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Hubbard RA, Su YR, Bowles EJA, Ichikawa L, Kerlikowske K, Lowry KP, Miglioretti DL, Tosteson ANA, Wernli KJ, Lee JM. Predicting five-year interval second breast cancer risk in women with prior breast cancer. J Natl Cancer Inst 2024; 116:929-937. [PMID: 38466940 PMCID: PMC11160498 DOI: 10.1093/jnci/djae063] [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: 11/28/2023] [Revised: 02/22/2024] [Accepted: 03/07/2024] [Indexed: 03/13/2024] Open
Abstract
BACKGROUND Annual surveillance mammography is recommended for women with a personal history of breast cancer. Risk prediction models that estimate mammography failures such as interval second breast cancers could help to tailor surveillance imaging regimens to women's individual risk profiles. METHODS In a cohort of women with a history of breast cancer receiving surveillance mammography in the Breast Cancer Surveillance Consortium in 1996-2019, we used Least Absolute Shrinkage and Selection Operator (LASSO)-penalized regression to estimate the probability of an interval second cancer (invasive cancer or ductal carcinoma in situ) in the 1 year after a negative surveillance mammogram. Based on predicted risks from this one-year risk model, we generated cumulative risks of an interval second cancer for the five-year period after each mammogram. Model performance was evaluated using cross-validation in the overall cohort and within race and ethnicity strata. RESULTS In 173 290 surveillance mammograms, we observed 496 interval cancers. One-year risk models were well-calibrated (expected/observed ratio = 1.00) with good accuracy (area under the receiver operating characteristic curve = 0.64). Model performance was similar across race and ethnicity groups. The median five-year cumulative risk was 1.20% (interquartile range 0.93%-1.63%). Median five-year risks were highest in women who were under age 40 or pre- or perimenopausal at diagnosis and those with estrogen receptor-negative primary breast cancers. CONCLUSIONS Our risk model identified women at high risk of interval second breast cancers who may benefit from additional surveillance imaging modalities. Risk models should be evaluated to determine if risk-guided supplemental surveillance imaging improves early detection and decreases surveillance failures.
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Affiliation(s)
- Rebecca A Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yu-Ru Su
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Erin J A Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Laura Ichikawa
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Kathryn P Lowry
- Department of Radiology, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington and Fred Hutchinson Cancer Center, Seattle, WA, USA
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Sprague BL, Chen S, Miglioretti DL, Gard CC, Tice JA, Hubbard RA, Aiello Bowles EJ, Kaufman PA, Kerlikowske K. Cumulative 6-Year Risk of Screen-Detected Ductal Carcinoma In Situ by Screening Frequency. JAMA Netw Open 2023; 6:e230166. [PMID: 36808238 PMCID: PMC9941892 DOI: 10.1001/jamanetworkopen.2023.0166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
IMPORTANCE Detection of ductal carcinoma in situ (DCIS) by mammography screening is a controversial outcome with potential benefits and harms. The association of mammography screening interval and woman's risk factors with the likelihood of DCIS detection after multiple screening rounds is poorly understood. OBJECTIVE To develop a 6-year risk prediction model for screen-detected DCIS according to mammography screening interval and women's risk factors. DESIGN, SETTING, AND PARTICIPANTS This Breast Cancer Surveillance Consortium cohort study assessed women aged 40 to 74 years undergoing mammography screening (digital mammography or digital breast tomosynthesis) from January 1, 2005, to December 31, 2020, at breast imaging facilities within 6 geographically diverse registries of the consortium. Data were analyzed between February and June 2022. EXPOSURES Screening interval (annual, biennial, or triennial), age, menopausal status, race and ethnicity, family history of breast cancer, benign breast biopsy history, breast density, body mass index, age at first birth, and false-positive mammography history. MAIN OUTCOMES AND MEASURES Screen-detected DCIS defined as a DCIS diagnosis within 12 months after a positive screening mammography result, with no concurrent invasive disease. RESULTS A total of 916 931 women (median [IQR] age at baseline, 54 [46-62] years; 12% Asian, 9% Black, 5% Hispanic/Latina, 69% White, 2% other or multiple races, and 4% missing) met the eligibility criteria, with 3757 screen-detected DCIS diagnoses. Screening round-specific risk estimates from multivariable logistic regression were well calibrated (expected-observed ratio, 1.00; 95% CI, 0.97-1.03) with a cross-validated area under the receiver operating characteristic curve of 0.639 (95% CI, 0.630-0.648). Cumulative 6-year risk of screen-detected DCIS estimated from screening round-specific risk estimates, accounting for competing risks of death and invasive cancer, varied widely by all included risk factors. Cumulative 6-year screen-detected DCIS risk increased with age and shorter screening interval. Among women aged 40 to 49 years, the mean 6-year screen-detected DCIS risk was 0.30% (IQR, 0.21%-0.37%) for annual screening, 0.21% (IQR, 0.14%-0.26%) for biennial screening, and 0.17% (IQR, 0.12%-0.22%) for triennial screening. Among women aged 70 to 74 years, the mean cumulative risks were 0.58% (IQR, 0.41%-0.69%) after 6 annual screens, 0.40% (IQR, 0.28%-0.48%) for 3 biennial screens, and 0.33% (IQR, 0.23%-0.39%) after 2 triennial screens. CONCLUSIONS AND RELEVANCE In this cohort study, 6-year screen-detected DCIS risk was higher with annual screening compared with biennial or triennial screening intervals. Estimates from the prediction model, along with risk estimates of other screening benefits and harms, could help inform policy makers' discussions of screening strategies.
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Affiliation(s)
- Brian L. Sprague
- Office of Health Promotion Research, University of Vermont, Burlington
- Department of Surgery, University of Vermont, Burlington
- University of Vermont Cancer Center, Burlington
| | - Shuai Chen
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Charlotte C. Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces
| | - Jeffrey A. Tice
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia
| | - Erin J. Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
| | - Peter A. Kaufman
- Division of Hematology/Oncology, University of Vermont Cancer Center, Burlington
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
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Kerlikowske K, Chen S, Golmakani MK, Sprague BL, Tice JA, Tosteson ANA, Rauscher GH, Henderson LM, Buist DSM, Lee JM, Gard CC, Miglioretti DL. Cumulative Advanced Breast Cancer Risk Prediction Model Developed in a Screening Mammography Population. J Natl Cancer Inst 2022; 114:676-685. [PMID: 35026019 PMCID: PMC9086807 DOI: 10.1093/jnci/djac008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Estimating advanced breast cancer risk in women undergoing annual or biennial mammography could identify women who may benefit from less or more intensive screening. We developed an actionable model to predict cumulative 6-year advanced cancer (prognostic pathologic stage II or higher) risk according to screening interval. METHODS We included 931 186 women aged 40-74 years in the Breast Cancer Surveillance Consortium undergoing 2 542 382 annual (prior mammogram within 11-18 months) or 752 049 biennial (prior within 19-30 months) screening mammograms. The prediction model includes age, race and ethnicity, body mass index, breast density, family history of breast cancer, and prior breast biopsy subdivided by menopausal status and screening interval. We used fivefold cross-validation to internally validate model performance. We defined higher than 95th percentile as high risk (>0.658%), higher than 75th percentile to 95th or less percentile as intermediate risk (0.380%-0.658%), and 75th or less percentile as low to average risk (<0.380%). RESULTS Obesity, high breast density, and proliferative disease with atypia were strongly associated with advanced cancer. The model is well calibrated and has an area under the receiver operating characteristics curve of 0.682 (95% confidence interval = 0.670 to 0.694). Based on women's predicted advanced cancer risk under annual and biennial screening, 69.1% had low or average risk regardless of screening interval, 12.4% intermediate risk with biennial screening and average risk with annual screening, and 17.4% intermediate or high risk regardless of screening interval. CONCLUSION Most women have low or average advanced cancer risk and can undergo biennial screening. Intermediate-risk women may consider annual screening, and high-risk women may consider supplemental imaging in addition to annual screening.
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Affiliation(s)
- Karla Kerlikowske
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Shuai Chen
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - Brian L Sprague
- Department of Surgery and Radiology, University of Vermont, Burlington, VT, USA
| | - Jeffrey A Tice
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Garth H Rauscher
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington, and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Charlotte C Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
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Ho TQH, Bissell MCS, Kerlikowske K, Hubbard RA, Sprague BL, Lee CI, Tice JA, Tosteson ANA, Miglioretti DL. Cumulative Probability of False-Positive Results After 10 Years of Screening With Digital Breast Tomosynthesis vs Digital Mammography. JAMA Netw Open 2022; 5:e222440. [PMID: 35333365 PMCID: PMC8956976 DOI: 10.1001/jamanetworkopen.2022.2440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 12/23/2021] [Indexed: 11/25/2022] Open
Abstract
Importance Breast cancer screening with digital breast tomosynthesis may decrease false-positive results compared with digital mammography. Objective To estimate the probability of receiving at least 1 false-positive result after 10 years of screening with digital breast tomosynthesis vs digital mammography in the US. Design, Setting, and Participants An observational comparative effectiveness study with data collected prospectively for screening examinations was performed between January 1, 2005, and December 31, 2018, at 126 radiology facilities in the Breast Cancer Surveillance Consortium. Analysis included 903 495 individuals aged 40 to 79 years. Data analysis was conducted from February 9 to September 7, 2021. Exposures Screening modality, screening interval, age, and Breast Imaging Reporting and Data System breast density. Main Outcomes and Measures Cumulative risk of at least 1 false-positive recall for further imaging, short-interval follow-up recommendation, and biopsy recommendation after 10 years of annual or biennial screening with digital breast tomosynthesis vs digital mammography, accounting for competing risks of breast cancer diagnosis and death. Results In this study of 903 495 women, 2 969 055 nonbaseline screening examinations were performed with interpretation by 699 radiologists. Mean (SD) age of the women at the time of the screening examinations was 57.6 (9.9) years, and 58% of the examinations were in individuals younger than 60 years and 46% were performed in women with dense breasts. A total of 15% of examinations used tomosynthesis. For annual screening, the 10-year cumulative probability of at least 1 false-positive result was significantly lower with tomosynthesis vs digital mammography for all outcomes: 49.6% vs 56.3% (difference, -6.7; 95% CI, -7.4 to -6.1) for recall, 16.6% vs 17.8% (difference, -1.1; 95% CI, -1.7 to -0.6) for short-interval follow-up recommendation, and 11.2% vs 11.7% (difference, -0.5; 95% CI, -1.0 to -0.1) for biopsy recommendation. For biennial screening, the cumulative probability of a false-positive recall was significantly lower for tomosynthesis vs digital mammography (35.7% vs 38.1%; difference, -2.4; 95% CI, -3.4 to -1.5), but cumulative probabilities did not differ significantly by modality for short-interval follow-up recommendation (10.3% vs 10.5%; difference, -0.1; 95% CI, -0.7 to 0.5) or biopsy recommendation (6.6% vs 6.7%; difference, -0.1; 95% CI, -0.5 to 0.4). Decreases in cumulative probabilities of false-positive results with tomosynthesis vs digital mammography were largest for annual screening in women with nondense breasts (differences for recall, -6.5 to -12.8; short-interval follow-up, 0.1 to -5.2; and biopsy recommendation, -0.5 to -3.1). Regardless of modality, cumulative probabilities of false-positive results were substantially lower for biennial vs annual screening (overall recall, 35.7 to 38.1 vs 49.6 to 56.3; short-interval follow-up, 10.3 to 10.5 vs 16.6 to 17.8; and biopsy recommendation, 6.6 to 6.7 vs 11.2 to 11.7); older vs younger age groups (eg, among annual screening in women ages 70-79 vs 40-49, recall, 39.8 to 47.0 vs 60.8 to 68.0; short-interval follow-up, 13.3 to 14.2 vs 20.7 to 20.9; and biopsy recommendation, 9.1 to 9.3 vs 13.2 to 13.4); and women with entirely fatty vs extremely dense breasts (eg, among annual screening in women aged 50-59 years, recall, 29.1 to 36.3 vs 58.8 to 60.4; short-interval follow-up, 8.9 to 11.6 vs 19.5 to 19.8; and biopsy recommendation, 4.9 to 8.0 vs 15.1 to 15.3). Conclusions and Relevance In this comparative effectiveness study, 10-year cumulative probabilities of false-positive results were lower on digital breast tomosynthesis vs digital mammography. Biennial screening interval, older age, and nondense breasts were associated with larger reductions in false-positive probabilities than screening modality.
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Affiliation(s)
- Thao-Quyen H. Ho
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
- Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam
| | - Michael C. S. Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
| | - Karla Kerlikowske
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco
- Department of Medicine, University of California, San Francisco
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Rebecca A. Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Brian L. Sprague
- Department of Surgery, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and University of Vermont Cancer Center, Burlington, Vermont
| | - Christoph I. Lee
- Department of Radiology, University of Washington School of Medicine, Seattle
- Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle
- Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - Jeffrey A. Tice
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco
| | - Anna N. A. Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth College, Lebanon, New Hampshire
- Department of Medicine, Geisel School of Medicine at Dartmouth, Hanover, Lebanon, New Hampshire
- Department of Oncology, Norris Cotton Cancer Center, Lebanon, New Hampshire
| | - Diana L. Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis School of Medicine, Davis
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle
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Tsuruda KM, Larsen M, Román M, Hofvind S. Cumulative risk of a false-positive screening result: A retrospective cohort study using empirical data from 10 biennial screening rounds in BreastScreen Norway. Cancer 2021; 128:1373-1380. [PMID: 34931707 DOI: 10.1002/cncr.34078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/17/2021] [Accepted: 12/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND False-positive screening results are an inevitable and commonly recognized disadvantage of mammographic screening. This study estimated the cumulative probability of experiencing a first false-positive screening result in women attending 10 biennial screening rounds in BreastScreen Norway, which targets women aged 50 to 69 years. METHODS This retrospective cohort study analyzed screening outcomes from 421,545 women who underwent 1,894,523 screening examinations during 1995-2019. Empirical data were used to calculate the cumulative risk of experiencing a first false-positive screening result and a first false-positive screening result that involved an invasive procedure over 10 screening rounds. Logistic regression was used to evaluate the effect of adjusting for irregular attendance, age at screening, and number of screens attended. RESULTS The cumulative risk of experiencing a first false-positive screening result was 18.04% (95% confidence interval [CI], 18.00%-18.07%). It was 5.01% (95% CI, 5.01%-5.02%) for experiencing a false-positive screening result that involved an invasive procedure. Adjusting for irregular attendance or age at screening did not appreciably affect these estimates. After adjustments for the number of screens attended, the cumulative risk of a first false-positive screening result was 18.28% (95% CI, 18.24%-18.32%), and the risk of a false-positive screening result including an invasive procedure was 5.11% (95% CI, 5.11%-5.22%). This suggested that there was minimal bias from dependent censoring. CONCLUSIONS Nearly 1 in 5 women will experience a false-positive screening result if they attend 10 biennial screening rounds in BreastScreen Norway. One in 20 will experience a false-positive screening result with an invasive procedure. LAY SUMMARY A false-positive screening result occurs when a woman attending mammographic screening is called back for further assessment because of suspicious findings, but the assessment does not detect breast cancer. Further assessment includes additional imaging. Usually, it involves ultrasound, and sometimes, it involves a biopsy. This study has evaluated the chance of experiencing a false-positive screening result among women attending 10 screening examinations over 20 years in BreastScreen Norway. Nearly 1 in 5 women will experience a false-positive screening result over 10 screening rounds. One in 20 women will experience a false-positive screening result involving a biopsy.
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Affiliation(s)
- Kaitlyn M Tsuruda
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, Barcelona, Spain
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Health and Care Sciences, Faculty of Health Sciences, Arctic University of Norway, Tromsø, Norway
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Ibáñez-Sanz G, Garcia M, Milà N, Hubbard RA, Vidal C, Binefa G, Benito L, Moreno V. False-Positive Results in a Population-Based Colorectal Screening Program: Cumulative Risk from 2000 to 2017 with Biennial Screening. Cancer Epidemiol Biomarkers Prev 2019; 28:1909-1916. [PMID: 31488415 DOI: 10.1158/1055-9965.epi-18-1368] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/08/2019] [Accepted: 08/28/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The aim of this study was to estimate the cumulative risk of a false-positive (FP) result in a fecal occult blood test (FOBT) through 7 screening rounds and to identify its associated factors in a population-based colorectal cancer screening program. METHODS Retrospective cohort study, which included participants ages 50 to 69 years of a colorectal cancer screening program in Catalonia, Spain. During this period, 2 FOBTs were used (guaiac and immunochemical). A discrete-time survival model was performed to identify risk factors of receiving a positive FOBT with no high-risk adenoma or colorectal cancer in the follow-up colonoscopy. We estimated the probability of having at least 1 FP over 7 screening rounds. RESULTS During the period of 2000 to 2017, the cumulative FP risk was 16.3% (IC95%: 14.6%-18.3%), adjusted by age, sex, and type of test. The median number of screens was 2. Participants who began screening at age 50 years had a 7.3% [95% confidence interval (CI), 6.35-8.51] and a 12.4% (95% CI, 11.00-13.94) probability of an FP with 4 screening rounds of guaiac-based test and immunochemical test, respectively. Age, the fecal immunochemical test, first screening, and number of personal screens were factors associated with an FP result among screenees. CONCLUSIONS The cumulative risk of an FP in colorectal screening using FOBT seems acceptable as the colonoscopy, with its high accuracy, lengthens the time until additional colorectal screening is required, while complication rates remain low. IMPACT It is useful to determine the cumulative FP risk in cancer screening for both advising individuals and for health resources planning.
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Affiliation(s)
- Gemma Ibáñez-Sanz
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Gastroenterology Department, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer Group, ONCOBELL Programme, Bellvitge Biomedical Research Institute Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
| | - Montse Garcia
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
- Cancer Prevention and Control Group, IDIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Milà
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer Group, ONCOBELL Programme, Bellvitge Biomedical Research Institute Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Carmen Vidal
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Cancer Prevention and Control Group, IDIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Gemma Binefa
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
- Cancer Prevention and Control Group, IDIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Llúcia Benito
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Víctor Moreno
- Cancer Prevention and Control Programme, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona, Spain
- Colorectal Cancer Group, ONCOBELL Programme, Bellvitge Biomedical Research Institute Hospitalet de Llobregat, Barcelona, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBEResp), Barcelona, Spain
- Department of Clinical Sciences, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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Lee JM, Abraham L, Lam DL, Buist DS, Kerlikowske K, Miglioretti DL, Houssami N, Lehman CD, Henderson LM, Hubbard RA. Cumulative Risk Distribution for Interval Invasive Second Breast Cancers After Negative Surveillance Mammography. J Clin Oncol 2018; 36:2070-2077. [PMID: 29718790 PMCID: PMC6036621 DOI: 10.1200/jco.2017.76.8267] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Purpose The aim of the current study was to characterize the risk of interval invasive second breast cancers within 5 years of primary breast cancer treatment. Methods We examined 65,084 surveillance mammograms from 18,366 women with a primary breast cancer diagnosis of unilateral ductal carcinoma in situ or stage I to III invasive breast carcinoma performed from 1996 to 2012 in the Breast Cancer Surveillance Consortium. Interval invasive breast cancer was defined as ipsilateral or contralateral cancer diagnosed within 1 year after a negative surveillance mammogram. Discrete-time survival models-adjusted for all covariates-were used to estimate the probability of interval invasive cancer, given the risk factors for each surveillance round, and aggregated across rounds to estimate the 5-year cumulative probability of interval invasive cancer. Results We observed 474 surveillance-detected cancers-334 invasive and 140 ductal carcinoma in situ-and 186 interval invasive cancers which yielded a cancer detection rate of 7.3 per 1,000 examinations (95% CI, 6.6 to 8.0) and an interval invasive cancer rate of 2.9 per 1,000 examinations (95% CI, 2.5 to 3.3). Median cumulative 5-year interval cancer risk was 1.4% (interquartile range, 0.8% to 2.3%; 10th to 90th percentile range, 0.5% to 3.7%), and 15% of women had ≥ 3% 5-year interval invasive cancer risk. Cumulative 5-year interval cancer risk was highest for women with estrogen receptor- and progesterone receptor-negative primary breast cancer (2.6%; 95% CI, 1.7% to 3.5%), interval cancer presentation at primary diagnosis (2.2%; 95% CI, 1.5% to 2.9%), and breast conservation without radiation (1.8%; 95% CI, 1.1% to 2.4%). Conclusion Risk of interval invasive second breast cancer varies across women and is influenced by characteristics that can be measured at initial diagnosis, treatment, and imaging. Risk prediction models that evaluate the risk of cancers not detected by surveillance mammography should be developed to inform discussions of tailored surveillance.
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Affiliation(s)
- Janie M. Lee
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Linn Abraham
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Diana L. Lam
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Diana S.M. Buist
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Karla Kerlikowske
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Diana L. Miglioretti
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Nehmat Houssami
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Constance D. Lehman
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Louise M. Henderson
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
| | - Rebecca A. Hubbard
- Janie M. Lee and Diana L. Lam, University of Washington, and Seattle Cancer Care Alliance; Linn Abraham, Diana S.M. Buist, and Diana L. Miglioretti, Kaiser Permanente Washington Health Research Institute, Seattle, WA; Karla Kerlikowske, Department of Veterans Affairs, University of California, San Francisco, San Francisco; Diana L. Miglioretti, University of California, Davis, Davis, CA; Nehmat Houssami, University of Sydney, Sydney, New South Wales, Australia; Constance D. Lehman, Massachusetts General Hospital, Boston, MA; Louise M. Henderson, University of North Carolina, Chapel Hill, Chapel Hill, NC; and Rebecca A. Hubbard, University of Pennsylvania, Philadelphia, PA
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Lilleborge M, Hofvind S, Sebuødegård S, Hauge R. Optimizing performance of BreastScreen Norway using value of information in graphical models. Stat Med 2018; 37:1531-1549. [DOI: 10.1002/sim.7601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Revised: 11/19/2017] [Accepted: 11/30/2017] [Indexed: 11/07/2022]
Affiliation(s)
- Marie Lilleborge
- Norwegian Computing Center; Postbox 114 Blindern 0314 Oslo Norway
| | - Solveig Hofvind
- Cancer Registry of Norway; Postbox 5313 Majorstuen 0304 Oslo Norway
| | | | - Ragnar Hauge
- Norwegian Computing Center; Postbox 114 Blindern 0314 Oslo Norway
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Román M, Quintana MJ, Ferrer J, Sala M, Castells X. Cumulative risk of breast cancer screening outcomes according to the presence of previous benign breast disease and family history of breast cancer: supporting personalised screening. Br J Cancer 2017; 116:1480-1485. [PMID: 28427083 PMCID: PMC5520087 DOI: 10.1038/bjc.2017.107] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/23/2017] [Accepted: 03/27/2017] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Our aim was to assess the cumulative risk of false-positive screening results, screen-detected cancer, and interval breast cancer in mammography screening among women with and without a previous benign breast disease and a family history of breast cancer. METHODS The cohort included 42 928 women first screened at the age of 50-51 years at three areas of the Spanish Screening Programme (Girona, and two areas in Barcelona) between 1996 and 2011, and followed up until December 2012. We used discrete-time survival models to estimate the cumulative risk of each screening outcome over 10 biennial screening exams. RESULTS The cumulative risk of false-positive results, screen-detected breast cancer, and interval cancer was 36.6, 5.3, and 1.4 for women with a previous benign breast disease, 24.1, 6.8, and 1.6% for women with a family history of breast cancer, 37.9, 9.0, and 3.2%; for women with both a previous benign breast disease and a family history, and 23.1, 3.2, and 0.9% for women without either of these antecedents, respectively. CONCLUSIONS Women with a benign breast disease or a family history of breast cancer had an increased cumulative risk of favourable and unfavourable screening outcomes than women without these characteristics. A family history of breast cancer did not increase the cumulative risk of false-positive results. Identifying different risk profiles among screening participants provides useful information to stratify women according to their individualised risk when personalised screening strategies are discussed.
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Affiliation(s)
- M Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, Barcelona 08003, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barrio Labeaga s/n, Bizkaia 48960, Spain
| | - M J Quintana
- Department of Epidemiology, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Sant Quintí 89, Barcelona 08026, Spain
| | - J Ferrer
- Department of Radiology, Hospital de Santa Caterina, Dr Castany s/n, Girona 17190, Spain
| | - M Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, Barcelona 08003, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barrio Labeaga s/n, Bizkaia 48960, Spain
| | - X Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim 25-29, Barcelona 08003, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Barrio Labeaga s/n, Bizkaia 48960, Spain
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