1
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Farber R, Marinovich ML, Pinna A, Houssami N, McGeechan K, Barratt A, Bell KJL. Systematic review and meta-analysis of prognostic characteristics for breast cancers in populations with digital vs film mammography indicate the transition may have increased both early detection and overdiagnosis. J Clin Epidemiol 2024; 171:111339. [PMID: 38570078 DOI: 10.1016/j.jclinepi.2024.111339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 03/14/2024] [Accepted: 03/25/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Film mammography has been replaced by digital mammography in breast screening programs globally. This led to a small increase in the rate of detection, but whether the detection of clinically important cancers increased is uncertain. We aimed to assess the impact on tumor characteristics of screen-detected and interval breast cancers. STUDY DESIGN AND SETTING We searched seven databases from inception to October 08, 2023, for publications comparing film and digital mammography within the same population of asymptomatic women at population (average) risk of breast cancer. We recorded reported tumor characteristics and assessed risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions tool. We synthesized results using meta-analyses of random effects. RESULTS Eighteen studies were included in the analysis from 8 countries, including 11,592,225 screening examinations (8,117,781 film; 3,474,444 digital). There were no differences in tumor size, morphology, grade, node status, receptor status, or stage in the pooled differences for screen-detected and interval invasive cancer tumor characteristics. There were statistically significant increases in screen-detected ductal carcinoma in situ (DCIS) across all grades: 0.05 (0.00-0.11), 0.14 (0.05-0.22), and 0.19 (0.05-0.33) per 1000 screens for low, intermediate, and high-grade DCIS, respectively. There were similar (non-statistically significant) increases in screen-detected invasive cancer across all grades. CONCLUSION The increased detection of all grades of DCIS and invasive cancer may indicate both increased early detection of more aggressive disease and increased overdiagnosis.
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Affiliation(s)
- Rachel Farber
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Michael L Marinovich
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Audrey Pinna
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; Department of medical imaging, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Nehmat Houssami
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Kevin McGeechan
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Alexandra Barratt
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia
| | - Katy J L Bell
- Faculty of Medicine and Health, Sydney School of Public Health, The University of Sydney, Sydney 2006, Australia.
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2
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Moshina N, Backmann HA, Skaane P, Hofvind S. Mammographic features and risk of breast cancer death among women with invasive screen-detected cancer in BreastScreen Norway 1996-2020. Eur Radiol 2024; 34:3364-3374. [PMID: 37935848 PMCID: PMC11126444 DOI: 10.1007/s00330-023-10369-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/26/2023] [Accepted: 09/02/2023] [Indexed: 11/09/2023]
Abstract
OBJECTIVES We explored associations between mammographic features and risk of breast cancer death among women with small (<15 mm) and large (≥15 mm) invasive screen-detected breast cancer. METHODS We included data from 17,614 women diagnosed with invasive breast cancer as a result of participation in BreastScreen Norway, 1996-2020. Data on mammographic features (mass, spiculated mass, architectural distortion, asymmetric density, density with calcification and calcification alone), tumour diameter and cause of death was obtained from the Cancer Registry of Norway. Cox regression was used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for breast cancer death by mammographic features using spiculated mass as reference, adjusting for age, tumour diameter and lymph node status. All analyses were dichotomised by tumour diameter (small versus large). RESULTS Mean age at diagnosis was 60.8 (standard deviation, SD=5.8) for 10,160 women with small tumours and 60.0 (SD=5.8) years for 7454 women with large tumours. The number of breast cancer deaths was 299 and 634, respectively. Mean time from diagnosis to death was 8.7 (SD=5.0) years for women with small tumours and 7.2 (4.6) years for women with large tumours. Using spiculated mass as reference, adjusted HR for breast cancer death among women with small tumours was 2.48 (95% CI 1.67-3.68) for calcification alone, while HR for women with large tumours was 1.30 (95% CI 1.02-1.66) for density with calcification. CONCLUSIONS Small screen-detected invasive cancers presenting as calcification and large screen-detected cancers presenting as density with calcification were associated with the highest risk of breast cancer death. CLINICAL RELEVANCE STATEMENT Small tumours (<15 mm) presented as calcification alone and large tumours (≥ 15 mm) presented as density with calcification were associated with the highest risk of breast cancer death among women with screen-detected invasive breast cancer diagnosed 1996-2020. KEY POINTS • Women diagnosed with invasive screen-detected breast cancer 1996-2020 were analysed. • Small screen-detected cancers presenting as calcification alone resulted in the highest risk of breast cancer death. • Large screen-detected cancers presenting as density with calcification resulted in the highest risk of breast cancer death.
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Affiliation(s)
- Nataliia Moshina
- Section for breast cancer screening, Cancer Registry of Norway, Oslo, Norway.
| | | | - Per Skaane
- Division of Radiology and Nuclear Medicine, Oslo University Hospital, Oslo, Norway
| | - Solveig Hofvind
- Section for breast cancer screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, The Arctic University of Norway, Tromsø, Norway
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3
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Jørgensen SF, Sagstad S, Louro J, Román M, Castells X, Hofvind S, Njor S. Comparisons of assessment pathways after abnormal mammography screening in Denmark, Norway, and Spain. Breast Cancer Res Treat 2024; 205:135-145. [PMID: 38285110 PMCID: PMC11063097 DOI: 10.1007/s10549-023-07219-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 12/10/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE To ensure high-quality screening programmes and effective utilization of resources, it is important to monitor how cancer detection is affected by different strategies performed at recall assessment. This study aimed to describe procedures performed at recall assessment and compare and evaluate the performance of the assessment in Denmark, Norway, and Spain in terms of screen-detected cancer (SDC) and interval cancer (IC) rates. METHODS We included women aged 50-69 years from Denmark, Norway, and Spain, who were recalled for assessment after screening mammography, and recorded all procedures performed during six months after diagnosis, and the timing of the procedures. Women were followed for two years and screen-detected and interval cancer, and sensitivity of recall was calculated and compared. RESULTS In total, data from 24,645 Danish, 30,050 Norwegian, and 41,809 Spanish women were included in the study. Most of the women had some assessment within 2 months in all three countries. SDC rates were higher in Denmark (0.57) and Norway (0.60) compared to Spain (0.38), as were the IC rates, i.e. 0.25 and 0.18 vs. 0.12, respectively. The sensitivity of the diagnostic follow-up was somewhat higher in Denmark (98.3%) and Norway (98.2%), compared to Spain (95.4%), but when excluding non-invasive assessment pathways, the sensitivities were comparable. CONCLUSION This comparison study showed variation in the assessment procedures used in the three countries as well as the SDC and IC rates and the sensitivity of recall.
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Affiliation(s)
- Susanne Fogh Jørgensen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NE, Denmark.
- Department of Data, Innovation and Research, Lillebaelt Hospital, Beriderbakken 4, 7100, Vejle, Denmark.
| | - Silje Sagstad
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Solveig Hofvind
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, The Arctic University of Norway, Tromsö, Norway
| | - Sisse Njor
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NE, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Data, Innovation and Research, Lillebaelt Hospital, Beriderbakken 4, 7100, Vejle, Denmark
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4
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Farber R, Houssami N, McGeechan K, Barratt A, Bell KJL. Breast Cancer Stage and Size Detected with Film versus Digital Mammography in New South Wales, Australia: A Population-Based Study Using Routinely Collected Data. Cancer Epidemiol Biomarkers Prev 2024; 33:671-680. [PMID: 38407377 DOI: 10.1158/1055-9965.epi-23-0813] [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: 07/14/2023] [Revised: 10/25/2023] [Accepted: 02/22/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Digital mammography has replaced film mammography in breast-screening programs globally, including Australia. This led to an increase in the rate of detection, but whether there was increased detection of clinically important cancers is uncertain. METHODS In this population-wide retrospective cohort study in New South Wales, Australia spanning 2004 to 2016 and including 4,631,656 screens, there were 22,965 cancers in women screened with film (n = 11,040) or digital mammography (n = 11,925). We examined the change in tumor characteristics overall and how these rates changed over time, accounting for changes in background rates using an interrupted time-series. Comparisons were made with unscreened women (n = 26,326) during this time. RESULTS We found increased detection of in situ cancer (3.36 per 10,000 screens), localized invasive, and smaller-sized breast cancers attributable to the change in mammography technology, whereas screen-detected intermediate-sized and metastatic breast cancers decreased. Rates of early-stage and intermediate-sized interval cancers increased, and late-stage (-1.62 per 10,000 screens) and large interval cancers decreased. In unscreened women, there were small increases in the temporal trends of cancers across all stages. CONCLUSIONS At least some of the increased detection of smaller early-stage cancers may have translated into a reduction in larger and late-stage cancers, indicating beneficial detection of cancers that would have otherwise progressed. However, the increased detection of smaller early-stage and small cancers may also have increased over-diagnosis of lesions that would otherwise have not caused harm. IMPACT Robust evaluation of potential benefits and harms is needed after changes to screening programs. See related In the Spotlight, p. 638.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Katy J L Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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5
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Heggland T, Vatten LJ, Opdahl S, Weedon-Fekjær H. Non-progressive breast carcinomas detected at mammography screening: a population study. Breast Cancer Res 2023; 25:80. [PMID: 37403150 PMCID: PMC10318793 DOI: 10.1186/s13058-023-01682-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/26/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Some breast carcinomas detected at screening, especially ductal carcinoma in situ, may have limited potential for progression to symptomatic disease. To determine non-progression is a challenge, but if all screening-detected breast tumors eventually reach a clinical stage, the cumulative incidence at a reasonably high age would be similar for women with or without screening, conditional on the women being alive. METHODS Using high-quality population data with 24 years of follow-up from the gradually introduced BreastScreen Norway program, we studied whether all breast carcinomas detected at mammography screening 50-69 years of age would progress to clinical symptoms within 85 years of age. First, we estimated the incidence rates of breast carcinomas by age in scenarios with or without screening, based on an extended age-period-cohort incidence model. Next, we estimated the frequency of non-progressive tumors among screening-detected cases, by calculating the difference in the cumulative rate of breast carcinomas between the screening and non-screening scenarios at 85 years of age. RESULTS Among women who attended BreastScreen Norway from the age of 50 to 69 years, we estimated that 1.1% of the participants were diagnosed with a breast carcinoma without the potential to progress to symptomatic disease by 85 years of age. This proportion of potentially non-progressive tumors corresponded to 15.7% [95% CI 3.3, 27.1] of breast carcinomas detected at screening. CONCLUSIONS Our findings suggest that nearly one in six breast carcinomas detected at screening may be non-progressive.
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Affiliation(s)
- Torunn Heggland
- Oslo Centre for Biostatistics and Epidemiology [OCBE], Research Support Services, Oslo University Hospital, Oslo, Norway.
- Oslo Centre for Biostatistics and Epidemiology, Department of Biostatistics, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway.
| | - Lars Johan Vatten
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Signe Opdahl
- Department of Public Health and Nursing, Faculty of Medicine and Health Science, Norwegian University of Science and Technology, Trondheim, Norway
| | - Harald Weedon-Fekjær
- Oslo Centre for Biostatistics and Epidemiology [OCBE], Research Support Services, Oslo University Hospital, Oslo, Norway
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6
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Lee CI, Abraham L, Miglioretti DL, Onega T, Kerlikowske K, Lee JM, Sprague BL, Tosteson ANA, Rauscher GH, Bowles EJA, diFlorio-Alexander RM, Henderson LM. National Performance Benchmarks for Screening Digital Breast Tomosynthesis: Update from the Breast Cancer Surveillance Consortium. Radiology 2023; 307:e222499. [PMID: 37039687 PMCID: PMC10323294 DOI: 10.1148/radiol.222499] [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: 09/28/2022] [Revised: 02/03/2023] [Accepted: 02/20/2023] [Indexed: 04/12/2023]
Abstract
Background It is important to establish screening mammography performance benchmarks for quality improvement efforts. Purpose To establish performance benchmarks for digital breast tomosynthesis (DBT) screening and evaluate performance trends over time in U.S. community practice. Materials and Methods In this retrospective study, DBT screening examinations were collected from five Breast Cancer Surveillance Consortium (BCSC) registries between 2011 and 2018. Performance measures included abnormal interpretation rate (AIR), cancer detection rate (CDR), sensitivity, specificity, and false-negative rate (FNR) and were calculated based on the American College of Radiology Breast Imaging Reporting and Data System, fifth edition, and compared with concurrent BCSC DM screening examinations, previously published BCSC and National Mammography Database benchmarks, and expert opinion acceptable performance ranges. Benchmarks were derived from the distribution of performance measures across radiologists (n = 84 or n = 73 depending on metric) and were presented as percentiles. Results A total of 896 101 women undergoing 2 301 766 screening examinations (458 175 DBT examinations [median age, 58 years; age range, 18-111 years] and 1 843 591 DM examinations [median age, 58 years; age range, 18-109 years]) were included in this study. DBT screening performance measures were as follows: AIR, 8.3% (95% CI: 7.5, 9.3); CDR per 1000 screens, 5.8 (95% CI: 5.4, 6.1); sensitivity, 87.4% (95% CI: 85.2, 89.4); specificity, 92.2% (95% CI: 91.3, 93.0); and FNR per 1000 screens, 0.8 (95% CI: 0.7, 1.0). When compared with BCSC DM screening examinations from the same time period and previously published BCSC and National Mammography Database performance benchmarks, all performance measures were higher for DBT except sensitivity and FNR, which were similar to concurrent and prior DM performance measures. The following proportions of radiologists achieved acceptable performance ranges with DBT: 97.6% for CDR, 91.8% for sensitivity, 75.0% for AIR, and 74.0% for specificity. Conclusion In U.S. community practice, large proportions of radiologists met acceptable performance ranges for screening performance metrics with DBT. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Lee and Moy in this issue.
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Affiliation(s)
- Christoph I. Lee
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Linn Abraham
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Diana L. Miglioretti
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Tracy Onega
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Karla Kerlikowske
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Janie M. Lee
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Brian L. Sprague
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Anna N. A. Tosteson
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Garth H. Rauscher
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Erin J. A. Bowles
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Roberta M. diFlorio-Alexander
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - Louise M. Henderson
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
| | - for the Breast Cancer Surveillance Consortium
- From the Department of Radiology, University of Washington School of
Medicine, Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson
Cancer Center, 825 Eastlake Ave E, LG-200, Seattle, WA 98109 (C.I.L., J.M.L.);
Department of Health Systems & Population Health, University of
Washington School of Public Health, Seattle, Wash (C.I.L.); Kaiser Permanente
Washington Health Research Institute, Kaiser Permanente Washington, Seattle,
Wash (C.I.L., L.A., D.L.M., J.M.L., E.J.A.B.); Division of Biostatistics,
Department of Public Health Sciences, University of California Davis School of
Medicine, Davis, Calif (D.L.M.); Department of Population Health Sciences, and
the Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah (T.O.);
Department of Medicine, Department of Epidemiology and Biostatistics, and
General Internal Medicine Section, Department of Veterans Affairs, University of
California, San Francisco, San Francisco, Calif (K.K.); Department of Surgery,
Office of Health Promotion Research, Larner College of Medicine at the
University of Vermont and University of Vermont Cancer Center, Burlington, Vt
(B.L.S.); The Dartmouth Institute for Health Policy and Clinical Practice,
Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon,
NH (A.N.A.T.); Division of Epidemiology and Biostatistics, School of Public
Health, University of Illinois at Chicago, Chicago, Ill (G.H.R.); Department of
Radiology, Geisel School of Medicine at Dartmouth, Lebanon, NH (R.M.d.A.); and
Department of Radiology, University of North Carolina, Chapel Hill, NC
(L.M.H.)
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7
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Kou K, Cameron J, Youl P, Pyke C, Chambers S, Dunn J, Aitken JF, Baade PD. Severity and risk factors of interval breast cancer in Queensland, Australia: a population-based study. Breast Cancer 2023; 30:466-477. [PMID: 36809492 PMCID: PMC10119209 DOI: 10.1007/s12282-023-01439-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/15/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Interval breast cancers (BC) are those diagnosed within 24 months of a negative mammogram. This study estimates the odds of being diagnosed with high-severity BC among screen-detected, interval, and other symptom-detected BC (no screening history within 2 years); and explores factors associated with being diagnosed with interval BC. METHODS Telephone interviews and self-administered questionnaires were conducted among women (n = 3,326) diagnosed with BC in 2010-2013 in Queensland. Respondents were categorised into screen-detected, interval, and other symptom-detected BCs. Data were analysed using logistic regressions with multiple imputation. RESULTS Compared with screen-detected BC, interval BC had higher odds of late-stage (OR = 3.50, 2.9-4.3), high-grade (OR = 2.36, 1.9-2.9) and triple-negative cancers (OR = 2.55, 1.9-3.5). Compared with other symptom-detected BC, interval BC had lower odds of late stage (OR = 0.75, 0.6-0.9), but higher odds of triple-negative cancers (OR = 1.68, 1.2-2.3). Among women who had a negative mammogram (n = 2,145), 69.8% were diagnosed at their next mammogram, while 30.2% were diagnosed with an interval cancer. Those with an interval cancer were more likely to have healthy weight (OR = 1.37, 1.1-1.7), received hormone replacement therapy (2-10 years: OR = 1.33, 1.0-1.7; > 10 years: OR = 1.55, 1.1-2.2), conducted monthly breast self-examinations (BSE) (OR = 1.66, 1.2-2.3) and had previous mammogram in a public facility (OR = 1.52, 1.2-2.0). CONCLUSION These results highlight the benefits of screening even among those with an interval cancer. Women-conducted BSE were more likely to have interval BC which may reflect their increased ability to notice symptoms between screening intervals.
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Affiliation(s)
- Kou Kou
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia
| | - Jessica Cameron
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia.,School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Philippa Youl
- Cancer Alliance Queensland, Metro South Hospital and Health Service, Woolloongabba, Australia
| | - Chris Pyke
- Mater Hospitals South Brisbane, Brisbane, Australia
| | - Suzanne Chambers
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Jeff Dunn
- Prostate Cancer Foundation of Australia, Sydney, Australia
| | - Joanne F Aitken
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia.,School of Public Health, The University of Queensland, Brisbane, Australia.,School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - Peter D Baade
- Cancer Council Queensland, Spring Hill, PO Box 201, Brisbane, QLD, 4001, Australia. .,Centre for Data Science, Faculty of Science, Queensland University of Technology, Brisbane, Australia. .,Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Parklands Drive, Southport, QLD, Australia.
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8
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Tomazelli J, Dias MBK, Ribeiro CM, Assis MD, Pla MAS, Canella EDO, Migowski A. Evaluation of breast cancer screening indicators in the female population using the National Health System, Brazil, 2018-2019: a descriptive study. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2023; 32:e2022567. [PMID: 37162109 PMCID: PMC10168689 DOI: 10.1590/s2237-96222023000200009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/23/2022] [Indexed: 05/11/2023] Open
Abstract
OBJETIVE to analyze breast cancer screening monitoring indicators in the female population using the Brazilian National Health System, from 2018 to 2019. METHODS this was a descriptive study based on Cancer Information System (SISCAN) data; screening indicators were calculated following deterministic linkage of the mammography and histopathology databases. RESULTS in 2018, 807,430 women aged 50 to 69 years were screened for breast cancer, 91% of whom had a benign result, 1.8% probably benign, 6.7% inconclusive results and 0.5% results suggestive of cancer; the positive mammogram rate was 9.0%; biopsy was estimated to be indicated for 1.6% of the women, 33.9% of whom had a malignant result, and the cancer confirmation rate was 5.4 per 1,000 women. CONCLUSION high benign lesion loss to follow-up was identified; the positive mammogram rate was lower than the international parameter, but the cancer detection rate was adequate and the percentage of inconclusive mammograms was acceptable.
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Affiliation(s)
- Jeane Tomazelli
- Instituto Nacional de Câncer, Divisão de Pesquisa Populacional, Rio de Janeiro, RJ, Brazil
| | - Maria Beatriz Kneipp Dias
- Instituto Nacional de Câncer, Divisão de Detecção Precoce e Apoio à Organização de Rede, Rio de Janeiro, RJ, Brazil
| | - Caroline Madalena Ribeiro
- Instituto Nacional de Câncer, Divisão de Detecção Precoce e Apoio à Organização de Rede, Rio de Janeiro, RJ, Brazil
| | - Mônica de Assis
- Instituto Nacional de Câncer, Divisão de Detecção Precoce e Apoio à Organização de Rede, Rio de Janeiro, RJ, Brazil
| | - Maria Asunción Sole Pla
- Instituto Nacional de Câncer, Divisão de Detecção Precoce e Apoio à Organização de Rede, Rio de Janeiro, RJ, Brazil
| | | | - Arn Migowski
- Instituto Nacional de Câncer, Divisão de Detecção Precoce e Apoio à Organização de Rede, Rio de Janeiro, RJ, Brazil
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9
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Farber R, Houssami N, Barnes I, McGeechan K, Barratt A, Bell KJL. Considerations for Evaluating the Introduction of New Cancer Screening Technology: Use of Interval Cancers to Assess Potential Benefits and Harms. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14647. [PMID: 36429373 PMCID: PMC9691207 DOI: 10.3390/ijerph192214647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 10/24/2022] [Accepted: 10/24/2022] [Indexed: 06/16/2023]
Abstract
This framework focuses on the importance of the consideration of the downstream intermediate and long-term health outcomes when a change to a screening program is introduced. The authors present a methodology for utilising the relationship between screen-detected and interval cancer rates to infer the benefits and harms associated with a change to the program. A review of the previous use of these measures in the literature is presented. The framework presents other aspects to consider when utilizing this methodology, and builds upon an existing framework that helps researchers, clinicians, and policy makers to consider the impacts of changes to screening programs on health outcomes. It is hoped that this research will inform future evaluative studies to assess the benefits and harms of changes to screening programs.
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Affiliation(s)
- Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney 2006, Australia
| | - Isabelle Barnes
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
- Centre for Women’s Health Research, College of Health, Medicine and Wellbeing, The University of Newcastle, Callaghan 2308, Australia
- Australian Longitudinal Study on Women’s Health, The University of Newcastle, Callaghan 2308, Australia
| | - Kevin McGeechan
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
| | - Katy J. L. Bell
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney 2006, Australia
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10
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Larsen M, Aglen CF, Lee CI, Hoff SR, Lund-Hanssen H, Lång K, Nygård JF, Ursin G, Hofvind S. Artificial Intelligence Evaluation of 122 969 Mammography Examinations from a Population-based Screening Program. Radiology 2022. [PMID: 35348377 DOI: 10.1148/radiol.212381:212381] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
Background Artificial intelligence (AI) has shown promising results for cancer detection with mammographic screening. However, evidence related to the use of AI in real screening settings remain sparse. Purpose To compare the performance of a commercially available AI system with routine, independent double reading with consensus as performed in a population-based screening program. Furthermore, the histopathologic characteristics of tumors with different AI scores were explored. Materials and Methods In this retrospective study, 122 969 screening examinations from 47 877 women performed at four screening units in BreastScreen Norway from October 2009 to December 2018 were included. The data set included 752 screen-detected cancers (6.1 per 1000 examinations) and 205 interval cancers (1.7 per 1000 examinations). Each examination had an AI score between 1 and 10, where 1 indicated low risk of breast cancer and 10 indicated high risk. Threshold 1, threshold 2, and threshold 3 were used to assess the performance of the AI system as a binary decision tool (selected vs not selected). Threshold 1 was set at an AI score of 10, threshold 2 was set to yield a selection rate similar to the consensus rate (8.8%), and threshold 3 was set to yield a selection rate similar to an average individual radiologist (5.8%). Descriptive statistics were used to summarize screening outcomes. Results A total of 653 of 752 screen-detected cancers (86.8%) and 92 of 205 interval cancers (44.9%) were given a score of 10 by the AI system (threshold 1). Using threshold 3, 80.1% of the screen-detected cancers (602 of 752) and 30.7% of the interval cancers (63 of 205) were selected. Screen-detected cancer with AI scores not selected using the thresholds had favorable histopathologic characteristics compared to those selected; opposite results were observed for interval cancer. Conclusion The proportion of screen-detected cancers not selected by the artificial intelligence (AI) system at the three evaluated thresholds was less than 20%. The overall performance of the AI system was promising according to cancer detection. © RSNA, 2022.
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Affiliation(s)
- Marthe Larsen
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Camilla F Aglen
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Christoph I Lee
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Solveig R Hoff
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Håkon Lund-Hanssen
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Kristina Lång
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Jan F Nygård
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Giske Ursin
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Solveig Hofvind
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
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Larsen M, Aglen CF, Lee CI, Hoff SR, Lund-Hanssen H, Lång K, Nygård JF, Ursin G, Hofvind S. Artificial Intelligence Evaluation of 122 969 Mammography Examinations from a Population-based Screening Program. Radiology 2022; 303:502-511. [PMID: 35348377 DOI: 10.1148/radiol.212381] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background Artificial intelligence (AI) has shown promising results for cancer detection with mammographic screening. However, evidence related to the use of AI in real screening settings remain sparse. Purpose To compare the performance of a commercially available AI system with routine, independent double reading with consensus as performed in a population-based screening program. Furthermore, the histopathologic characteristics of tumors with different AI scores were explored. Materials and Methods In this retrospective study, 122 969 screening examinations from 47 877 women performed at four screening units in BreastScreen Norway from October 2009 to December 2018 were included. The data set included 752 screen-detected cancers (6.1 per 1000 examinations) and 205 interval cancers (1.7 per 1000 examinations). Each examination had an AI score between 1 and 10, where 1 indicated low risk of breast cancer and 10 indicated high risk. Threshold 1, threshold 2, and threshold 3 were used to assess the performance of the AI system as a binary decision tool (selected vs not selected). Threshold 1 was set at an AI score of 10, threshold 2 was set to yield a selection rate similar to the consensus rate (8.8%), and threshold 3 was set to yield a selection rate similar to an average individual radiologist (5.8%). Descriptive statistics were used to summarize screening outcomes. Results A total of 653 of 752 screen-detected cancers (86.8%) and 92 of 205 interval cancers (44.9%) were given a score of 10 by the AI system (threshold 1). Using threshold 3, 80.1% of the screen-detected cancers (602 of 752) and 30.7% of the interval cancers (63 of 205) were selected. Screen-detected cancer with AI scores not selected using the thresholds had favorable histopathologic characteristics compared to those selected; opposite results were observed for interval cancer. Conclusion The proportion of screen-detected cancers not selected by the artificial intelligence (AI) system at the three evaluated thresholds was less than 20%. The overall performance of the AI system was promising according to cancer detection. © RSNA, 2022.
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Affiliation(s)
- Marthe Larsen
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Camilla F Aglen
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Christoph I Lee
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Solveig R Hoff
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Håkon Lund-Hanssen
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Kristina Lång
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Jan F Nygård
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Giske Ursin
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
| | - Solveig Hofvind
- From the Section for Breast Cancer Screening (M.L., C.F.A., S.H.) and Department of Register Informatics (J.F.N.), Cancer Registry of Norway (G.U.), P.O. Box 5313, 0304 Oslo, Norway; Department of Health and Care Sciences, Faculty of Health Sciences, The Arctic University of Norway, Tromsø, Norway (S.H.); Department of Radiology, University of Washington School of Medicine, Seattle, Wash (C.I.L.); Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Wash (C.I.L.); Department of Radiology, Ålesund Hospital, Møre og Romsdal Hospital Trust, Ålesund, Norway (S.R.H.); Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, National University for Science and Technology, Trondheim, Norway (S.R.H.); Department of Radiology and Nuclear Medicine, St Olavs University Hospital, Trondheim, Norway (H.L.H.); Department of Translational Medicine, Lund University, Lund, Sweden (K.L.); and Unilabs Mammography Unit, Skåne University Hospital, Malmö, Sweden (K.L.)
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Farber R, Houssami N, Wortley S, Jacklyn G, Marinovich ML, McGeechan K, Barratt A, Bell K. Impact of Full-Field Digital Mammography Versus Film-Screen Mammography in Population Screening: A Meta-Analysis. J Natl Cancer Inst 2021; 113:16-26. [PMID: 32572492 PMCID: PMC7781455 DOI: 10.1093/jnci/djaa080] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 03/02/2020] [Accepted: 05/20/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Breast screening programs replaced film mammography with digital mammography, and the effects of this practice shift in population screening on health outcomes can be measured through examination of cancer detection and interval cancer rates. METHODS A systematic review and random effects meta-analysis were undertaken. Seven databases were searched for publications that compared film with digital mammography within the same population of asymptomatic women and reported cancer detection and/or interval cancer rates. RESULTS The analysis included 24 studies with 16 583 743 screening examinations (10 968 843 film and 5 614 900 digital). The pooled difference in the cancer detection rate showed an increase of 0.51 per 1000 screens (95% confidence interval [CI] = 0.19 to 0.83), greater relative increase for ductal carcinoma in situ (25.2%, 95% CI = 17.4% to 33.5%) than invasive (4%, 95% CI = -3% to 13%), and a recall rate increase of 6.95 (95% CI = 3.47 to 10.42) per 1000 screens after the transition from film to digital mammography. Seven studies (80.8% of screens) reported interval cancers: the pooled difference showed no change in the interval cancer rate with -0.02 per 1000 screens (95% CI = -0.06 to 0.03). Restricting analysis to studies at low risk of bias resulted in findings consistent with the overall pooled results for all outcomes. CONCLUSIONS The increase in cancer detection following the practice shift to digital mammography did not translate into a reduction in the interval cancer rate. Recall rates were increased. These results suggest the transition from film to digital mammography did not result in health benefits for screened women. This analysis reinforces the need to carefully evaluate effects of future changes in technology, such as tomosynthesis, to ensure new technology leads to improved health outcomes and beyond technical gains.
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Affiliation(s)
- Rachel Farber
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Sally Wortley
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Gemma Jacklyn
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Michael L Marinovich
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Kevin McGeechan
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Alexandra Barratt
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
| | - Katy Bell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, New South Wales, Australia
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13
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Hong S, Song SY, Park B, Suh M, Choi KS, Jung SE, Kim MJ, Lee EH, Lee CW, Jun JK. Effect of Digital Mammography for Breast Cancer Screening: A Comparative Study of More than 8 Million Korean Women. Radiology 2019; 294:247-255. [PMID: 31793847 DOI: 10.1148/radiol.2019190951] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Full-field digital mammography (FFDM) has been accepted as a superior modality for breast cancer screening compared with conventional screen-film mammography (SFM), especially in women younger than 50 years or with dense breasts. Purpose To evaluate the accuracy of FFDM for breast cancer screening. Materials and Methods Data from January 1, 2011 to December 31, 2013 in the database from a nationwide breast cancer screening program linked with the national cancer registry were retrospectively analyzed. The study included Korean women aged 40-79 years who had undergone screening mammography with SFM, computed radiography (CR), or FFDM. The sensitivity, specificity, positive predictive value (PPV), and absolute and relative differences among these modalities were calculated, followed by pairwise comparison tests with multiple testing corrections. The areas under the receiver operating characteristic curve (AUCs) were also estimated and compared by using the DeLong method with Bonferroni correction. Results Among the 8 482 803 women included (mean age, 55 years ± 10), 34.4% (2 920 279 of 8 482 803), 51.7% (4 385 807 of 8 482 803), and 13.9% (1 176 717 of 8 482 803) underwent SFM, CR, and FFDM, respectively. The sensitivity and PPV were higher for FFDM than for SFM (adjusted odds ratio, 1.77 [95% confidence interval {CI}: 1.62, 1.95] for sensitivity and 1.36 [95% CI: 1.29, 1.43] for PPV) and CR (adjusted odds ratio, 1.70 [95% CI: 1.56, 1.85] for sensitivity and 1.26 [95% CI: 1.20, 1.32] for PPV), whereas specificity was lower with FFDM. The overall AUC for FFDM was 0.80 (95% CI: 0.80, 0.81), which was higher than that for SFM (0.75 [95% CI: 0.75, 0.76]) and CR (0.76 [95% CI: 0.75, 0.76]). P < .05 was found for differences in sensitivity, PPV, and AUC among modalities overall and in most of the subgroups of age, breast density, and screening round. Conclusion Full-field digital mammography allows better discrimination or prediction of breast cancer in the general female population than screen-film mammography or computed radiography, regardless of age, breast density, or screening round. © RSNA, 2019 Online supplemental material is available for this article.
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Affiliation(s)
- Seri Hong
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Soo Yeon Song
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Boyoung Park
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Mina Suh
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Kui Son Choi
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Seung Eun Jung
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Min Jung Kim
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Eun Hye Lee
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Chan Wha Lee
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
| | - Jae Kwan Jun
- From the National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang 10408, Republic of Korea (S.H., S.Y.S., B.P., M.S., K.S.C., J.K.J.); Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Republic of Korea (K.S.C., J.K.J.); Department of Radiology, Eunpyeong St Mary's Hospital, the Catholic University of Korea College of Medicine, Seoul, Republic of Korea (S.E.J.); Department of Radiology, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea (M.J.K.); Department of Radiology, Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea (E.H.L.); and Department of Radiology, National Cancer Center Hospital, National Cancer Center, Goyang, Republic of Korea (C.W.L.)
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Hoff SR, Myklebust TÅ, Lee CI, Hofvind S. Influence of Mammography Volume on Radiologists’ Performance: Results from BreastScreen Norway. Radiology 2019; 292:289-296. [DOI: 10.1148/radiol.2019182684] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Arnold M, Pfeifer K, Quante AS. Is risk-stratified breast cancer screening economically efficient in Germany? PLoS One 2019; 14:e0217213. [PMID: 31120970 PMCID: PMC6532918 DOI: 10.1371/journal.pone.0217213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/07/2019] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES Risk stratification has so far been evaluated under the assumption that women fully adhere to screening recommendations. However, the participation in German cancer screening programs remains low at 54%. The question arises whether risk-stratified screening is economically efficient under the assumption that adherence is not perfect. METHOD We have adapted a micro-simulation Markov model to the German context. Annual, biennial, and triennial routine screening are compared with five risk-adapted strategies using thresholds of relative risk to stratify screening frequencies. We used three outcome variables (mortality reduction, quality-adjusted life years, and false-positive results) under the assumption of full adherence vs. an adherence rate of 54%. Strategies are evaluated using efficiency frontiers and probabilistic sensitivity analysis (PSA). RESULTS The reduced adherence rate affects both performance and cost; incremental cost-effectiveness ratios remain constant. The results of PSA show that risk-stratified screening strategies are more efficient than biennial routine screening under certain conditions. At any willingness-to-pay (WTP), there is a risk-stratified alternative with a higher likelihood of being the best choice. However, without explicit decision criteria and WTP, risk-stratified screening is not more efficient than biennial routine screening. Potential improvements in the adherence rates have significant health gains and budgetary implications. CONCLUSION If the participation rate for mammographic screening is as low as in Germany, stratified screening is not clearly more efficient than routine screening but dependent on the WTP. A more promising design for future stratified strategies is the combination of risk stratification mechanisms with interventions to improve the low adherence in selected high-risk groups.
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Affiliation(s)
- Matthias Arnold
- Centre for Health Economics, University of York, York, United Kingdom
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München – German Research Center for Environmental Health, Neuherberg, Germany
| | - Katharina Pfeifer
- Frauenklinik, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
| | - Anne S. Quante
- Frauenklinik, Klinikum Rechts der Isar, Technical University Munich (TUM), Munich, Germany
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Steponaviciene L, Vincerzevskiene I, Briediene R, Urbonas V, Vanseviciute-Petkeviciene R, Smailyte G. Breast Cancer Screening Program in Lithuania: Interval Cancers and Program Sensitivity After 7 Years of Mammography Screening. Cancer Control 2019; 26:1073274819874122. [PMID: 31502471 PMCID: PMC6755864 DOI: 10.1177/1073274819874122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/23/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Analysis of interval cancers is critical in determining the sensitivity of screening and represents an objective measure of the quality of mammography screening program (MSP). METHODS Period analyzed: from 2006 to 2012. The rate of screen-detected, interval cancers and program sensitivity were measured. A comparison of screen-detected and interval cancers was performed. RESULTS During the period of the study, 429 473 women were screened and 1297 were found to have cancer. The overall screen-detected cancer rate was 30.2 per 10 000 women screened. Four hundred thirty-one case of interval cancers have occurred during the period of the study. The interval cancer ratio (ICR) was 0.25. Overall sensitivity of MSP amounted to 75.1%. Slightly lower sensitivity was found among the youngest age-group, especially for those with lobular cancers. Interval cancers were bigger in size, more often with metastases in lymph nodes, than screen-detected cancers, but these differences were not statistically significant. CONCLUSIONS Overall program sensitivity in Lithuania is about 75%, ICR is 0.25, and these parameters are comparable to other European countries.
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Affiliation(s)
- Laura Steponaviciene
- Laboratory of Cancer Epidemiology, National Cancer Institute,
Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences of the
Faculty of Medicine of Vilnius University, Lithuania
| | - Ieva Vincerzevskiene
- Laboratory of Cancer Epidemiology, National Cancer Institute,
Vilnius, Lithuania
| | - Ruta Briediene
- Department of Radiology, National Cancer Institute, Vilnius,
Lithuania
- Department of Radiology, Medical Physics and Nuclear Medicine,
Vilnius University, Vilnius, Lithuania
| | - Vincas Urbonas
- Laboratory of Clinical Oncology, National Cancer Institute, Vilnius,
Lithuania
| | | | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute,
Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences of the
Faculty of Medicine of Vilnius University, Lithuania
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Arnold M, Quante AS. Personalized Mammography Screening and Screening Adherence-A Simulation and Economic Evaluation. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2018; 21:799-808. [PMID: 30005752 DOI: 10.1016/j.jval.2017.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 11/23/2017] [Accepted: 12/13/2017] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Personalized breast cancer screening has so far been economically evaluated under the assumption of full screening adherence. This is the first study to evaluate the effects of nonadherence on the evaluation and selection of personalized screening strategies. METHODS Different adherence scenarios were established on the basis of findings from the literature. A Markov microsimulation model was adapted to evaluate the effects of these adherence scenarios on three different personalized strategies. RESULTS First, three adherence scenarios describing the relationship between risk and adherence were identified: 1) a positive association between risk and screening adherence, 2) a negative association, or 3) a curvilinear relationship. Second, these three adherence scenarios were evaluated in three personalized strategies. Our results show that it is more the absolute adherence rate than the nature of the risk-adherence relationship that is important to determine which strategy is the most cost-effective. Furthermore, probabilistic sensitivity analyses showed that there are risk-stratified screening strategies that are more cost-effective than routine screening if the willingness-to-pay threshold for screening is below US $60,000. CONCLUSIONS Our results show that "nonadherence" affects the relative performance of screening strategies. Thus, it is necessary to include the true adherence level to evaluate personalized screening strategies and to select the best strategy.
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Affiliation(s)
- Matthias Arnold
- Munich Center of Health Sciences, Ludwig-Maximilians-Universität, Munich, Germany; Institute of Health Economics and Health Care Management, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.
| | - Anne S Quante
- Chair of Genetic Epidemiology, IBE, Faculty of Medicine, LMU Munich, Germany; Institute of Genetic Epidemiology, Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany; Department of Gynecology and Obstetrics, University Hospital rechts der Isar, Technical University Munich, Munich, Germany
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Roubidoux MA, Shih-Pei Wu P, Nolte ELR, Begay JA, Joe AI. Availability of prior mammograms affects incomplete report rates in mobile screening mammography. Breast Cancer Res Treat 2018; 171:667-673. [PMID: 29951970 DOI: 10.1007/s10549-018-4861-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/20/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Mobile mammography can improve access to screening mammography in rural areas and underserved populations. We evaluated the frequency of incomplete reports in mobile mammography screening and the relationships between prior mammograms and recall rates. METHODS The frequency of incomplete mammogram reports, the subgroups of those needing prior comparison mammograms, recalls for additional imaging, and availability of prior mammograms of a mobile screening mammography unit were compared with fixed site mammography from January 1, 2007 through December 31, 2009. All mobile unit mammograms were full field digital mammography (FFDM). Differences between rates of recall, incomplete reports, and availability of prior mammograms were calculated using the Chi-Square statistic. RESULTS Of 2640 mobile mammography cases, 21.9% (578) reports were incomplete, versus 15.2% (7653) (p ≤ 0.001) of 50325 fixed site reports. Of incomplete cases, recall for additional imaging occurred among 8.3% (218) of mobile mammography reports versus 11.3% (5708) (p ≤ 0.001) of fixed site reports. Prior mammograms were needed among 13.6% (360) of mobile mammography versus 3.9% (1945) (p ≤ 0.001) of fixed site reports. Mobile mammography recall rate varied with availability of prior mammograms: 16.0% (54) when no prior mammograms, 7.6% (127) when prior mammograms were elsewhere but unavailable and 5.9% (37) when prior FFDM were immediately available (p ≤ 0.001). CONCLUSIONS Incomplete reports were more frequent in mobile mammography than the fixed site. The availability of prior comparison mammograms at time of interpretation decreased the rate of incomplete mammogram reports. Recall rates were higher without prior comparison mammograms and lowest when comparison FFDM mammograms were available.
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Affiliation(s)
- Marilyn A Roubidoux
- Division of Breast Imaging, Department of Radiology, Michigan Medicine - University of Michigan, University of Michigan Health System, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, 2902TC, Ann Arbor, MI, 48109, USA.
| | - Peggy Shih-Pei Wu
- Kaiser Permanente, South Sacramento Medical Group, 6600 Bruceville Rd, 1st Floor, Sacramento, CA, 95823, USA
| | - Emily L Roen Nolte
- Rosalind Franklin University of Medicine and Science, 3333 Greenbay Rd, North Chicago, IL, 60064, USA
| | - Joel A Begay
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Annette I Joe
- Division of Breast Imaging, Department of Radiology, Michigan Medicine - University of Michigan, University of Michigan Health System, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, 2902TC, Ann Arbor, MI, 48109, USA
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19
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Shi P, Zhong J, Rampun A, Wang H. A hierarchical pipeline for breast boundary segmentation and calcification detection in mammograms. Comput Biol Med 2018; 96:178-188. [DOI: 10.1016/j.compbiomed.2018.03.011] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 02/19/2018] [Accepted: 03/14/2018] [Indexed: 02/03/2023]
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20
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Hofvind S, Sagstad S, Sebuødegård S, Chen Y, Roman M, Lee CI. Interval Breast Cancer Rates and Histopathologic Tumor Characteristics after False-Positive Findings at Mammography in a Population-based Screening Program. Radiology 2018; 287:58-67. [DOI: 10.1148/radiol.2017162159] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Solveig Hofvind
- From the Cancer Registry of Norway, PO 5313 Majorstuen, 0304 Oslo, Norway (S.H., S. Sagstad, S. Sebuødegård); Department of Pathology, Akershus Universitetssykehus HF, Lorenskog, Norway (Y.C.); Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, Barcelona, Spain (M.R.); and Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Wash (C.I.L.)
| | - Silje Sagstad
- From the Cancer Registry of Norway, PO 5313 Majorstuen, 0304 Oslo, Norway (S.H., S. Sagstad, S. Sebuødegård); Department of Pathology, Akershus Universitetssykehus HF, Lorenskog, Norway (Y.C.); Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, Barcelona, Spain (M.R.); and Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Wash (C.I.L.)
| | - Sofie Sebuødegård
- From the Cancer Registry of Norway, PO 5313 Majorstuen, 0304 Oslo, Norway (S.H., S. Sagstad, S. Sebuødegård); Department of Pathology, Akershus Universitetssykehus HF, Lorenskog, Norway (Y.C.); Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, Barcelona, Spain (M.R.); and Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Wash (C.I.L.)
| | - Ying Chen
- From the Cancer Registry of Norway, PO 5313 Majorstuen, 0304 Oslo, Norway (S.H., S. Sagstad, S. Sebuødegård); Department of Pathology, Akershus Universitetssykehus HF, Lorenskog, Norway (Y.C.); Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, Barcelona, Spain (M.R.); and Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Wash (C.I.L.)
| | - Marta Roman
- From the Cancer Registry of Norway, PO 5313 Majorstuen, 0304 Oslo, Norway (S.H., S. Sagstad, S. Sebuødegård); Department of Pathology, Akershus Universitetssykehus HF, Lorenskog, Norway (Y.C.); Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, Barcelona, Spain (M.R.); and Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Wash (C.I.L.)
| | - Christoph I. Lee
- From the Cancer Registry of Norway, PO 5313 Majorstuen, 0304 Oslo, Norway (S.H., S. Sagstad, S. Sebuødegård); Department of Pathology, Akershus Universitetssykehus HF, Lorenskog, Norway (Y.C.); Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, Barcelona, Spain (M.R.); and Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Wash (C.I.L.)
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Sankatsing VDV, Fracheboud J, de Munck L, Broeders MJM, van Ravesteyn NT, Heijnsdijk EAM, Verbeek ALM, Otten JDM, Pijnappel RM, Siesling S, de Koning HJ. Detection and interval cancer rates during the transition from screen-film to digital mammography in population-based screening. BMC Cancer 2018; 18:256. [PMID: 29506487 PMCID: PMC5839006 DOI: 10.1186/s12885-018-4122-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 02/12/2018] [Indexed: 12/29/2022] Open
Abstract
Background Between 2003 and 2010 digital mammography (DM) gradually replaced screen-film mammography (SFM) in the Dutch breast cancer screening programme (BCSP). Previous studies showed increases in detection rate (DR) after the transition to DM. However, national interval cancer rates (ICR) have not yet been reported. Methods We assessed programme sensitivity and specificity during the transition period to DM, analysing nationwide data on screen-detected and interval cancers. Data of 7.3 million screens in women aged 49–74, between 2004 and 2011, were linked to the Netherlands Cancer Registry to obtain data on interval cancers. Age-adjusted DRs, ICRs and recall rates (RR) per 1000 screens and programme sensitivity and specificity were calculated by year, age and screening modality. Results 41,662 screen-detected and 16,160 interval cancers were analysed. The DR significantly increased from 5.13 (95% confidence interval (CI):5.00–5.30) in 2004 to 6.34 (95% CI:6.15–6.47) in 2011, for both in situ (2004:0.73;2011:1.24) and invasive cancers (2004:4.42;2011:5.07), whereas the ICR remained stable (2004: 2.16 (95% CI2.06–2.25);2011: 2.13 (95% CI:2.04–2.22)). The RR changed significantly from 14.0 to 21.4. Programme sensitivity significantly increased, mainly between ages 49–59, from 70.0% (95% CI:68.9–71.2) to 74.4% (95% CI:73.5–75.4) whereas specificity slightly declined (2004:99.1% (95% CI:99.09–99.13);2011:98.5% (95% CI:98.45–98.50)). The overall DR was significantly higher for DM than for SFM (6.24;5.36) as was programme sensitivity (73.6%;70.1%), the ICR was similar (2.19;2.20) and specificity was significantly lower for DM (98.5%;98.9%). Conclusions During the transition from SFM to DM, there was a significant rise in DR and a stable ICR, leading to increased programme sensitivity. Although the recall rate increased, programme specificity remained high compared to other countries. These findings indicate that the performance of DM in a nationwide screening programme is not inferior to, and may be even better, than that of SFM. Electronic supplementary material The online version of this article (10.1186/s12885-018-4122-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Valérie D V Sankatsing
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands.
| | - Jacques Fracheboud
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
| | - Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), PO Box 19079, Utrecht, 3501, DB, The Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands.,Dutch Reference Center for Screening, PO Box 6873, Nijmegen, 6503, GJ, The Netherlands
| | | | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
| | - André L M Verbeek
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Johannes D M Otten
- Department for Health Evidence, Radboud University Medical Center, PO Box 9101, Nijmegen, 6500, HB, The Netherlands
| | - Ruud M Pijnappel
- Dutch Reference Center for Screening, PO Box 6873, Nijmegen, 6503, GJ, The Netherlands.,Department of Radiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation (IKNL), PO Box 19079, Utrecht, 3501, DB, The Netherlands.,Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, PO Box 217, Enschede, 7500, AE, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, PO Box 2040, Rotterdam, 3015, CN, The Netherlands
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Westvik ÅS, Weedon-Fekjær H, Mæhlen J, Liestøl K. Evaluating different breast tumor progression models using screening data. BMC Cancer 2018; 18:209. [PMID: 29463227 PMCID: PMC5819671 DOI: 10.1186/s12885-018-4130-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 02/14/2018] [Indexed: 11/10/2022] Open
Abstract
Background Mammography screening is used to detect breast cancer at an early treatable stage, reducing breast cancer mortality. Traditionally, breast cancer has been seen as a disease with only progressive lesions, and here we examine the validity of this assumption by testing if incidence levels after introducing mammography screening can be reproduced assuming only progressive tumors. Methods Breast cancer incidence data 1990–2009 obtained from the initially screened Norwegian counties (Akershus, Oslo, Rogaland and Hordaland) was included, covering the time-period before, during and after the introduction of mammography screening. From 1996 women aged 50–69 were invited for biennial public screening. Using estimates of tumor growth and screening sensitivity based on pre-screening and prevalence screening data (1990–1998), we simulated incidence levels during the following period (1999–2009). Results The simulated incidence levels during the period with repeated screenings were markedly below the observed levels. The results were robust to changes in model parameters. Adjusting for hormone replacement therapy use, we obtained levels closer to the observed levels. However, there was still a marked gap, and only by assuming some tumors that undergo regressive changes or enter a markedly less detectable state, was our model able to reproduce the observed incidence levels. Conclusions Models with strictly progressive tumors are only able to partly explain the changes in incidence levels observed after screening introduction in the initially screened Norwegian counties. More complex explanations than a time shift in detection of future clinical cancers seem to be needed to reproduce the incidence trends, questioning the basis for many over-diagnosis calculations. As data are not randomized, similar studies in other populations are wanted to exclude effect of unknown confounders. Electronic supplementary material The online version of this article (10.1186/s12885-018-4130-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Harald Weedon-Fekjær
- Oslo Center for biostatistics and epidemiology, Research Support Services, Oslo University Hospital, Norway, P.O. Box 4956 Nydalen, 0424, Oslo, Norway.
| | - Jan Mæhlen
- Department of Pathology, Oslo University Hospital, Norway, P.O. Box 4956 Nydalen, 0424, Oslo, Norway
| | - Knut Liestøl
- Center of Cancer Biomedicine, Department of Informatics, University of Oslo, Norway, P.O. Box 1080 Blindern, 0316, Oslo, Norway
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Performance of breast cancer screening using digital breast tomosynthesis: results from the prospective population-based Oslo Tomosynthesis Screening Trial. Breast Cancer Res Treat 2018; 169:489-496. [DOI: 10.1007/s10549-018-4705-2] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Accepted: 11/10/2017] [Indexed: 11/25/2022]
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Lund E, Nakamura A, Thalabard JC. No overdiagnosis in the Norwegian Breast Cancer Screening Program estimated by combining record linkage and questionnaire information in the Norwegian Women and Cancer study. Eur J Cancer 2018; 89:102-112. [DOI: 10.1016/j.ejca.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/25/2017] [Accepted: 11/02/2017] [Indexed: 01/30/2023]
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Autier P, Boniol M. Mammography screening: A major issue in medicine. Eur J Cancer 2017; 90:34-62. [PMID: 29272783 DOI: 10.1016/j.ejca.2017.11.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 01/20/2023]
Abstract
Breast cancer mortality is declining in most high-income countries. The role of mammography screening in these declines is much debated. Screening impacts cancer mortality through decreasing the incidence of number of advanced cancers with poor prognosis, while therapies and patient management impact cancer mortality through decreasing the fatality of cancers. The effectiveness of cancer screening is the ability of a screening method to curb the incidence of advanced cancers in populations. Methods for evaluating cancer screening effectiveness are based on the monitoring of age-adjusted incidence rates of advanced cancers that should decrease after the introduction of screening. Likewise, cancer-specific mortality rates should decline more rapidly in areas with screening than in areas without or with lower levels of screening but where patient management is similar. These two criteria have provided evidence that screening for colorectal and cervical cancer contributes to decreasing the mortality associated with these two cancers. In contrast, screening for neuroblastoma in children was discontinued in the early 2000s because these two criteria were not met. In addition, overdiagnosis - i.e. the detection of non-progressing occult neuroblastoma that would not have been life-threatening during the subject's lifetime - is a major undesirable consequence of screening. Accumulating epidemiological data show that in populations where mammography screening has been widespread for a long time, there has been no or only a modest decline in the incidence of advanced cancers, including that of de novo metastatic (stage IV) cancers at diagnosis. Moreover, breast cancer mortality reductions are similar in areas with early introduction and high penetration of screening and in areas with late introduction and low penetration of screening. Overdiagnosis is commonplace, representing 20% or more of all breast cancers among women invited to screening and 30-50% of screen-detected cancers. Overdiagnosis leads to overtreatment and inflicts considerable physical, psychological and economic harm on many women. Overdiagnosis has also exerted considerable disruptive effects on the interpretation of clinical outcomes expressed in percentages (instead of rates) or as overall survival (instead of mortality rates or stage-specific survival). Rates of radical mastectomies have not decreased following the introduction of screening and keep rising in some countries (e.g. the United States of America (USA)). Hence, the epidemiological picture of mammography screening closely resembles that of screening for neuroblastoma. Reappraisals of Swedish mammography trials demonstrate that the design and statistical analysis of these trials were different from those of all trials on screening for cancers other than breast cancer. We found compelling indications that these trials overestimated reductions in breast cancer mortality associated with screening, in part because of the statistical analyses themselves, in part because of improved therapies and underreporting of breast cancer as the underlying cause of death in screening groups. In this regard, Swedish trials should publish the stage-specific breast cancer mortality rates for the screening and control groups separately. Results of the Greater New York Health Insurance Plan trial are biased because of the underreporting of breast cancer cases and deaths that occurred in women who did not participate in screening. After 17 years of follow-up, the United Kingdom (UK) Age Trial showed no benefit from mammography screening starting at age 39-41. Until around 2005, most proponents of breast screening backed the monitoring of changes in advanced cancer incidence and comparative studies on breast cancer mortality for the evaluation of breast screening effectiveness. However, in an attempt to mitigate the contradictions between results of mammography trials and population data, breast-screening proponents have elected to change the criteria for the evaluation of cancer screening effectiveness, giving precedence to incidence-based mortality (IBM) and case-control studies. But practically all IBM studies on mammography screening have a strong ecological component in their design. The two IBM studies done in Norway that meet all methodological requirements do not document significant reductions in breast cancer mortality associated with mammography screening. Because of their propensity to exaggerate the health benefits of screening, case-control studies may demonstrate that mammography screening could reduce the risk of death from diseases other than breast cancer. Numerous statistical model approaches have been conducted for estimating the contributions of screening and of patient management to reductions in breast cancer mortality. Unverified assumptions are needed for running these models. For instance, many models assume that if screening had not occurred, the majority of screen-detected asymptomatic cancers would have progressed to symptomatic advanced cancers. This assumption is not grounded in evidence because a large proportion of screen-detected breast cancers represent overdiagnosis and hence non-progressing tumours. The accumulation of population data in well-screened populations diminishes the relevance of model approaches. The comparison of the performance of different screening modalities - e.g. mammography, digital mammography, ultrasonography, magnetic resonance imaging (MRI), three-dimensional tomosynthesis (TDT) - concentrates on detection rates, which is the ability of a technique to detect more cancers than other techniques. However, a greater detection rate tells little about the capacity to prevent interval and advanced cancers and could just reflect additional overdiagnosis. Studies based on the incidence of advanced cancers and on the evaluation of overdiagnosis should be conducted before marketing new breast-imaging technologies. Women at high risk of breast cancer (i.e. 30% lifetime risk and more), such as women with BRCA1/2 mutations, require a close breast surveillance. MRI is the preferred imaging method until more radical risk-reduction options are eventually adopted. For women with an intermediate risk of breast cancer (i.e. 10-29% lifetime risk), including women with extremely dense breast at mammography, there is no evidence that more frequent mammography screening or screening with other modalities actually reduces the risk of breast cancer death. A plethora of epidemiological data shows that, since 1985, progress in the management of breast cancer patients has led to marked reductions in stage-specific breast cancer mortality, even for patients with disseminated disease (i.e. stage IV cancer) at diagnosis. In contrast, the epidemiological data point to a marginal contribution of mammography screening in the decline in breast cancer mortality. Moreover, the more effective the treatments, the less favourable are the harm-benefit balance of screening mammography. New, effective methods for breast screening are needed, as well as research on risk-based screening strategies.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at IPRI, International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, 69130 Ecully Lyon, France; International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France.
| | - Mathieu Boniol
- University of Strathclyde Institute of Global Public Health at IPRI, International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, 69130 Ecully Lyon, France; International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France
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Autier P, Boniol M, Koechlin A, Pizot C, Boniol M. Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. BMJ 2017; 359:j5224. [PMID: 29208760 PMCID: PMC5712859 DOI: 10.1136/bmj.j5224] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammography screening programme, the Netherlands.Participants Dutch women of all ages, 1989 to 2012.Main outcome measures Stage specific age adjusted incidence of breast cancer from 1989 to 2012. The extra numbers of in situ and stage 1 breast tumours associated with screening were estimated by comparing rates in women aged 50-74 with those in age groups not invited to screening. Overdiagnosis was estimated after subtraction of the lead time cancers. Breast cancer mortality reductions and overdiagnosis during 2010-12 were computed without (scenario 1) and with (scenario 2) a cohort effect on mortality secular trends.Results The incidence of stage 2-4 breast cancers in women aged 50 or more was 168 per 100 000 in 1989 and 166 per 100 000 in 2012. Screening would be associated with a 5% mortality reduction in scenario 1 and with no influence on mortality in scenario 2. In both scenarios, improved treatments would be associated with 28% reductions in mortality. Overdiagnosis has steadily increased over time with the extension of screening to women aged 70-75 and with the introduction of digital mammography. After deduction of clinical lead time cancers, 33% of cancers found in women invited to screening in 2010-12 and 59% of screen detected cancers would be overdiagnosed.Conclusions The Dutch mammography screening programme seems to have little impact on the burden of advanced breast cancers, which suggests a marginal effect on breast cancer mortality. About half of screen detected breast cancers would represent overdiagnosis.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
| | - Magali Boniol
- International Prevention Research Institute, Lyon, France
| | - Alice Koechlin
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
| | - Cécile Pizot
- International Prevention Research Institute, Lyon, France
| | - Mathieu Boniol
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
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Jacklyn G, McGeechan K, Irwig L, Houssami N, Morrell S, Bell K, Barratt A. Trends in stage-specific breast cancer incidence in New South Wales, Australia: insights into the effects of 25 years of screening mammography. Breast Cancer Res Treat 2017; 166:843-854. [PMID: 28822001 DOI: 10.1007/s10549-017-4443-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 08/04/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE Screening mammography aims to improve breast cancer (BC) prognosis by increasing the incidence of early-stage tumours in order to decrease the incidence of late-stage cancer, but no reports have investigated these potential effects in an Australian population. Therefore we aimed to identify temporal trends in stage-specific BC in New South Wales (NSW), Australia, between 1972 and 2012. METHODS An observational study of women who received a diagnosis of BC from 1972-2012 as recorded in the NSW Cancer Registry, a population-based registry with almost complete coverage and high rates of histological verification. We analysed trends in stage-specific incidence before screening and compared them to periods after screening began. Our primary group of interest was women in the target age range of 50-69 years, though trends in women outside the target age were also assessed. RESULTS Screening was not associated with lower incidence of late-stage BC at diagnosis. Incidence for all stages remained higher than prescreening levels. In women aged 50-69 years, the incidence of carcinoma in situ (CIS), localised and regional BC has more than doubled compared to the prescreening era, with incidence rate ratios ranging from 2.0 for regional (95% CI 1.95-2.13) to 121.8 for CIS (95% CI 82.58-179.72). Before the introduction of screening, there was a downward trend in distant metastatic BC incidence, and after the introduction of screening there was an increase (IRR 1.8; 95% CI 1.62-2.00). In women too young to screen the incidence of late-stage BC at diagnosis also increased, whereas localised disease was stable. CONCLUSIONS The incidence of all stages of BC has increased over the past 40 years, with the greatest rise seen during the established screening period for women aged 50-69 years. Our findings suggest that some of the expected benefits of screening may not have been realised and are consistent with overdiagnosis.
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Affiliation(s)
- Gemma Jacklyn
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
| | - Kevin McGeechan
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia.,Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Les Irwig
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia
| | - Nehmat Houssami
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW, 2006, Australia
| | - Stephen Morrell
- School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Katy Bell
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
| | - Alexandra Barratt
- Wiser Healthcare, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia
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van Bommel RMG, Weber R, Voogd AC, Nederend J, Louwman MWJ, Venderink D, Strobbe LJA, Rutten MJC, Plaisier ML, Lohle PN, Hooijen MJH, Tjan-Heijnen VCG, Duijm LEM. Interval breast cancer characteristics before, during and after the transition from screen-film to full-field digital screening mammography. BMC Cancer 2017; 17:315. [PMID: 28476109 PMCID: PMC5420149 DOI: 10.1186/s12885-017-3294-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 04/24/2017] [Indexed: 12/02/2022] Open
Abstract
Background To determine the proportion of “true” interval cancers and tumor characteristics of interval breast cancers prior to, during and after the transition from screen-film mammography screening (SFM) to full-field digital mammography screening (FFDM). Methods We included all women with interval cancers detected between January 2006 and January 2014. Breast imaging reports, biopsy results and breast surgery reports of all women recalled at screening mammography and of all women with interval breast cancers were collected. Two experienced screening radiologists reviewed the diagnostic mammograms, on which the interval cancers were diagnosed, as well as the prior screening mammograms and determined whether or not the interval cancer had been missed on the most recent screening mammogram. If not missed, the cancer was considered an occult (“true”) interval cancer. Results A total of 442 interval cancers had been diagnosed, of which 144 at SFM with a prior SFM (SFM-SFM), 159 at FFDM with a prior SFM (FFDM-SFM) and 139 at FFDM with a prior FFDM (FFDM-FFDM). The transition from SFM to FFDM screening resulted in the diagnosis of more occult (“true”) interval cancers at FFDM-SFM than at SFM-SFM (65.4% (104/159) versus 49.3% (71/144), P < 0.01), but this increase was no longer statistically significant in women who had been screened digitally for the second time (57.6% (80/139) at FFDM-FFDM versus 49.3% (71/144) at SFM-SFM). Tumor characteristics were comparable for the three interval cancer cohorts, except of a lower porportion (75.7 and 78.0% versus 67.2% af FFDM-FFDM, P < 0.05) of invasive ductal cancers at FFDM with prior FFDM. Conclusions An increase in the proportion of occult interval cancers is observed during the transition from SFM to FFDM screening mammography. However, this increase seems temporary and is no longer detectable after the second round of digital screening. Tumor characteristics and type of surgery are comparable for interval cancers detected prior to, during and after the transition from SFM to FFDM screening mammography, except of a lower proportion of invasive ductal cancers after the transition.
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Affiliation(s)
- Rob M G van Bommel
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Roy Weber
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos, 100, Nijmegen, The Netherlands
| | - Luc J A Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Matthieu J C Rutten
- Department of Radiology, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW, 's-Hertogenbosch, The Netherlands
| | - Menno L Plaisier
- Department of Radiology, Maxima Medical Centre, De Run 4600, 5504 DB, Veldhoven, The Netherlands
| | - Paul N Lohle
- Department of Radiology, St Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC, Tilburg, The Netherlands
| | - Marianne J H Hooijen
- Department of Radiology, St Anna Hospital, Bogardeind 2, 5664 EH, Geldrop, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos, 100, Nijmegen, The Netherlands.,Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands
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Impact of the Introduction of Digital Mammography in an Organized Screening Program on the Recall and Detection Rate. J Digit Imaging 2017; 29:235-42. [PMID: 26537932 DOI: 10.1007/s10278-015-9843-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
In 2012, the Reggio Emilia Breast Cancer Screening Program introduced digital mammography in all its facilities at the same time. The aim of this work is to analyze the impact of digital mammography introduction on the recall rate, detection rate, and positive predictive value. The program actively invites women aged 45-74 years. We included women screened in 2011, all of whom underwent film-screen mammography, and all women screened in 2012, all of whom underwent digital mammography. Double reading was used for all mammograms, with arbitration in the event of disagreement. A total of 42,240 women underwent screen-film mammography and 45,196 underwent digital mammography. The recall rate increased from 3.3 to 4.4% in the first year of digital mammography (relative recall adjusted by age and round 1.46, 95% CI = 1.37-1.56); the positivity rate for each individual reading, before arbitration, rose from 3 to 5.7%. The digital mammography recall rate decreased during 2012: after 12 months, it was similar to the recall rate with screen-film mammography. The detection rate was similar: 5.9/1000 and 5.2/1000 with screen-film and digital mammography, respectively (adjusted relative detection rate 0.95, 95% CI = 0.79-1.13). The relative detection rate for ductal carcinoma in situ remained the same. The introduction of digital mammography to our organized screening program had a negative impact on specificity, thereby increasing the recall rate. The effect was limited to the first 12 months after introduction and was attenuated by the double reading with arbitration. We did not observe any relevant effects on the detection rate.
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Rößler AC, Kalender W, Kolditz D, Steiding C, Ruth V, Preuss C, Peter SC, Brehm B, Hammon M, Schulz-Wendtland R, Wenkel E. Performance of Photon-Counting Breast Computed Tomography, Digital Mammography, and Digital Breast Tomosynthesis in Evaluating Breast Specimens. Acad Radiol 2017; 24:184-190. [PMID: 27888024 DOI: 10.1016/j.acra.2016.09.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 09/21/2016] [Accepted: 09/25/2016] [Indexed: 10/20/2022]
Abstract
RATIONALE AND OBJECTIVES This study compared a novel photon-counting breast computed tomography (pcBCT) system with digital mammography (DM) and digital breast tomosynthesis (DBT) systems. For this reason, surgical specimens were examined with all three techniques and rated by three observers. MATERIALS AND METHODS A total of 30 surgical specimens were investigated with DM, DBT, and pcBCT; the associated images were shown to three experienced radiologists. Findings (22 microcalcifications and 23 mass lesions) were recorded and compared to the results of the pathological examination. Sensitivity and specificity for detection of microcalcifications and lesions were calculated and displayed using receiver operating characteristic curves. RESULTS Sensitivity for microcalcifications was 82% for DM, 70% for DBT, and 85% for pcBCT. Specificity for microcalcifications was 71% for DM, 75% for DBT, and 83% for pcBCT. Sensitivity for lesions was 45% for DM, 62% for DBT, and 65% for pcBCT. Specificity for lesions was 76% for DM, 62% for DBT, and 76% for pcBCT. CONCLUSIONS pcBCT showed a comparable or superior performance compared to the clinically approved DM and DBT systems. Mass lesion detectability can be increased further by the use of contrast media.
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Le MT, Mothersill CE, Seymour CB, McNeill FE. Is the false-positive rate in mammography in North America too high? Br J Radiol 2016; 89:20160045. [PMID: 27187600 PMCID: PMC5124917 DOI: 10.1259/bjr.20160045] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 04/04/2016] [Accepted: 05/16/2016] [Indexed: 01/23/2023] Open
Abstract
The practice of investigating pathological abnormalities in the breasts of females who are asymptomatic is primarily employed using X-ray mammography. The importance of breast screening is reflected in the mortality-based benefits observed among females who are found to possess invasive breast carcinoma prior to the manifestation of clinical symptoms. It is estimated that population-based screening constitutes a 17% reduction in the breast cancer mortality rate among females affected by invasive breast carcinoma. In spite of the significant utility that screening confers in those affected by invasive cancer, limitations associated with screening manifest as potential harms affecting individuals who are free of invasive disease. Disease-free and benign tumour-bearing individuals who are subjected to diagnostic work-up following a screening examination constitute a population of cases referred to as false positives (FPs). This article discusses factors contributing to the FP rate in mammography and extends the discussion to an assessment of the consequences associated with FP reporting. We conclude that the mammography FP rate in North America is in excess based upon the observation of overtreatment of in situ lesions and the disproportionate distribution of detriment and benefit among the population of individuals recalled for diagnostic work-up subsequent to screening. To address the excessive incidence of FPs in mammography, we investigate solutions that may be employed to remediate the current status of the FP rate. Subsequently, it can be suggested that improvements in the breast-screening protocol, medical litigation risk, image interpretation software and the implementation of image acquisition modalities that overcome superimposition effects are promising solutions.
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Affiliation(s)
- Michelle T Le
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Carmel E Mothersill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Colin B Seymour
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Fiona E McNeill
- Medical Physics & Applied Radiation Sciences Department, McMaster University, Hamilton, ON, Canada
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de Munck L, de Bock GH, Otter R, Reiding D, Broeders MJM, Willemse PHB, Siesling S. Digital vs screen-film mammography in population-based breast cancer screening: performance indicators and tumour characteristics of screen-detected and interval cancers. Br J Cancer 2016; 115:517-24. [PMID: 27490807 PMCID: PMC4997549 DOI: 10.1038/bjc.2016.226] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 05/13/2016] [Accepted: 07/03/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Full-field digital mammography (FFDM) has replaced screen-film mammography (SFM) in most breast cancer screening programs due to technological advantages such as possibilities to adjust contrast, better image quality and transfer capabilities. This study describes the performance indicators during the transition from SFM to FFDM and the characteristics of screen-detected and interval cancers. METHODS Data of the Dutch breast cancer screening program, region North from 2004 to 2010 were linked to The Netherlands Cancer Registry (N=902 868). Performance indicators and tumour characteristics of screen-detected and interval cancers were compared between FFDM and SFM. RESULTS After initial screens, recall rates were 2.1% (SFM) and 3.0% (FFDM; P<0.001). The positive predictive values (PPV) were 25.6% (SFM) and 19.9% (FFDM; P=0.002). Detection rates were similar, as were all performance indicators after subsequent screens. Similar percentages of low-grade ductal carcinoma in situ (DCIS) were found for SFM and FFDM. Invasive cancers diagnosed after subsequent screens with FFDM were more often of high-grade (P=0.024) and ductal type (P=0.030). The incidence rates of interval cancers were similar for SFM and FFDM after initial (2.69/1000 vs 2.51/1000; P=0.787) and subsequent screens (2.30 vs 2.41; P=0.652), with similar tumour characteristics. CONCLUSIONS FFDM resulted in similar rates of screen-detected and interval cancers, indicating that FFDM performs as well as SFM in a breast cancer screening program. No signs of an increase in low-grade DCIS (which might connote possible overdiagnosis) were seen. Nonetheless, after initial screening, which accounts for 12% of all screens, FFDM resulted in higher recall rate and lower PPV that requires attention.
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Affiliation(s)
- Linda de Munck
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands
| | - Geertruida H de Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Renée Otter
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Dick Reiding
- National Cancer Screening Programme, region North, PO Box 425, Groningen 9700 AK, The Netherlands
| | - Mireille JM Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, Nijmegen 6500 HB, The Netherlands
- Dutch Reference Centre for Screening, PO Box 6873, Nijmegen 6503 GJ, The Netherlands
| | - Pax HB Willemse
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, PO Box 30001, Groningen 9700 RB, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, PO Box 19079, Utrecht 3501 DB, The Netherlands
- Department of Health Technology & Services Research, University of Twente, PO Box 217, Enschede 7500 AE, The Netherlands
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Domingo L, Hofvind S, Hubbard RA, Román M, Benkeser D, Sala M, Castells X. Cross-national comparison of screening mammography accuracy measures in U.S., Norway, and Spain. Eur Radiol 2016; 26:2520-8. [PMID: 26560729 PMCID: PMC4927608 DOI: 10.1007/s00330-015-4074-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 09/19/2015] [Accepted: 10/15/2015] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To compare accuracy measures for mammographic screening in Norway, Spain, and the US. METHODS Information from women aged 50-69 years who underwent mammographic screening 1996-2009 in the US (898,418 women), Norway (527,464), and Spain (517,317) was included. Screen-detected cancer, interval cancer, and the false-positive rates, sensitivity, specificity, positive predictive value (PPV) for recalls (PPV-1), PPV for biopsies (PPV-2), 1/PPV-1 and 1/PPV-2 were computed for each country. Analyses were stratified by age, screening history, time since last screening, calendar year, and mammography modality. RESULTS The rate of screen-detected cancers was 4.5, 5.5, and 4.0 per 1000 screening exams in the US, Norway, and Spain respectively. The highest sensitivity and lowest specificity were reported in the US (83.1 % and 91.3 %, respectively), followed by Spain (79.0 % and 96.2 %) and Norway (75.5 % and 97.1 %). In Norway, Spain and the US, PPV-1 was 16.4 %, 9.8 %, and 4.9 %, and PPV-2 was 39.4 %, 38.9 %, and 25.9 %, respectively. The number of women needed to recall to detect one cancer was 20.3, 6.1, and 10.2 in the US, Norway, and Spain, respectively. CONCLUSIONS Differences were found across countries, suggesting that opportunistic screening may translate into higher sensitivity at the cost of lower specificity and PPV. KEY POINTS • Positive predictive value is higher in population-based screening programmes in Spain and Norway. • Opportunistic mammography screening in the US has lower positive predictive value. • Screening settings in the US translate into higher sensitivity and lower specificity. • The clinical burden may be higher for women screened opportunistically.
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Affiliation(s)
- Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg Marítim 25-29, 08003, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Solveig Hofvind
- Department of Screening, Cancer Registry of Norway, P.O. 5313, Majorstua, 0304, Oslo, Norway
- Faculty of Health Science, Oslo and Akershus University College of Applied Sciences, P.O. 4, St. Olavs Plass, 0130, Oslo, Norway
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 604 Blockley Hall, 423 Guardian Dr, Philadelphia, PA, 19104, USA
| | - Marta Román
- Department of Screening, Cancer Registry of Norway, P.O. 5313, Majorstua, 0304, Oslo, Norway
- National Advisory Unit for Women's Health, Oslo University Hospital, Rikshospitalet, P.O. 4950, Nydalen, 0424, Oslo, Norway
| | - David Benkeser
- Department of Biostatistics, School of Public Health, University of Washington, F-600, Health Sciences Building, Seattle, WA, 98195, USA
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg Marítim 25-29, 08003, Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg Marítim 25-29, 08003, Barcelona, Spain.
- Research Network on Health Services in Chronic Diseases (REDISSEC), Madrid, Spain.
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Théberge I, Vandal N, Langlois A, Pelletier É, Brisson J. Detection Rate, Recall Rate, and Positive Predictive Value of Digital Compared to Screen-Film Mammography in the Quebec Population-Based Breast Cancer Screening Program. Can Assoc Radiol J 2016; 67:330-338. [PMID: 27451910 DOI: 10.1016/j.carj.2016.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 01/21/2016] [Accepted: 02/25/2016] [Indexed: 10/21/2022] Open
Abstract
PURPOSE The study sought to compare performance indicators of computed radiography (CR) using different plate readers, digital direct radiography (DR), and screen-film mammography (SFM) in a population-based screening program. METHODS This analysis involved women 50-69 years of age who participated in the breast screening program of Quebec (Canada) and who had screening mammogram between January 1, 2007, and September 30, 2012. The detection rate, recall rate, and positive predictive value of CR (n = 672,125 mammograms) and DR (n = 60,023) were compared to SFM (n = 782,894) using mixed-effect logistic regression, adjusting for potential confounders. No institutional review board approval was required. RESULTS CR was not associated with change in cancer detection rate (odds ratio [OR]: 0.95; 95% confidence interval [CI]: 0.88-1.03), but with a small increase in recall rate (OR: 1.03; 95% CI: 1.01-1.06) compared to SFM. The association of CR with recall rate varies with the CR plate reader manufacturer (P < .0001). DR was not associated with change in detection rate (OR: 1.06; 95% CI: 0.89-1.25), but with an increase in the recall rate (OR: 1.25; 95% CI: 1.19-1.30) compared to SFM. CONCLUSIONS In our screening program, digital mammograms gave detection rates equivalent to those of SFM, but with an increase of recall rate, particularly for DR. If this situation persists, the adoption of DR may increase the adverse effects of screening with little or no benefit for women.
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Affiliation(s)
- Isabelle Théberge
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada.
| | - Nathalie Vandal
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - André Langlois
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Éric Pelletier
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada
| | - Jacques Brisson
- Institut national de Santé Publique du Québec, Québec City, Québec, Canada; Department of Social and Preventive Medicine, Faculty of Medicine, Laval University, Québec City, Québec, Canada
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Characteristics and prognosis of interval cancers after biennial screen-film or full-field digital screening mammography. Breast Cancer Res Treat 2016; 158:471-83. [DOI: 10.1007/s10549-016-3882-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
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36
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Weber RJP, van Bommel RMG, Setz-Pels W, Voogd AC, Klompenhouwer EG, Louwman MW, Strobbe LJA, Tjan-Heijnen VCG, Duijm LEM. Type and Extent of Surgery for Screen-Detected and Interval Cancers at Blinded Versus Nonblinded Double-Reading in a Population-Based Screening Mammography Program. Ann Surg Oncol 2016; 23:3822-3830. [DOI: 10.1245/s10434-016-5295-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Indexed: 01/02/2023]
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Moshina N, Ursin G, Roman M, Sebuødegård S, Hofvind S. Positive predictive values by mammographic density and screening mode in the Norwegian Breast Cancer Screening Program. Eur J Radiol 2015; 85:248-254. [PMID: 26724673 DOI: 10.1016/j.ejrad.2015.11.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 11/13/2015] [Accepted: 11/22/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To investigate the probability of breast cancer among women recalled due to abnormal findings on the screening mammograms (PPV-1) and among women who underwent an invasive procedure (PPV-2) by mammographic density (MD), screening mode and age. METHODS We used information about 28,826 recall examinations from 26,951 subsequently screened women in the Norwegian Breast Cancer Screening Program, 1996-2010. The radiologists who performed the recall examinations subjectively classified MD on the mammograms into three categories: fatty (<30% fibroglandular tissue); medium dense (30-70%) and dense (>70%). Screening mode was defined as screen-film mammography (SFM) and full-field digital mammography (FFDM). We examined trends of PPVs by MD, screening mode and age. We used logistic regression to estimate odds ratio (OR) of screen-detected breast cancer associated with MD among women recalled, adjusting for screening mode and age. RESULTS PPV-1 and PPV-2 decreased by increasing MD, regardless of screening mode (p for trend <0.05 for both PPVs). PPV-1 and PPV-2 were statistically significantly higher for FFDM compared with SFM for women with fatty breasts. Among women recalled, the adjusted OR of breast cancer decreased with increasing MD. Compared with women with fatty breasts, the OR was 0.90 (95% CI: 0.84-0.96) for those with medium dense breasts and 0.85 (95% CI: 0.76-0.95) for those with dense breasts. CONCLUSION PPVs decreased by increasing MD. Fewer women needed to be recalled or undergo an invasive procedure to detect one breast cancer among those with fatty versus dense breasts in the screening program in Norway, 1996-2010.
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Affiliation(s)
| | - Giske Ursin
- Cancer Registry of Norway, Oslo, Norway; Institute of Basic Medical Sciences, Medical Faculty, University of Oslo, Oslo, Norway; Department of Preventive Medicine, University of Southern California, CA, USA.
| | - Marta Roman
- Cancer Registry of Norway, Oslo, Norway; Department of Women and Children's Health, Oslo University Hospital, Oslo, Norway.
| | | | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway; Oslo and Akershus University College of Applied Sciences, Faculty of Health Science, Oslo, Norway.
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Ward EM, DeSantis CE, Lin CC, Kramer JL, Jemal A, Kohler B, Brawley OW, Gansler T. Cancer statistics: Breast cancer in situ. CA Cancer J Clin 2015; 65:481-95. [PMID: 26431342 DOI: 10.3322/caac.21321] [Citation(s) in RCA: 166] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 08/06/2015] [Accepted: 09/02/2015] [Indexed: 01/11/2023] Open
Abstract
An estimated 60,290 new cases of breast carcinoma in situ are expected to be diagnosed in 2015, and approximately 1 in 33 women is likely to receive an in situ breast cancer diagnosis in her lifetime. Although in situ breast cancers are relatively common, their clinical significance and optimal treatment are topics of uncertainty and concern for both patients and clinicians. In this article, the American Cancer Society provides information about occurrence and treatment patterns for the 2 major subtypes of in situ breast cancer in the United States-ductal carcinoma in situ and lobular carcinoma in situ-using data from the North American Association of Central Cancer Registries and the 13 oldest Surveillance, Epidemiology, and End Results registries. The authors also present an overview of in situ breast cancer detection, treatment, risk factors, and prevention and discuss research needs and initiatives.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma in Situ/epidemiology
- Carcinoma in Situ/pathology
- Carcinoma in Situ/surgery
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Female
- Humans
- Incidence
- Middle Aged
- Registries
- Risk Factors
- United States/epidemiology
- Young Adult
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Affiliation(s)
- Elizabeth M Ward
- National Vice President, Intramural Research, American Cancer Society, Atlanta, GA
| | - Carol E DeSantis
- Senior Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Chun Chieh Lin
- Senior Epidemiologist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Joan L Kramer
- Assistant Professor of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Betsy Kohler
- Executive Director, North American Association of Central Cancer Registries, Springfield, IL
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Director of Medical Content, American Cancer Society, Atlanta, GA
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Prummel MV, Muradali D, Shumak R, Majpruz V, Brown P, Jiang H, Done SJ, Yaffe MJ, Chiarelli AM. Digital Compared with Screen-Film Mammography: Measures of Diagnostic Accuracy among Women Screened in the Ontario Breast Screening Program. Radiology 2015; 278:365-73. [PMID: 26334680 DOI: 10.1148/radiol.2015150733] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To compare measures of diagnostic accuracy between large concurrent cohorts of women screened with digital computed radiography (CR), direct radiography (DR), and screen-film mammography (SFM). MATERIALS AND METHODS This study was approved by the University of Toronto Research Ethics Board; informed consent was not required. Three concurrent cohorts of women aged 50-74 years who were screened from 2008-2009 in the Ontario Breast Screening Program with SFM (487,334 screening examinations, 403,688 women), DR (254,758 screening examinations, 220,520 women), or CR (74,140 screening examinations, 64,210 women) were followed for 2 years or until breast cancer diagnosis. Breast cancers were classified as screening-detected or interval on the basis of the woman's final screening and assessment results. Interval cancer rate (per 10 000 negative screening examinations), sensitivity, and specificity were compared across the cohorts by using mixed-effects logistic regression analysis. RESULTS Interval cancer rates were higher, although not significantly so, for CR (15.2 per 10,000; 95% confidence interval [CI]: 12.8, 17.8) and were similar for DR (13.7 per 10,000; 95% CI: 12.4, 15.0) compared with SFM (13.0 per 10,000; 95% CI: 12.1, 13.9). For CR versus SFM, specificity was similar while sensitivity was significantly lower (odds ratio [OR] = 0.62; 95% CI: 0.47, 0.83; P = .001), particularly for invasive cancers detected at a rescreening examination, for women with breast density of less than 75%, for women with no family history, and for postmenopausal women. For DR versus SFM, sensitivity was similar while specificity was lower (OR = 0.92; 95% CI: 0.87, 0.98; P = .01), particularly for rescreening examinations, for women aged 60-74 years, for women with breast density of less than 75%, for women with a family history, and for women who were postmenopausal. CONCLUSION Given the 38% lower sensitivity of CR imaging systems compared with SFM, programs should assess the continued use of this technology for breast screening.
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Affiliation(s)
- Maegan V Prummel
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Derek Muradali
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Rene Shumak
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Vicky Majpruz
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Patrick Brown
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Hedy Jiang
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Susan J Done
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Martin J Yaffe
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
| | - Anna M Chiarelli
- From the Department of Prevention and Cancer Control, Cancer Care Ontario, 505 University Ave, Toronto, ON, Canada M5G 1X3 (M.V.P., D.M., R.S., V.M., P.B., H.J., A.M.C.); Dalla Lana School of Public Health, University of Toronto, Toronto, Ont, Canada (P.B., A.M.C.); Campbell Family Institute for Breast Cancer Research, University Health Network, Toronto, Ont, Canada (S.J.D.); and Department of Physical Sciences, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada (M.J.Y.)
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van Ravesteyn NT, van Lier L, Schechter CB, Ekwueme DU, Royalty J, Miller JW, Near AM, Cronin KA, Heijnsdijk EAM, Mandelblatt JS, de Koning HJ. Transition from film to digital mammography: impact for breast cancer screening through the national breast and cervical cancer early detection program. Am J Prev Med 2015; 48:535-42. [PMID: 25891052 PMCID: PMC4405659 DOI: 10.1016/j.amepre.2014.11.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/28/2014] [Accepted: 11/17/2014] [Indexed: 10/23/2022]
Abstract
INTRODUCTION The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides mammograms and diagnostic services for low-income, uninsured women aged 40-64 years. Mammography facilities within the NBCCEDP gradually shifted from plain-film to digital mammography. The purpose of this study is to assess the impact of replacing film with digital mammography on health effects (deaths averted, life-years gained [LYG]); costs (for screening and diagnostics); and number of women reached. METHODS NBCCEDP 2010 data and data representative of the program's target population were used in two established microsimulation models. Models simulated observed screening behavior including different screening intervals (annual, biennial, irregular) and starting ages (40, 50 years) for white, black, and Hispanic women. Model runs were performed in 2012. RESULTS The models predicted 8.0-8.3 LYG per 1,000 film screens for black women, 5.9-7.5 for white women, and 4.0-4.5 for Hispanic women. For all race/ethnicity groups, digital mammography had more LYG than film mammography (2%-4%), but had higher costs (34%-35%). Assuming a fixed budget, 25%-26% fewer women could be served, resulting in 22%-24% fewer LYG if all mammograms were converted to digital. The loss in LYG could be reversed to an 8%-13% increase by only including biennial screening. CONCLUSIONS Digital could result in slightly more LYG than film mammography. However, with a fixed budget, fewer women may be served with fewer LYG. Changes in the program, such as only including biennial screening, will increase LYG/screen and could offset the potential decrease in LYG when shifting to digital mammography.
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Affiliation(s)
| | - Lisanne van Lier
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam; Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Clyde B Schechter
- Departments of Family & Social Medicine and Epidemiology & Population Health, Albert Einstein School of Medicine, Bronx, New York
| | | | | | | | - Aimee M Near
- Department of Oncology, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Kathleen A Cronin
- Statistical Research and Application Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland
| | | | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University, Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center, Rotterdam
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Weber RJ, Nederend J, Voogd AC, Strobbe LJ, Duijm LE. Screening outcome and surgical treatment during and after the transition from screen-film to digital screening mammography in the south of The Netherlands. Int J Cancer 2014; 137:135-43. [DOI: 10.1002/ijc.29354] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 11/11/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Roy J.P. Weber
- Department of Radiology; Catharina Hospital; Eindhoven The Netherlands
| | - Joost Nederend
- Department of Radiology; Catharina Hospital; Eindhoven The Netherlands
| | - Adri C. Voogd
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry; Eindhoven The Netherlands
- Department of Epidemiology; Maastricht University; Maastricht The Netherlands
| | - Luc J. Strobbe
- Department of Surgery; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| | - Lucien E.M. Duijm
- Department of Radiology; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
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Impact of risk factors on different interval cancer subtypes in a population-based breast cancer screening programme. PLoS One 2014; 9:e110207. [PMID: 25333936 PMCID: PMC4204862 DOI: 10.1371/journal.pone.0110207] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 09/10/2014] [Indexed: 11/23/2022] Open
Abstract
Background Interval cancers are primary breast cancers diagnosed in women after a negative screening test and before the next screening invitation. Our aim was to evaluate risk factors for interval cancer and their subtypes and to compare the risk factors identified with those associated with incident screen-detected cancers. Methods We analyzed data from 645,764 women participating in the Spanish breast cancer screening program from 2000–2006 and followed-up until 2009. A total of 5,309 screen-detected and 1,653 interval cancers were diagnosed. Among the latter, 1,012 could be classified on the basis of findings in screening and diagnostic mammograms, consisting of 489 true interval cancers (48.2%), 235 false-negatives (23.2%), 172 minimal-signs (17.2%) and 114 occult tumors (11.3%). Information on the screening protocol and women's characteristics were obtained from the screening program registry. Cause-specific Cox regression models were used to estimate the hazard ratios (HR) of risks factors for interval cancer and incident screen-detected cancer. A multinomial regression model, using screen-detected tumors as a reference group, was used to assess the effect of breast density and other factors on the occurrence of interval cancer subtypes. Results A previous false-positive was the main risk factor for interval cancer (HR = 2.71, 95%CI: 2.28–3.23); this risk was higher for false-negatives (HR = 8.79, 95%CI: 6.24–12.40) than for true interval cancer (HR = 2.26, 95%CI: 1.59–3.21). A family history of breast cancer was associated with true intervals (HR = 2.11, 95%CI: 1.60–2.78), previous benign biopsy with a false-negatives (HR = 1.83, 95%CI: 1.23–2.71). High breast density was mainly associated with occult tumors (RRR = 4.92, 95%CI: 2.58–9.38), followed by true intervals (RRR = 1.67, 95%CI: 1.18–2.36) and false-negatives (RRR = 1.58, 95%CI: 1.00–2.49). Conclusion The role of women's characteristics differs among interval cancer subtypes. This information could be useful to improve effectiveness of breast cancer screening programmes and to better classify subgroups of women with different risks of developing cancer.
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Sala M, Domingo L, Macià F, Comas M, Burón A, Castells X. Does digital mammography suppose an advance in early diagnosis? Trends in performance indicators 6 years after digitalization. Eur Radiol 2014; 25:850-9. [PMID: 25257856 PMCID: PMC4328118 DOI: 10.1007/s00330-014-3431-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/19/2014] [Accepted: 09/03/2014] [Indexed: 11/26/2022]
Abstract
Purpose To provide a complete evaluation of the long-term impact of full-field digital mammography (FFDM) on the improvement of early diagnosis in a population-based screening program. Methods We included 82,961 screen-film mammograms (SFM) and 79,031 FFDM from women aged 50–69 screened biennially from 1995–2010 in Spain and followed-up to 2012. The first screening round of the program was excluded. Rates of cancer detection, interval cancer, tumoral characteristics and other quality indicators were compared between SFM and FFDM periods using the Chi-square test. Multivariate logistic regression models were fitted. Results Detection of ductal carcinoma in situ (DCIS) significantly increased with FFDM (0.05 % vs 0.09 %; p = 0.010), along with the proportion of small invasive cancers (<20 mm) (69.37 % vs 78.90 %; p = 0.040). The false-positive rate decreased with FFDM (4.79 % vs 3.38 %; p < 0.001) without differences in the cancer detection rate (0.42 % vs 0.43 %; p = 0.685) or in the interval cancer rate (0.14 % vs 0.14 %; p = 0.816). Adjusted models showed a significant increase in the detection of DCIS in the FFDM periods. Conclusion Digitalization has supposed an improvement in early diagnosis because DCIS and small invasive cancers increased without a change in detection rate. Moreover, false-positive reduction without an increase in the interval cancer rate was confirmed. Key Points • Cancer detection did not increase after 6 years of digital mammography • Ductal carcinoma in situ rates remained higher throughout the digital period • The proportion of small invasive cancers was higher with digital mammography • We observed an improvement in early diagnosis with digital mammography • False-positive rates remained lower throughout the digital period without interval cancer increase
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Affiliation(s)
- Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Pg. Marítim 25-29, 08003, Barcelona, Spain,
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Boyd NF, Huszti E, Melnichouk O, Martin LJ, Hislop G, Chiarelli A, Yaffe MJ, Minkin S. Mammographic features associated with interval breast cancers in screening programs. Breast Cancer Res 2014; 16:417. [PMID: 25346388 PMCID: PMC4187338 DOI: 10.1186/s13058-014-0417-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 07/22/2014] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Percent mammographic density (PMD) is associated with an increased risk of interval breast cancer in screening programs, as are younger age, pre-menopausal status, lower body mass index and hormone therapy. These factors are also associated with variations in PMD. We have examined whether these variables influence the relative frequency of interval and screen-detected breast cancer, independently or through their associations with PMD. We also examined the association of tumor size with PMD and dense and non-dense areas in screen-detected and interval breast cancers. METHODS We used data from three case-control studies nested in screened populations. Interval breast cancer was defined as invasive breast cancer detected within 12 months of a negative mammogram. We used a computer-assisted method of measuring the dense and total areas of breast tissue in the first (baseline) mammogram taken at entry to screening programs and calculated the non-dense area and PMD. We compared these mammographic features, and other risk factors at baseline, in women with screen-detected (n = 718) and interval breast cancer (n = 125). RESULTS In multi-variable analysis, the baseline characteristics of younger age, greater dense area and smaller non-dense mammographic area were significantly associated with interval breast cancer compared to screen-detected breast cancer. Compared to screen-detected breast cancers, interval cancers had a larger maximum tumor diameter within each mammographic measure. CONCLUSIONS Age and the dense and non-dense areas in the baseline mammogram were independently associated with interval breast cancers in screening programs. These results suggest that decreased detection of cancers caused by the area of dense tissue, and more rapid growth associated with a smaller non-dense area, may both contribute to risk of interval breast cancer. Tailoring screening to individual mammographic characteristics at baseline may reduce the number of interval cancers.
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Affiliation(s)
- Norman F Boyd
- The Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, Room 10-415, 610 University Avenue, Toronto, M5G 2M9 ON Canada
| | - Ella Huszti
- The Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, Room 10-415, 610 University Avenue, Toronto, M5G 2M9 ON Canada
| | - Olga Melnichouk
- The Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, Room 10-415, 610 University Avenue, Toronto, M5G 2M9 ON Canada
| | - Lisa J Martin
- The Campbell Family Institute for Breast Cancer Research, Ontario Cancer Institute, Room 10-415, 610 University Avenue, Toronto, M5G 2M9 ON Canada
| | - Greg Hislop
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, V6T 1Z9 BC Canada
| | - Anna Chiarelli
- Prevention and Cancer Control, Cancer Care, 620 University Avenue, Toronto, M5G 2L7 ON Canada
| | - Martin J Yaffe
- Imaging Research, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, M4N 3M5 ON Canada
| | - Salomon Minkin
- Ontario Cancer Institute, 610 University Avenue, Toronto, M5G 2M9 ON Canada
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