the French decentralized health care system. Consequences on health results were analysed explaining related medical and sociological factors. The main change was the rate of positive mammograms which differed from the recall rate given in the European recommendations. With the new protocol the rate of assessments more than doubled: 6% in year 2000 and 14% in 2003. International comparisons are difficult since each country has a different organisation. Moreover the coexistence in France of organized screening and opportunistic screening causes a complex issue for evaluation of impact indicators of this population based programme.
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Affiliation(s)
- B Séradour
- Médecin-Radiologue, Association ARCADES, Hôpital de la Timone Bat. F, Rue Saint Pierre, 13385 Marseille Cedex 5, France.
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Rodvall Y, Kemetli L, Tishelman C, Törnberg S. Factors related to participation in a cervical cancer screening programme in urban Sweden. Eur J Cancer Prev 2005; 14:459-66. [PMID: 16175050 DOI: 10.1097/01.cej.0000178078.21910.da] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Fifty-six per cent of invited women aged 25-60 attended the Population-based Cervical Cancer Screening Programme (PCCSP) in Stockholm, Sweden in 1994-1996. The objective of this study was to explore factors related to participation in this PCCSP. Registry data on all women aged 25-60 invited to the PCCSP from 1994 to 1996 (n=307,552) was matched with a national longitudinal population database. Women in the youngest age group (25-29 years old) were found to be less likely to participate in the PCCSP than women in older age groups. Married women or widows attended the programme more often (OR 1.32, 95% confidence interval (95% CI) 1.29-1.34 and OR 1.36, 95% CI 1.27-1.45, respectively) than did single women. Women in the labour force were more likely to participate than those who were not in the labour force (OR 1.82, 95% CI 1.78-1.87). The participation rate was not lower for immigrant women from developing countries than for those born in Sweden. We found that age, marital status and being in the labour force or not are factors associated with participation in the cervical cancer screening programme.
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Affiliation(s)
- Y Rodvall
- Department of Occupational and Environmental Health, Stockholm Centre of Public Health, Norrbacka, 3rd floor, SE-171 76, Stockholm, Sweden.
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