1
|
Qenam BA, Li T, Alshabibi A, Frazer H, Ekpo E, Brennan P. Test-set results can predict participants' development in breast-screen cancer detection: An observational cohort study. Health Sci Rep 2024; 7:e2161. [PMID: 38895553 PMCID: PMC11183186 DOI: 10.1002/hsr2.2161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 04/19/2024] [Accepted: 05/13/2024] [Indexed: 06/21/2024] Open
Abstract
Background and Aim Test-sets are standardized assessments used to evaluate reader performance in breast screening. Understanding how test-set results affect real-world performance can help refine their use as a quality improvement tool. The aim of this study is to explore if mammographic test-set results could identify breast-screening readers who improved their cancer detection in association with test-set training. Methods Test-set results of 41 participants were linked to their annual cancer detection rate change in two periods oriented around their first test-set participation year. Correlation tests and a multiple linear regression model investigated the relationship between each metric in the test-set results and the change in detection rates. Additionally, participants were divided based on their improvement status between the two periods, and Mann-Whitney U test was used to determine if the subgroups differed in their test-set metrics. Results Test-set records indicated multiple significant correlations with the change in breast cancer detection rate: a moderate positive correlation with sensitivity (0.688, p < 0.001), a moderate negative correlation with specificity (-0.528, p < 0.001), and a low to moderate positive correlation with lesion sensitivity (0.469, p = 0.002), and the number of years screen-reading mammograms (0.365, p = 0.02). In addition, the overall regression was statistically significant (F (2,38) = 18.456 p < 0.001), with an R² of 0.493 (adjusted R² = 0.466) based on sensitivity (F = 27.132, p < 0.001) and specificity (F = 9.78, p = 0.003). Subgrouping the cohort based on the change in cancer detection indicated that the improved group is significantly higher in sensitivity (p < 0.001) and lesion sensitivity (p = 0.02) but lower in specificity (p = 0.003). Conclusion Sensitivity and specificity are the strongest test-set performance measures to predict the change in breast cancer detection in real-world breast screening settings following test-set participation.
Collapse
Affiliation(s)
- Basel A. Qenam
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
- Department of Radiological Sciences, College of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Tong Li
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
- The Daffodil CentreThe University of Sydney, A Joint Venture with Cancer CouncilSydneyNew South WalesAustralia
- Sydney School of Public Health, Faculty of Medicine and HealthUniversity of SydneySydneyNew South WalesAustralia
| | - Abdulaziz Alshabibi
- Department of Radiological Sciences, College of Applied Medical SciencesKing Saud UniversityRiyadhSaudi Arabia
| | - Helen Frazer
- Screening and Assessment Service, St Vincent's BreastScreenFitzroyVictoriaAustralia
| | - Ernest Ekpo
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
- Orange Radiology, Laboratories and Research CentreCalabarNigeria
| | - Patrick Brennan
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Faculty of Medicine and HealthThe University of SydneyCamperdownNew South WalesAustralia
| |
Collapse
|
2
|
van Strien-Knippenberg IS, Arjangi-Babetti H, Timmermans DRM, Schrauwen L, Fransen MP, Melles M, Damman OC. Communicating the results of risk-based breast cancer screening through visualizations of risk: a participatory design approach. BMC Med Inform Decis Mak 2024; 24:78. [PMID: 38500098 PMCID: PMC10949766 DOI: 10.1186/s12911-024-02483-6] [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: 07/20/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Risk-based breast cancer (BC) screening raises new questions regarding information provision and risk communication. This study aimed to: 1) investigate women's beliefs and knowledge (i.e., mental models) regarding BC risk and (risk-based) BC screening in view of implications for information development; 2) develop novel informational materials to communicate the screening result in risk-based BC screening, including risk visualizations of both quantitative and qualitative information, from a Human-Centered Design perspective. METHODS Phase 1: Interviews were conducted (n = 15, 40-50 years, 5 lower health literate) on women's beliefs about BC risk and (risk-based) BC screening. Phase 2: In three participatory design sessions, women (n = 4-6 across sessions, 40-50 years, 2-3 lower health literate) made assignments and created and evaluated visualizations of risk information central to the screening result. Prototypes were evaluated in two additional sessions (n = 2, 54-62 years, 0-1 lower health literate). Phase 3: Experts (n = 5) and women (n = 9, 40-74 years) evaluated the resulting materials. Two other experts were consulted throughout the development process to ensure that the content of the information materials was accurate. Interviews were transcribed literally and analysed using qualitative thematic analysis, focusing on implications for information development. Notes, assignments and materials from the participatory design sessions were summarized and main themes were identified. RESULTS Women in both interviews and design sessions were positive about risk-based BC screening, especially because personal risk factors would be taken into account. However, they emphasized that the rationale of risk-based screening and classification into a risk category should be clearly stated and visualized, especially for higher- and lower-risk categories (which may cause anxiety or feelings of unfairness due to a lower screening frequency). Women wanted to know their personal risk, preferably visualized in an icon array, and wanted advice on risk reduction and breast self-examination. However, most risk factors were considered modifiable by women, and the risk factor breast density was not known, implying that information should emphasize that BC risk depends on multiple factors, including breast density. CONCLUSIONS The information materials, including risk visualizations of both quantitative and qualitative information, developed from a Human-Centered Design perspective and a mental model approach, were positively evaluated by the target group.
Collapse
Affiliation(s)
- Inge S van Strien-Knippenberg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Hannah Arjangi-Babetti
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laura Schrauwen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Marijke Melles
- Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Chen X, Li H. Bruceine D and Narclasine inhibit the proliferation of breast cancer cells and the prediction of potential drug targets. PLoS One 2024; 19:e0297203. [PMID: 38215156 PMCID: PMC10786365 DOI: 10.1371/journal.pone.0297203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 12/31/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Breast cancer is one of the most common female malignancies. This study explored the underlying mechanism through which the two plant compounds (Brucaine D and Narclasine) inhibited the proliferation of breast cancer cells. OBJECTIVE The purpose of this study was to explore the effect of Brucaine D and Narclasine on breast cancer development and their potential drug targets. METHODS GSE85871 dataset containing 212 samples and the hallmark gene set "h.all.v2023.1.Hs.symbols.gmt" were downloaded from the Gene Expression Omnibus (GEO) database and the Molecular Signatures Database (MSigDB) database, respectively. Principal component analysis (PCA) was applied to classify clusters showing similar gene expression pattern. Single sample gene set enrichment analysis (ssGSEA) was used to calculate the hallmark score for different drug treatment groups. The expressions of genes related to angiogenesis, glycolysis and cell cycle were detected. Protein-protein interaction (PPI) network analysis was performed to study the interaction of the hub genes. Then, HERB database was employed to identify potential target genes for Narclasine and Bruceine D. Finally, in vitro experiments were conducted to validate partial drug-target pair. RESULTS PCA analysis showed that the significant changes in gene expression patterns took place in 6 drugs treatment groups (Narciclasine, Bruceine D, Japonicone A, 1beta-hydroxyalatolactone, Britanin, and four mixture drugs) in comparison to the remaining drug treatment groups. The ssGSEA pathway enrichment analysis demonstrated that Narciclasine and Bruceine treatments had similar enriched pathways, for instance, suppressed pathways related to angiogenesis, Glycolysis, and cell cycle, etc.. Further gene expression analysis confirmed that Narciclasine and Bruceine had a strong ability to inhibit these cell cycle genes, and that MYC, CHEK2, MELK, CDK4 and EZH2 were closely interacted with each other in the PPI analysis. Drug target prediction revealed that Androgen Receptor (AR) and Estrogen Receptor 1 (ESR1) were the targets for Bruceine D, and Cytochrome P450 3A4 enzyme (CYP3A4) was the target for Narciclasine. Cell experiments also confirmed the connections between Narciclasine and CYP3A4. CONCLUSION The present study uncovered that Narciclasine and Bruceine D could inhibit the growth of breast cancer and also predicted the potential targets for these two drugs, providing a new therapeutic direction for breast cancer patients.
Collapse
Affiliation(s)
- Xinhao Chen
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| | - Hua Li
- School of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, China
| |
Collapse
|
4
|
Xu H, Xu B. Breast cancer: Epidemiology, risk factors and screening. Chin J Cancer Res 2023; 35:565-583. [PMID: 38204449 PMCID: PMC10774137 DOI: 10.21147/j.issn.1000-9604.2023.06.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/14/2023] [Indexed: 01/12/2024] Open
Abstract
Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally, epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer. This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography, ultrasound, magnetic resonance imaging (MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.
Collapse
Affiliation(s)
- Hangcheng Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Binghe Xu
- Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| |
Collapse
|
5
|
Njor SH, Heinävaara S, Stefansdóttir H, Nygård M, Guðmundsdóttir EM, Bhargava S, Leivonen A, Campbell S, Søborg B, Hofvind S, Sarkeala T, Vejborg I, Lamminmäki M. Differences in mammography screening attendance among non-Western immigrants in Denmark, Finland, Iceland and Norway. Prev Med Rep 2023; 36:102516. [PMID: 38116274 PMCID: PMC10728433 DOI: 10.1016/j.pmedr.2023.102516] [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: 05/01/2023] [Revised: 11/16/2023] [Accepted: 11/18/2023] [Indexed: 12/21/2023] Open
Abstract
Several studies have shown that attendance rates are lower among non-Western immigrants than among natives. As the Nordic countries have quite similar health systems and populations but also differences in the organisation of their organised mammography screening programmes, differences in attendance rates could highlight organisational factors that might increase the attendance rates. Mammography screening is offered free of charge in Denmark and Finland, but not in Iceland and Norway. Contrarily to the other countries, Iceland do not send out pre-booked appointment. The study population included natives and non-Western immigrants aged 50-69 years, who had at least one invitation to the national mammography screening programmes in Denmark (2008-2017), Finland (2001-2017), Iceland (2001-2020) or Norway (2001-2015). Relative risks (RRs) of attendance were estimated and adjusted for age group and calendar period. The study population included 116.033 non-Western immigrants and more than 2 million natives. The attendance rates were significantly lower among non-Western immigrants than among natives, with an adjusted relative risk of 0.81/0.80 in Denmark and Finland, 0.62 in Norway, and 0.40 in Iceland. The lower attendance rates among immigrants in Norway and Iceland did not seem to be due to differences in birth country, immigration age, or educational level, but might be explained by organisational factors. Offering free-of-charge mammography screening in Norway and Iceland and/or including a pre-booked appointment in the invitation letters in Iceland might increase the attendance rate among non-Western immigrants.
Collapse
Affiliation(s)
- Sisse Helle Njor
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Denmark
- Department of Clinical Medicine, Aarhus University, Denmark
| | - Sirpa Heinävaara
- Finnish Cancer Registry, Helsinki, Finland
- Department of Public Health, University of Helsinki, Finland
| | | | - Mari Nygård
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
| | | | - Sameer Bhargava
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | | | | | - Bo Søborg
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Denmark
| | - Solveig Hofvind
- Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
- Department of Health and Care Sciences, The Arctic University of Norway, Tromsø, Norway
| | | | - Ilse Vejborg
- Department of Breast Examinations, Copenhagen University Hospital Herlev, Gentofte, Denmark
| | | |
Collapse
|
6
|
Ng AY, Oberije CJG, Ambrózay É, Szabó E, Serfőző O, Karpati E, Fox G, Glocker B, Morris EA, Forrai G, Kecskemethy PD. Prospective implementation of AI-assisted screen reading to improve early detection of breast cancer. Nat Med 2023; 29:3044-3049. [PMID: 37973948 PMCID: PMC10719086 DOI: 10.1038/s41591-023-02625-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
Artificial intelligence (AI) has the potential to improve breast cancer screening; however, prospective evidence of the safe implementation of AI into real clinical practice is limited. A commercially available AI system was implemented as an additional reader to standard double reading to flag cases for further arbitration review among screened women. Performance was assessed prospectively in three phases: a single-center pilot rollout, a wider multicenter pilot rollout and a full live rollout. The results showed that, compared to double reading, implementing the AI-assisted additional-reader process could achieve 0.7-1.6 additional cancer detection per 1,000 cases, with 0.16-0.30% additional recalls, 0-0.23% unnecessary recalls and a 0.1-1.9% increase in positive predictive value (PPV) after 7-11% additional human reads of AI-flagged cases (equating to 4-6% additional overall reading workload). The majority of cancerous cases detected by the AI-assisted additional-reader process were invasive (83.3%) and small-sized (≤10 mm, 47.0%). This evaluation suggests that using AI as an additional reader can improve the early detection of breast cancer with relevant prognostic features, with minimal to no unnecessary recalls. Although the AI-assisted additional-reader workflow requires additional reads, the higher PPV suggests that it can increase screening effectiveness.
Collapse
Affiliation(s)
- Annie Y Ng
- Kheiron Medical Technologies, London, UK.
| | | | | | | | | | | | | | - Ben Glocker
- Kheiron Medical Technologies, London, UK
- Department of Computing, Imperial College London, London, UK
| | | | | | | |
Collapse
|
7
|
Portero de la Cruz S, Béjar LM, Cebrino J. Temporal Evolution and Associated Factors of Adherence to Mammography Screening among Women in Spain: Results from Two National Health Surveys (2017-2020). Healthcare (Basel) 2023; 11:2934. [PMID: 37998426 PMCID: PMC10671473 DOI: 10.3390/healthcare11222934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Ensuring equity in cancer screening is recommended by the European Commission. Despite the fact that breast cancer screening is a free population-based program in Spain, there remains considerable variation in the adherence to screening rate among population groups. This study was designed to describe the adherence of breast cancer screening in women in Spain, to evaluate the evolution in the period from 2017 to 2020, and to determine the variables that influence choosing to undergo breast cancer screening. A nationwide cross-sectional study with 7220 females aged 50-69 years from the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain was performed. We investigated mammography uptake rates, with socio-demographic factors, lifestyle habits, and health-related characteristics as independent variables. Multivariable logistic regression was used to identify the associated factors of mammography adherence. Of the women, 78% had undergone mammography in the previous two years, and there was a significant decrease in the uptake rate for breast cancer screening from 2017 (81.23%) to 2020 (74.68%) (p < 0.001). Educational level, marital status, residential location, nationality, smoking status, alcohol consumption, and leisure-time physical activity were all associated factors of mammography uptake.
Collapse
Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal, S/N, 14071 Córdoba, Spain
- Research Group GE10 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain
| | - Luis M. Béjar
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
| |
Collapse
|
8
|
Michalopoulou E, Clauser P, Gilbert FJ, Pijnappel RM, Mann RM, Baltzer PAT, Chen Y, Fallenberg EM. A survey by the European Society of Breast Imaging on radiologists' preferences regarding quality assurance measures of image interpretation in screening and diagnostic mammography. Eur Radiol 2023; 33:8103-8111. [PMID: 37481690 PMCID: PMC10598074 DOI: 10.1007/s00330-023-09973-7] [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] [Indexed: 07/24/2023]
Abstract
OBJECTIVES Quality assurance (QA) of image interpretation plays a key role in screening and diagnostic mammography, maintaining minimum standards and supporting continuous improvement in interpreting images. However, the QA structure across Europe shows considerable variation. The European Society of Breast Imaging (EUSOBI) conducted a survey among the members to collect information on radiologists' preferences regarding QA measures in mammography. MATERIALS AND METHODS An anonymous online survey consisting of 25 questions was distributed to all EUSOBI members and national breast radiology bodies in Europe. The questions were designed to collect demographic characteristics, information on responders' mammography workload and data about QA measures currently used in their country. Data was analysed using descriptive statistical analysis, the χ2 test, linear regression, and Durbin-Watson statistic test. RESULTS In total, 251 breast radiologists from 34 countries completed the survey. Most respondents were providing both screening and symptomatic services (137/251, 54.6%), working in an academic hospital (85/251, 33.9%) and reading 1000-4999 cases per year (109/251, 43.4%). More than half of them (133/251, 53%) had established QA measures in their workplace. Although less than one-third (71/251, 28.3%) had to participate in regular performance testing, the vast majority (190/251, 75.7%) agreed that a mandatory test would be helpful to improve their skills. CONCLUSION QA measures were in place for more than half of the respondents working in screening and diagnostic mammography to evaluate their breast imaging performance. Although there were substantial differences between countries, the importance of having QA in the workplace and implemented was widely acknowledged by radiologists. CLINICAL RELEVANCE STATEMENT Although several quality assurance (QA) measures of image interpretation are recommended by European bodies or national organisations, the QA in mammography is quite heterogenous between countries and reporting settings, and not always actively implemented across Europe. KEY POINTS The first survey that presents radiologists' preferences regarding QA measures of image interpretation in mammography. Quality assurance measures in the workplace are better-established for breast screening compared to diagnostic mammography. Radiologists consider that performance tests would help to improve their mammography interpretation skills.
Collapse
Affiliation(s)
- Eleni Michalopoulou
- University of Nottingham, School of Medicine, Clinical Sciences Building, City Hospital Campus, Hucknall Road, NG5 1PB, Nottingham, UK.
| | - Paola Clauser
- Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, 1090, Vienna, Austria
| | - Fiona J Gilbert
- Department of Radiology, Clinical School, Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, CB2 0QQ, UK
| | - Ruud M Pijnappel
- University Medical Centre Utrecht, Utrecht University, Heidelberglaan 100, 3584, Utrecht, CX, The Netherlands
- Dutch Expert Centre for Screening, Wijchenseweg 101, 6538, Nijmegen, SW, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Centre, 6525, Nijmegen, The Netherlands
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-guided Therapy, Allgemeines Krankenhaus, Medical University of Vienna, 1090, Vienna, Austria
| | - Yan Chen
- University of Nottingham, School of Medicine, Clinical Sciences Building, City Hospital Campus, Hucknall Road, NG5 1PB, Nottingham, UK
| | - Eva Maria Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, München, Germany
| |
Collapse
|
9
|
Obermann M, Nohava L, Frass-Kriegl R, Soanca O, Ginefri JC, Felblinger J, Clauser P, Baltzer PA, Laistler E. Panoramic Magnetic Resonance Imaging of the Breast With a Wearable Coil Vest. Invest Radiol 2023; 58:799-810. [PMID: 37227137 PMCID: PMC10581436 DOI: 10.1097/rli.0000000000000991] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/21/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Breast cancer, the most common malignant cancer in women worldwide, is typically diagnosed by x-ray mammography, which is an unpleasant procedure, has low sensitivity in women with dense breasts, and involves ionizing radiation. Breast magnetic resonance imaging (MRI) is the most sensitive imaging modality and works without ionizing radiation, but is currently constrained to the prone imaging position due to suboptimal hardware, therefore hampering the clinical workflow. OBJECTIVES The aim of this work is to improve image quality in breast MRI, to simplify the clinical workflow, shorten measurement time, and achieve consistency in breast shape with other procedures such as ultrasound, surgery, and radiation therapy. MATERIALS AND METHODS To this end, we propose "panoramic breast MRI"-an approach combining a wearable radiofrequency coil for 3 T breast MRI (the "BraCoil"), acquisition in the supine position, and a panoramic visualization of the images. We demonstrate the potential of panoramic breast MRI in a pilot study on 12 healthy volunteers and 1 patient, and compare it to the state of the art. RESULTS With the BraCoil, we demonstrate up to 3-fold signal-to-noise ratio compared with clinical standard coils and acceleration factors up to 6 × 4. Panoramic visualization of supine breast images reduces the number of slices to be viewed by a factor of 2-4. CONCLUSIONS Panoramic breast MRI allows for high-quality diagnostic imaging and facilitated correlation to other diagnostic and interventional procedures. The developed wearable radiofrequency coil in combination with dedicated image processing has the potential to improve patient comfort while enabling more time-efficient breast MRI compared with clinical coils.
Collapse
|
10
|
Di Gennaro G, Licata F, Greco F, Beomonte Zobel B, Mallio CA. Interest in mammography across European countries: a retrospective "Google Trends" comparative study. Quant Imaging Med Surg 2023; 13:7523-7529. [PMID: 37969630 PMCID: PMC10644145 DOI: 10.21037/qims-23-196] [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: 02/17/2023] [Accepted: 07/21/2023] [Indexed: 11/17/2023]
Abstract
Background Breast cancer is currently the most prevalent and impacting cancer among women and mammography has been recommended for screening by The European Commission Initiative on Breast Cancer since 2003. The objective of this study is to estimate the interest in breast cancer screening breast cancer in European countries by analyzing data from online searches for the term "mammography" obtained via Google Trends. Methods The relative search volumes (RSVs) of the term "mammography" translated into various languages and relating to the January 2010-December 2022 period were downloaded from Google Trends. The between-countries differences growth of interest was estimated by a regression model in which the country-time interaction term was introduced. Results France [coefficient (coeff): 0.23; 95% confidence interval (CI): 0.18-0.28], United Kingdom (coeff: 0.22; 95% CI: 0.18-0.27) and Germany (coeff: 0.21; 95% CI: 0.16-0.25) showed the higher growth in mammography interest when compared to the average growth. The lowest growths were observed in Eastern European countries: Croatia (coeff: -0.13; 95% CI: -0.18 to -0.09), Serbia (coeff: -0.14; 95% CI: -0.18 to -0.09), Greece (coeff: -0.14; 95% CI: -0.18 to -0.09), Slovenia (coeff: -0.15; 95% CI: -0.2 to -0.11) and Bosnia-Herzegovina (coeff: -0.15; 95% CI: -0.2 to -0.11). Conclusions These exploratory findings suggest that online interest in mammography is lower in countries with lower screening coverage and higher breast cancer mortality. These countries could adopt strategies to raise awareness of breast cancer prevention.
Collapse
Affiliation(s)
- Gianfranco Di Gennaro
- Department of Health Sciences, Chair of Medical Statistics, “Magna Græcia” University of Catanzaro, Catanzaro, Italy
| | - Francesca Licata
- Department of Health Sciences, School of Medicine, “Magna Græcia” University of Catanzaro, Catanzaro, Italy
| | - Federico Greco
- Department of Radiology, Cittadella della Salute Azienda Sanitaria Locale di Lecce, Piazza Filippo Bottazzi, Lecce, Italy
| | - Bruno Beomonte Zobel
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
- Research Unit of Diagnostic Imaging, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| | - Carlo Augusto Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, Roma, Italy
- Research Unit of Diagnostic Imaging, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Roma, Italy
| |
Collapse
|
11
|
Vieira-Coimbra M, Nogueira-Martins N, Zadykowicz R, Rodrigues Gaspar H, Calleja-Agius J, Pakiz M, Mukhopadhyay S, Mahmood T. Provision of screening services for cervical and breast cancer - A scientific study commissioned by the European Board & College of Obstetrics and Gynaecology (EBCOG). Eur J Obstet Gynecol Reprod Biol 2023; 289:208-216. [PMID: 37679212 DOI: 10.1016/j.ejogrb.2023.08.385] [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] [Indexed: 09/09/2023]
Abstract
OBJECTIVE Cancer screening can play an important role in early detection, improving treatment outcomes and reducing morbidity and mortality. Breast and cervical cancers belong to the most common gynaecological cancers group. Countries provide different screening programmes on its eligible population basis centred on different health care policies. This scientific study aims to assess and understand the health inequalities in the member countries of the European Board & College of Obstetrics and Gynaecology (EBCOG) as regards screening programmes of gynaecological cancer, with a special focus on breast and cervical cancers' screening strategies. STUDY DESIGN A descriptive questionnaire-based study was conducted, addressed to EBCOG member countries. RESULTS Ninety-one percent of the countries have an organized national or regional screening programme for cervical cancer. Of these, 45% of countries use both cytology and testing for Human Papilloma Virus (HPV) as screening test, 31% use cytology exclusively and 17% only perform HPV testing. Considerable differences were found regarding the interval of screening test: there are countries performing HPV detection triennially, while others perform only conventional cytology every 5 years. Sixty-nine percent of countries included in this study begin screening for cervical cancer in women aged 25 to 29 years, four of them using HPV detection as the screening test. Six countries begin cervical cancer screening before the age of 25. As regards vaccination against HPV, almost all countries have implemented national HPV vaccination programme, except in Poland and Turkey. The 9-valent HPV vaccine is the most frequently offered (77% of countries) and the majority vaccination programmes include both girls and boys. As regards breast cancer screening, all thirty-two countries have an implemented screening programme. All countries perform mammography as the screening test, 62.5% of them begin in women aged 50 to 54, with a 2-yearly interval in the majority. In five countries, screening programmes are performed biennially, starting between 45 and 49 years old. Seven countries start in women aged 41 to 44. CONCLUSIONS There are discrepancies around gynaecological cancer screenings provision among EBCOG member countries. It is important to establish European recommendations about screening for gynaecological cancers, in order to standardize the access to equitable better health care in gynaecological cancers within Europe.
Collapse
Affiliation(s)
- Márcia Vieira-Coimbra
- Department of Gynaecology and Obstetrics of Centro Hospitalar Tondela-Viseu EPE, Viseu, Portugal.
| | - Nuno Nogueira-Martins
- Department of Gynaecology and Obstetrics of Centro Hospitalar Tondela-Viseu EPE, Viseu, Portugal
| | - Rafal Zadykowicz
- Department of Obstetrics, Perinatology and Gynaecology, Medical University of Warsaw, Poland
| | - Hugo Rodrigues Gaspar
- Department of Gynaecology and Obstetrics of Hospital Central do Funchal, Madeira, Portugal
| | - Jean Calleja-Agius
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Malta
| | - Maja Pakiz
- Department for Gynaecologic and Breast Oncology, University Medical Centre Maribor, Slovenia
| | - Sambit Mukhopadhyay
- Department of Obstetrics and Gynaecology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Tahir Mahmood
- Visiting Consultant Gynaecologist Spire Murrayfield Hospital, Edinburgh, Scotland, UK and Chair Standing Committee on Standards of Care and Position Statements of EBCOG
| |
Collapse
|
12
|
Mubarik S, Malik SS, Yanran Z, Hak E, Nawsherwan, Wang F, Yu C. Estimating disparities in breast cancer screening programs towards mortality, case fatality, and DALYs across BRICS-plus. BMC Med 2023; 21:299. [PMID: 37653535 PMCID: PMC10472654 DOI: 10.1186/s12916-023-03004-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Numerous studies over the past four decades have revealed that breast cancer screening (BCS) significantly reduces breast cancer (BC) mortality. However, in BRICS-plus countries, the association between BCS and BC case fatality and disability are unknown. This study examines the association of different BCS approaches with age-standardized mortality, case-fatality, and disability-adjusted life years (DALYs) rates, as well as with other biological and sociodemographic risk variables, across BRICS-plus from a national and economic perspective. METHODS In this ecological study applying mixed-effect multilevel regression models, a country-specific dataset was analyzed by combining data from the Global Burden of Disease study 2019 on female age-standardized BC mortality, incidence, and DALYs rates with information on national/regional BCS availability (against no such program or only a pilot program) and BCS type (only self-breast examination (SBE) and/or clinical breast examination (CBE) [SBE/CBE] versus SBE/CBE with mammographic screening availability [MM and/or SBE/CBE] versus SBE/CBE/mammographic with digital mammography and/or ultrasound (US) [DMM/US and/or previous tests] in BRICS-plus countries. RESULTS Compared to self/clinical breast examinations (SBE/CBE) across BRICS-plus, more complex BCS program availability was the most significant predictor of decreased mortality [MM and/or SBE/CBE: - 2.64, p < 0.001; DMM/US and/or previous tests: - 1.40, p < 0.001]. In the BRICS-plus, CVD presence, high BMI, second-hand smoke, and active smoking all contributed to an increase in BC mortality and DALY rate. High-income and middle-income regions in BRICS-plus had significantly lower age-standardized BC mortality, case-fatality, and DALYs rates than low-income regions when nationwide BC screening programs were implemented. CONCLUSIONS The availability of mammography (digital or traditional) and BCS is associated with breast cancer burden in BRICS-plus countries, with regional variations. In light of high-quality evidence from previous causal studies, these findings further support the preventive role of mammography screening for BCS at the national level. Intervening on BCS related risk factors may further reduce the disease burden associated with BC.
Collapse
Affiliation(s)
- Sumaira Mubarik
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Saima Shakil Malik
- Center for Biotechnology & Genomic Medicine (CBGM) Medical College of Georgia Augusta University, 1462 Laney Walker Blvd, Augusta, GA, 30912-4810, USA
| | - Zhang Yanran
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China
- Wuhan Jinyintan Hospital, Tongji Medical College of Huazhong University of Science and Technology; Hubei Clinical Research Center for Infectious Diseases; Wuhan Research Center for Communicable Disease Diagnosis and Treatment, Chinese Academy of Medical Sciences; Joint Laboratory of Infectious Diseases and Health, Wuhan Institute of Virology and Wuhan Jinyintan Hospital, Chinese Academy of Sciences, Wuhan, Hubei, China
| | - Eelko Hak
- PharmacoTherapy, -Epidemiology and -Economics, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
| | - Nawsherwan
- Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, 361000, China
| | - Fang Wang
- Department of Biostatistics, School of Public Health, Xuzhou Medical University, Xuzhou, 221004, Jiangsu, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, 185 Donghu Road, Wuhan, 430071, Hubei, China.
| |
Collapse
|
13
|
Champendal M, Marmy L, Malamateniou C, Sá Dos Reis C. Artificial intelligence to support person-centred care in breast imaging - A scoping review. J Med Imaging Radiat Sci 2023; 54:511-544. [PMID: 37183076 DOI: 10.1016/j.jmir.2023.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/05/2023] [Accepted: 04/11/2023] [Indexed: 05/16/2023]
Abstract
AIM To overview Artificial Intelligence (AI) developments and applications in breast imaging (BI) focused on providing person-centred care in diagnosis and treatment for breast pathologies. METHODS The scoping review was conducted in accordance with the Joanna Briggs Institute methodology. The search was conducted on MEDLINE, Embase, CINAHL, Web of science, IEEE explore and arxiv during July 2022 and included only studies published after 2016, in French and English. Combination of keywords and Medical Subject Headings terms (MeSH) related to breast imaging and AI were used. No keywords or MeSH terms related to patients, or the person-centred care (PCC) concept were included. Three independent reviewers screened all abstracts and titles, and all eligible full-text publications during a second stage. RESULTS 3417 results were identified by the search and 106 studies were included for meeting all criteria. Six themes relating to the AI-enabled PCC in BI were identified: individualised risk prediction/growth and prediction/false negative reduction (44.3%), treatment assessment (32.1%), tumour type prediction (11.3%), unnecessary biopsies reduction (5.7%), patients' preferences (2.8%) and other issues (3.8%). The main BI modalities explored in the included studies were magnetic resonance imaging (MRI) (31.1%), mammography (27.4%) and ultrasound (23.6%). The studies were predominantly retrospective, and some variations (age range, data source, race, medical imaging) were present in the datasets used. CONCLUSIONS The AI tools for person-centred care are mainly designed for risk and cancer prediction and disease management to identify the most suitable treatment. However, further studies are needed for image acquisition optimisation for different patient groups, improvement and customisation of patient experience and for communicating to patients the options and pathways of disease management.
Collapse
Affiliation(s)
- Mélanie Champendal
- School of Health Sciences HESAV, HES-SO; University of Applied Sciences Western Switzerland: Lausanne, CH.
| | - Laurent Marmy
- School of Health Sciences HESAV, HES-SO; University of Applied Sciences Western Switzerland: Lausanne, CH.
| | - Christina Malamateniou
- School of Health Sciences HESAV, HES-SO; University of Applied Sciences Western Switzerland: Lausanne, CH; Department of Radiography, Division of Midwifery and Radiography, School of Health Sciences, University of London, London, UK.
| | - Cláudia Sá Dos Reis
- School of Health Sciences HESAV, HES-SO; University of Applied Sciences Western Switzerland: Lausanne, CH.
| |
Collapse
|
14
|
Siviengphanom S, Gandomkar Z, Lewis SJ, Brennan PC. Global Radiomic Features from Mammography for Predicting Difficult-To-Interpret Normal Cases. J Digit Imaging 2023; 36:1541-1552. [PMID: 37253894 PMCID: PMC10406750 DOI: 10.1007/s10278-023-00836-7] [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: 11/28/2022] [Revised: 04/05/2023] [Accepted: 04/13/2023] [Indexed: 06/01/2023] Open
Abstract
This work aimed to investigate whether global radiomic features (GRFs) from mammograms can predict difficult-to-interpret normal cases (NCs). Assessments from 537 readers interpreting 239 normal mammograms were used to categorise cases as 120 difficult-to-interpret and 119 easy-to-interpret based on cases having the highest and lowest difficulty scores, respectively. Using lattice- and squared-based approaches, 34 handcrafted GRFs per image were extracted and normalised. Three classifiers were constructed: (i) CC and (ii) MLO using the GRFs from corresponding craniocaudal and mediolateral oblique images only, based on the random forest technique for distinguishing difficult- from easy-to-interpret NCs, and (iii) CC + MLO using the median predictive scores from both CC and MLO models. Useful GRFs for the CC and MLO models were recognised using a scree test. The CC and MLO models were trained and validated using the leave-one-out-cross-validation. The models' performances were assessed by the AUC and compared using the DeLong test. A Kruskal-Wallis test was used to examine if the 34 GRFs differed between difficult- and easy-to-interpret NCs and if difficulty level based on the traditional breast density (BD) categories differed among 115 low-BD and 124 high-BD NCs. The CC + MLO model achieved higher performance (0.71 AUC) than the individual CC and MLO model alone (0.66 each), but statistically non-significant difference was found (all p > 0.05). Six GRFs were identified to be valuable in describing difficult-to-interpret NCs. Twenty features, when compared between difficult- and easy-to-interpret NCs, differed significantly (p < 0.05). No statistically significant difference was observed in difficulty between low- and high-BD NCs (p = 0.709). GRF mammographic analysis can predict difficult-to-interpret NCs.
Collapse
Affiliation(s)
- Somphone Siviengphanom
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia.
| | - Ziba Gandomkar
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia
| | - Sarah J Lewis
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia
| | - Patrick C Brennan
- Medical Image Optimisation and Perception Group, Discipline of Medical Imaging Science, Sydney School of Health Sciences, Faculty of Medicine and Health, the University of Sydney, Sydney, NSW, 2006, Australia
| |
Collapse
|
15
|
Sharma N, Ng AY, James JJ, Khara G, Ambrózay É, Austin CC, Forrai G, Fox G, Glocker B, Heindl A, Karpati E, Rijken TM, Venkataraman V, Yearsley JE, Kecskemethy PD. Multi-vendor evaluation of artificial intelligence as an independent reader for double reading in breast cancer screening on 275,900 mammograms. BMC Cancer 2023; 23:460. [PMID: 37208717 DOI: 10.1186/s12885-023-10890-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/26/2023] [Indexed: 05/21/2023] Open
Abstract
BACKGROUND Double reading (DR) in screening mammography increases cancer detection and lowers recall rates, but has sustainability challenges due to workforce shortages. Artificial intelligence (AI) as an independent reader (IR) in DR may provide a cost-effective solution with the potential to improve screening performance. Evidence for AI to generalise across different patient populations, screening programmes and equipment vendors, however, is still lacking. METHODS This retrospective study simulated DR with AI as an IR, using data representative of real-world deployments (275,900 cases, 177,882 participants) from four mammography equipment vendors, seven screening sites, and two countries. Non-inferiority and superiority were assessed for relevant screening metrics. RESULTS DR with AI, compared with human DR, showed at least non-inferior recall rate, cancer detection rate, sensitivity, specificity and positive predictive value (PPV) for each mammography vendor and site, and superior recall rate, specificity, and PPV for some. The simulation indicates that using AI would have increased arbitration rate (3.3% to 12.3%), but could have reduced human workload by 30.0% to 44.8%. CONCLUSIONS AI has potential as an IR in the DR workflow across different screening programmes, mammography equipment and geographies, substantially reducing human reader workload while maintaining or improving standard of care. TRIAL REGISTRATION ISRCTN18056078 (20/03/2019; retrospectively registered).
Collapse
Affiliation(s)
- Nisha Sharma
- The Leeds Teaching Hospital NHS Trust, Leeds, UK
| | - Annie Y Ng
- Kheiron Medical Technologies, London, UK.
| | - Jonathan J James
- Nottingham Breast Institute, City Hospital, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | | | | | - Gábor Forrai
- Duna Medical Center, Budapest, Hungary
- GÉ-RAD Kft, Budapest, Hungary
| | | | - Ben Glocker
- Kheiron Medical Technologies, London, UK
- Department of Computing, Imperial College London, London, UK
| | | | - Edit Karpati
- Kheiron Medical Technologies, London, UK
- Medicover, Budapest, Hungary
| | | | | | | | | |
Collapse
|
16
|
Ho PJ, Lim EH, Mohamed Ri NKB, Hartman M, Wong FY, Li J. Will Absolute Risk Estimation for Time to Next Screen Work for an Asian Mammography Screening Population? Cancers (Basel) 2023; 15:cancers15092559. [PMID: 37174025 PMCID: PMC10177032 DOI: 10.3390/cancers15092559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
Personalized breast cancer risk profiling has the potential to promote shared decision-making and improve compliance with routine screening. We assessed the Gail model's performance in predicting the short-term (2- and 5-year) and the long-term (10- and 15-year) absolute risks in 28,234 asymptomatic Asian women. Absolute risks were calculated using different relative risk estimates and Breast cancer incidence and mortality rates (White, Asian-American, or the Singapore Asian population). Using linear models, we tested the association of absolute risk and age at breast cancer occurrence. Model discrimination was moderate (AUC range: 0.580-0.628). Calibration was better for longer-term prediction horizons (E/Olong-term ranges: 0.86-1.71; E/Oshort-term ranges:1.24-3.36). Subgroup analyses show that the model underestimates risk in women with breast cancer family history, positive recall status, and prior breast biopsy, and overestimates risk in underweight women. The Gail model absolute risk does not predict the age of breast cancer occurrence. Breast cancer risk prediction tools performed better with population-specific parameters. Two-year absolute risk estimation is attractive for breast cancer screening programs, but the models tested are not suitable for identifying Asian women at increased risk within this short interval.
Collapse
Affiliation(s)
- Peh Joo Ho
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Genome, Singapore 138672, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore
| | - Nur Khaliesah Binte Mohamed Ri
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore 117549, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
- Department of Surgery, University Surgical Cluster, National University Hospital, Singapore 119228, Singapore
| | - Fuh Yong Wong
- Division of Radiation Oncology, National Cancer Centre Singapore, Singapore 168583, Singapore
| | - Jingmei Li
- Genome Institute of Singapore (GIS), Agency for Science, Technology and Research (A*STAR), 60 Biopolis Street, Genome, Singapore 138672, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore 119228, Singapore
| |
Collapse
|
17
|
Cömert D, van Gils CH, Veldhuis WB, Mann RM. Challenges and Changes of the Breast Cancer Screening Paradigm. J Magn Reson Imaging 2023; 57:706-726. [PMID: 36349728 DOI: 10.1002/jmri.28495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 10/07/2022] [Accepted: 10/07/2022] [Indexed: 11/11/2022] Open
Abstract
Since four decades mammography is used for early breast cancer detection in asymptomatic women and still remains the gold standard imaging modality. However, population screening programs can be personalized and women can be divided into different groups based on risk factors and personal preferences. The availability of new and evolving imaging modalities, for example, digital breast tomosynthesis, dynamic-contrast-enhanced magnetic resonance imaging (MRI), abbreviated MRI protocols, diffusion-weighted MRI, and contrast-enhanced mammography leads to new challenges and perspectives regarding the feasibility and potential harms of breast cancer screening. The aim of this review is to discuss the current guidelines for different risk groups, to analyze the recent published studies about the diagnostic performance of the imaging modalities and to discuss new developments and future perspectives. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 6.
Collapse
Affiliation(s)
- Didem Cömert
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Carla H van Gils
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wouter B Veldhuis
- Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Ritse M Mann
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Radiology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| |
Collapse
|
18
|
Garpenhag L, Dahlman D. Participation in screening for breast and cervical cancer among women with current or previous drug use: a survey study. BMC Public Health 2023; 23:352. [PMID: 36797737 PMCID: PMC9936631 DOI: 10.1186/s12889-023-15236-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 02/08/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Women with current or previous drug use (WCPDU) have an increased risk of poor breast and cervical cancer outcomes. Screening is known to decrease the mortality of these common cancer forms, but screening participation has been sparsely investigated among women with drug dependency. The aim of this study was to assess participation in screening for breast and cervical cancer among WCPDU. METHODS We recruited WCPDU to a survey study, from six opioid substitution treatment (OST) clinics and one needle exchange program (NEP) in Malmö, Sweden, and through the Drug Users Union in Stockholm, Sweden. The survey was constructed according to results from focus group discussions about cancer screening in a sample of women in OST. Survey data were analyzed using descriptive statistics. We analyzed associations between non-compliance to screening and healthcare contact (OST, NEP or none) by logistic regression analysis; unadjusted and adjusted for age, native language, housing situation, educational attainment and main source of income. RESULTS A total of 298 women (median age 43 years) responded to the survey. The self-reported compliance with cancer screening recommendations was 29% for breast cancer screening and 41% for cervical cancer screening. Non-compliance with cervical cancer screening was associated with NEP participation in univariate but not multivariate analysis. We did not find an association between non-compliance with breast cancer screening and healthcare contact. Non-compliance with screening for cervical cancer was also associated with unstable housing in univariate and multivariate analyses, and inversely associated with increasing age in a univariate analysis. Non-compliance with breast cancer was associated with unstable housing in a univariate analysis, and inversely associated with not having Swedish as a native language in a multivariate analysis. CONCLUSION The self-reported compliance with the national cancer screening programs for breast cancer and cervical cancer of WCPDU is notably lower than in the Swedish general population. Women with unstable housing seem to be particularly vulnerable to non-compliance with cancer screening. Interventions to minimize barriers to cancer screening are crucial to decrease the increased cancer morbidity and mortality among WCPDU.
Collapse
Affiliation(s)
- Lars Garpenhag
- grid.4514.40000 0001 0930 2361Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden
| | - Disa Dahlman
- Center for Primary Health Care Research, Department of Clinical Sciences, Lund University/Region Skåne, Malmö, Sweden. .,Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| |
Collapse
|
19
|
Trieu PD(Y, Mello-Thoms CR, Barron ML, Lewis SJ. Look how far we have come: BREAST cancer detection education on the international stage. Front Oncol 2023; 12:1023714. [PMID: 36686760 PMCID: PMC9846523 DOI: 10.3389/fonc.2022.1023714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
The development of screening mammography over 30 years has remarkedly reduced breast cancer-associated mortality by 20%-30% through detection of small cancer lesions at early stages. Yet breast screening programmes may function differently in each nation depending on the incidence rate, national legislation, local health infrastructure and training opportunities including feedback on performance. Mammography has been the frontline breast cancer screening tool for several decades; however, it is estimated that there are 15% to 35% of cancers missed on screening which are owing to perceptual and decision-making errors by radiologists and other readers. Furthermore, mammography screening is not available in all countries and the increased speed in the number of new breast cancer cases among less developed countries exceeds that of the developed world in recent decades. Studies conducted through the BreastScreen Reader Assessment Strategy (BREAST) training tools for breast screening readers have documented benchmarking and significant variation in diagnostic performances in screening mammogram test sets in different countries. The performance of the radiologists from less well-established breast screening countries such as China, Mongolia and Vietnam were significant lower in detecting early-stage cancers than radiologists from developed countries such as Australia, USA, Singapore, Italy. Differences in breast features and cancer presentations, discrepancies in the level of experiences in reading screening mammograms, the availability of high-quality national breast screening program and breast image interpretation training courses between developed and less developed countries are likely to have impact on the variation of readers' performances. Hence dedicated education training programs with the ability to tailor to different reader cohorts and different population presentations are suggested to ameliorate challenges in exposure to a range of cancer cases and improve the interpretation skills of local radiologists. Findings from this review provide a good understanding of the radiologist' performances and their improvement using the education interventions, primarily the BREAST program, which has been deployed in a large range of developing and developed countries in the last decade. Self-testing and immediate feedback loops have been shown to have important implications for benchmarking and improving the diagnostic accuracy in radiology worldwide for better breast cancer control.
Collapse
Affiliation(s)
- Phuong Dung (Yun) Trieu
- Discipline of Medical Imaging Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Claudia R. Mello-Thoms
- Discipline of Medical Imaging Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Melissa L. Barron
- Discipline of Medical Imaging Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sarah J. Lewis
- Discipline of Medical Imaging Sciences, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
20
|
Sekacheva M, Boroda A, Fatyanova A, Rozhkov A, Bagmet N. Clinical validation of the novel CLIA-CA-62 assay efficacy for early-stage breast cancer detection. Front Oncol 2023; 13:1009863. [PMID: 37207139 PMCID: PMC10189101 DOI: 10.3389/fonc.2023.1009863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 04/17/2023] [Indexed: 05/21/2023] Open
Abstract
Background Without organized screening programs up to 60-70% of breast cancers are diagnosed at advanced stages that have significantly lower five-year survival rate and poorer outcomes, which is a serious global public health problem. The purpose of the blind clinical study was the assessment of the novel in-vitro diagnostic chemiluminescent CLIA-CA-62 assay for early-stage breast cancer detection. Methods Blind serum samples of 196 BC patients with known TNM staging, 85% with DCIS, Stage I & IIA, and 73 healthy control subjects were analyzed with the CLIA-CA-62 and CA 15-3 ELISA assays. Results were also compared to the pathology findings and to published data from mammography, MRI, ultrasound, and multi-cancer early detection test (MCED). Results The CLIA-CA-62 overall sensitivity for BC was 92% (100% for DCIS) at 93% specificity and it decreased in invasive stages (Stage I=97%, Stage II=85% and Stage III=83%). For the CA 15-3 assay sensitivity was 27-46% at 80% specificity. Sensitivity for mammography was 63-80% at 60% specificity, depending on the stage and the parenchymal density. Conclusion These results demonstrate that CLIA-CA-62 immunoassay could prove useful as a supplement to current mammography screening and other imaging methods, thus increasing the diagnostic sensitivity in DCIS and Stage I breast cancer detection.
Collapse
Affiliation(s)
- Marina Sekacheva
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Moscow, Russia
- *Correspondence: Marina Sekacheva,
| | - Alexander Boroda
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Anastasia Fatyanova
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander Rozhkov
- World-Class Research Center “Digital Biodesign and Personalized Healthcare”, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Nikolai Bagmet
- Department of Biliary, Hepatic, and Pancreatic Surgery, B.V. Petrovsky Russian Scientific Center of Surgery, Moscow, Russia
| |
Collapse
|
21
|
Muacevic A, Adler JR, Couceiro C, Santos C, Araujo AV, Alegre I, Santos C, Campos Costa F, Cardoso D, Cardoso V, Sampaio R, Cardoso F, Gascón P. Prevalence of Imaging-Detected Silent Female Breast Cancer in Autopsy Specimens: A Study Using Image-Guided Biopsies. Cureus 2022; 14:e32776. [PMID: 36686129 PMCID: PMC9854332 DOI: 10.7759/cureus.32776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2022] [Indexed: 12/24/2022] Open
Abstract
Background This study was conducted to evaluate the prevalence of imaging-detected silent breast cancer in females, with the hypothesis that the incidence of imaging-detected silent breast cancer in females is greater than the true disease incidence. The main purpose of this study is the attempt to prove whether breast imaging can identify silent breast cancers that apparently are common in serial histology analysis. Methodology A series of 217 consecutive medicolegal autopsies on fresh Portuguese cadavers were performed from July 2016 to December 2019 at the National Institute of Legal Medicine and Forensic Science, Lisbon, Portugal. The criteria for exclusion were age younger than 40 years, the autopsy performed in less than 48 hours after death, any major injury to one or both breasts, and known or clinically evident breast cancer. Once the eligibility criteria were met, and the sample collection authorization was obtained, a bilateral subcutaneous modi-fied radical mastectomy was performed in each fresh cadaver at the National Institute of Legal Medicine and Forensic Science. Mammography, ecography, and excisional biopsies of suspect areas were conducted on the collected samples. Results The indication for excisional biopsy by imaging was assigned in eight cases, and no breast cancer was discovered in the excised specimens. Conclusions In light of the findings, it cannot be concluded that the imaging-detected silent breast cancer prevalence is higher than the actual incidence of the disease, so the author's initial hypothesis was rejected. Mammography does not overdiagnose breast cancer. Benign breast alterations are common, accounting for 43.6% of the corpses collected, while low-suspicion alterations were discovered in 1.84% of breast samples. The objective examination, which included inspection and palpation, missed 37.5% of the biopsied breast changes. This finding indicated that an objective examination leads to a significant number of false-negative results which cannot be used as a screening method.
Collapse
|
22
|
Alatawi YM, Alshomrani HA, Baeshen SM, Alkhamisi HH, Almazrui RM, Alghamdi MS, Bugshan SM, Alafif TK, Hijazi HA, Alahmadi JR, Ashoor SA, Alamri AM, Alkhilaiwi F. Evaluation of participation and performance indicators in a breast cancer screening program in Saudi Arabia. Saudi Med J 2022; 43:1260-1264. [PMID: 36379533 PMCID: PMC10043913 DOI: 10.15537/smj.2022.43.11.20220269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/25/2022] [Indexed: 06/16/2023] Open
Abstract
OBJECTIVES To evaluate early performance indicators for breast cancer screening at the King Abdulaziz University Hospital in Saudi Arabia. METHODS This study retrospectively evaluated data from women who underwent their first breast cancer screening program in Jeddah, Saudi Arabia between 2012 and 2019. Data on screening results were used to estimate performance indicators and generate descriptive statistics. RESULTS Of the 16000 women invited from 2012 to 2019, a total of 1911 (11.9%) participated. The majority of women (68.8%) were between 40 and 55 years old. Based on the screening process results, 26.6%, 40.1%, 9.7%, 1.3%, 0.7%, and 5.2% of women had BI-RADS scores of R1, R2, R3, R4, R5, and R0 respectively. The remaining 16.3% did not have mammogram records. The recall rate, or the percentage of women who underwent further evaluation, was 19.9%; 18.9% underwent a biopsy procedure. In addition, 1.6% of women had cancer screen-detected, although only 0.7% were diagnosed with breast cancer. CONCLUSION In light of the low participation and high recall rates, it is essential that the screening program utilizes performance indicators to optimize resource utilization and ensure the quality of the service provided. Additionally, a national framework and standardized performance indicators could mitigate this problem for other cancer screening programs.
Collapse
Affiliation(s)
- Yasser M. Alatawi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Hala A. Alshomrani
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sara M. Baeshen
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Hayat H. Alkhamisi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Roaa M. Almazrui
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Mohammed S. Alghamdi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sara M. Bugshan
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Tarik K. Alafif
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Hussam A. Hijazi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Jawaher R. Alahmadi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Sawsan A. Ashoor
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Ahmad M. Alamri
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| | - Faris Alkhilaiwi
- From the Department of Pharmacy Practice (Alatawi), Faculty of Pharmacy, University of Tabuk, Tabuk; from the Department of Natural Products and Alternative Medicine (Alshomrani, Baeshen, Alkhamisi, Almazrui, Alghamdi, Alkhilaiwi), Faculty of Pharmacy, King Abdulaziz University; from the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer (Bugshan), King Abdulaziz University; from the Department of Radiology (Hijazi, Alahmadi, Ashoor), Faculty of Medicine, King Abdulaziz University Hospital; from the Regenerative Medicine Unit (Alkhilaiwi), King Fahd Medical Research Center; King Abdulaziz University, Jeddah; from the Computer Science Department (Alafif), Jamoum University College, Umm Al-Qura University, Jamoum; from the Department of Clinical Laboratory Sciences (Alamri), College of Applied Medical Sciences, King Khalid University; from the Cancer Research Unit (Alamri), King Khalid University, Abha, Kingdom of Saudi Arabia.
| |
Collapse
|
23
|
Gastounioti A, Eriksson M, Cohen EA, Mankowski W, Pantalone L, Ehsan S, McCarthy AM, Kontos D, Hall P, Conant EF. External Validation of a Mammography-Derived AI-Based Risk Model in a U.S. Breast Cancer Screening Cohort of White and Black Women. Cancers (Basel) 2022; 14:cancers14194803. [PMID: 36230723 PMCID: PMC9564051 DOI: 10.3390/cancers14194803] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/26/2022] [Accepted: 09/28/2022] [Indexed: 11/16/2022] Open
Abstract
Despite the demonstrated potential of artificial intelligence (AI) in breast cancer risk assessment for personalizing screening recommendations, further validation is required regarding AI model bias and generalizability. We performed external validation on a U.S. screening cohort of a mammography-derived AI breast cancer risk model originally developed for European screening cohorts. We retrospectively identified 176 breast cancers with exams 3 months to 2 years prior to cancer diagnosis and a random sample of 4963 controls from women with at least one-year negative follow-up. A risk score for each woman was calculated via the AI risk model. Age-adjusted areas under the ROC curves (AUCs) were estimated for the entire cohort and separately for White and Black women. The Gail 5-year risk model was also evaluated for comparison. The overall AUC was 0.68 (95% CIs 0.64−0.72) for all women, 0.67 (0.61−0.72) for White women, and 0.70 (0.65−0.76) for Black women. The AI risk model significantly outperformed the Gail risk model for all women p < 0.01 and for Black women p < 0.01, but not for White women p = 0.38. The performance of the mammography-derived AI risk model was comparable to previously reported European validation results; non-significantly different when comparing White and Black women; and overall, significantly higher than that of the Gail model.
Collapse
Affiliation(s)
- Aimilia Gastounioti
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO 63110, USA
- Correspondence: (A.G.); (E.F.C.); Tel.: +1-314-286-0553 (A.G.); +1-2156624032 (E.F.C.)
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Eric A. Cohen
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Walter Mankowski
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Lauren Pantalone
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sarah Ehsan
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Anne Marie McCarthy
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Despina Kontos
- Center for Biomedical Image Computing and Analytics (CBICA), University of Pennsylvania, Philadelphia, PA 19104, USA
- Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, 171 77 Stockholm, Sweden
- Department of Oncology, Södersjukhuset, 118 83 Stockholm, Sweden
| | - Emily F. Conant
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA
- Correspondence: (A.G.); (E.F.C.); Tel.: +1-314-286-0553 (A.G.); +1-2156624032 (E.F.C.)
| |
Collapse
|
24
|
Arzanova E, Mayrovitz HN. The Epidemiology of Breast Cancer. Breast Cancer 2022. [DOI: 10.36255/exon-publications-breast-cancer-epidemiology] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
|
25
|
Lim ZL, Ho PJ, Khng AJ, Yeoh YS, Ong ATW, Tan BKT, Tan EY, Tan SM, Lim GH, Lee JA, Tan VKM, Hu J, Li J, Hartman M. Mammography screening is associated with more favourable breast cancer tumour characteristics and better overall survival: case-only analysis of 3739 Asian breast cancer patients. BMC Med 2022; 20:239. [PMID: 35922814 PMCID: PMC9351273 DOI: 10.1186/s12916-022-02440-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/15/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Early detection of breast cancer (BC) through mammography screening (MAM) is known to reduce mortality. We examined the differential effect that mammography has on BC characteristics and overall survival and the sociodemographic determinants of MAM utilization in a multi-ethnic Asian population. METHODS This study included 3739 BC patients from the Singapore Breast Cancer Cohort (2010-2018). Self-reported sociodemographic characteristics were collected using a structured questionnaire. Clinical data were obtained through medical records. Patients were classified as screeners (last screening mammogram ≤ 2 years before diagnosis), non-screeners (aware but did not attend or last screen > 2years), and those unaware of MAM. Associations between MAM behaviour (MB) and sociodemographic factors and MB and tumour characteristics were examined using multinomial regression. Ten-year overall survival was modelled using Cox regression. RESULTS Patients unaware of screening were more likely diagnosed with late stage (ORstage III vs stage I (Ref) [95% CI]: 4.94 [3.45-7.07], p < 0.001), high grade (ORpoorly vs well-differentiated (reference): 1.53 [1.06-2.20], p = 0.022), nodal-positive, large size (OR>5cm vs ≤2cm (reference): 5.06 [3.10-8.25], p < 0.001), and HER2-positive tumours (ORHER2-negative vs HER2-positive (reference): 0.72 [0.53-0.97], p = 0.028). Similar trends were observed between screeners and non-screeners with smaller effect sizes. Overall survival was significantly shorter than screeners in the both groups (HRnon-screeners: 1.89 [1.22-2.94], p = 0.005; HRunaware: 2.90 [1.69-4.98], p < 0.001). Non-screeners and those unaware were less health conscious, older, of Malay ethnicity, less highly educated, of lower socioeconomic status, more frequently ever smokers, and less physically active. Among screeners, there were more reported personal histories of benign breast surgeries or gynaecological conditions and positive family history of breast cancer. CONCLUSIONS Mammography attendance is associated with more favourable BC characteristics and overall survival. Disparities in the utility of MAM services suggest that different strategies may be needed to improve MAM uptake.
Collapse
Affiliation(s)
- Zi Lin Lim
- Genome Institute of Singapore, Laboratory of Women's Health & Genetics, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Peh Joo Ho
- Genome Institute of Singapore, Laboratory of Women's Health & Genetics, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore
| | - Alexis Jiaying Khng
- Genome Institute of Singapore, Laboratory of Women's Health & Genetics, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore
| | - Yen Shing Yeoh
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore
| | - Amanda Tse Woon Ong
- Department of Surgery, National University Hospital, Singapore, 119054, Singapore
| | - Benita Kiat Tee Tan
- Department of General Surgery, Sengkang General Hospital, Singapore, 544886, Singapore.,Department of Breast Surgery, Singapore General Hospital, Singapore, 168753, Singapore.,Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Ern Yu Tan
- Department of General Surgery, Tan Tock Seng Hospital, Singapore, 308433, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technology University, Singapore, 308232, Singapore
| | - Su-Ming Tan
- Division of Breast Surgery, Changi General Hospital, Singapore, 529889, Singapore
| | - Geok Hoon Lim
- Breast Department, KK Women's and Children's Hospital, Singapore, 229899, Singapore.,Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Jung Ah Lee
- Duke-NUS Medical School, Singapore, 169857, Singapore
| | - Veronique Kiak-Mien Tan
- Department of Breast Surgery, Singapore General Hospital, Singapore, 168753, Singapore.,Division of Surgery and Surgical Oncology, National Cancer Centre Singapore, Singapore, 169610, Singapore
| | - Jesse Hu
- Department of General Surgery, Ng Teng Fong General Hospital, Singapore, 609606, Singapore
| | - Jingmei Li
- Genome Institute of Singapore, Laboratory of Women's Health & Genetics, 60 Biopolis Street, Genome, #02-01, Singapore, 138672, Singapore. .,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore.
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, 117549, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 117597, Singapore.,Department of Surgery, National University Hospital, Singapore, 119054, Singapore
| |
Collapse
|
26
|
Dhakal R, Noula M, Roupa Z, Yamasaki EN. A Scoping Review on the Status of Female Breast Cancer in Asia with a Special Focus on Nepal. BREAST CANCER: TARGETS AND THERAPY 2022; 14:229-246. [PMID: 36052152 PMCID: PMC9427118 DOI: 10.2147/bctt.s366530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 07/26/2022] [Indexed: 12/24/2022]
Abstract
This study aimed to provide updated evidence on the status of female breast cancer and cancer treatment facilities in Asia, with a special focus on Nepal. This review used search phrases that included, breast neoplasm or cancer, health status, epidemiology, breast cancer survivors, cancer care facilities, Asia, Nepal. Researchers examined databases from January 2011 to December 2020 (PubMed, PMC, Google Scholar, and the reference lists of included papers). Studies of any design and reviews, were included in the study, except for qualitative studies. The study findings are presented in a narrative synthesis format using Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for Scoping Reviews. An initial search resulted in 974 papers, and 896 were reviewed after being checked for duplication using the Zotero software. Accordingly, utilizing the inclusion and exclusion criteria, 188 publications were selected, and after review of titles and abstracts, an additional 98 papers were removed for different reasons. Finally, the study looked at 90 female breast cancer papers. Results showed that the number of cases of breast cancer is growing all around the world, including in Asia and Nepal. Age, early menarche, late menopause, nulliparity, positive family history, excessive fat consumption, alcohol, and smoking are all frequent risk factors for breast cancer found in Asian women. Breast self-examination, clinical breast examination, and mammography screening are common methods for detecting breast carcinoma. Chemotherapy, radiation, and modified mastectomy are commonly used options for treatment. The number of breast cancer survivors is growing throughout the world, indicating better clinical care. There is a paucity of survival data in many Asian countries, including Nepal. There is also a scarcity of health workforce specialized in cancer care and treatment, as well as a few health facilities that are available to treat cancer cases in many Asian countries, including Nepal.
Collapse
Affiliation(s)
- Rojana Dhakal
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
- Department of Nursing, School of Health and Allied Sciences, Pokhara University, Kaski, Gandaki Province, Nepal
- Correspondence: Rojana Dhakal, Department of Nursing, School of Health and Allied Sciences, Pokhara University, Kaski, Gandaki Province, Nepal, Email ;
| | - Maria Noula
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Zoe Roupa
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| | - Edna N Yamasaki
- Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus
| |
Collapse
|
27
|
Icanervilia AV, van der Schans J, Cao Q, de Carvalho AC, Cordova-Pozo K, At Thobari J, Postma MJ, van Asselt ADI. Economic evaluations of mammography to screen for breast cancer in low- and middle-income countries: A systematic review. J Glob Health 2022; 12:04048. [PMID: 35837900 PMCID: PMC9284087 DOI: 10.7189/jogh.12.04048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background Low- and middle-income countries (LMICs) have limited resources compared to high-income countries (HICs). Therefore, it is critical that LMICs implement cost-effective strategies to reduce the burden of breast cancer. This study aimed to answer the question of whether mammography is a cost-effective breast cancer screening method in LMICs. Methods A systematic article search was conducted through Medline, Embase, Web of Science, and Econlit. Studies were included only if they conducted a full economic evaluation and focused on mammography screening in LMICs. Two reviewers screened through the title and abstract of each article and continued with full-text selection. Data were extracted and synthesized narratively. Quality assessment for each included study was conducted using the Consensus Health Economic Criteria (CHEC) extended checklist. Results This review identified 21 studies economically evaluating mammography as a breast cancer screening method in LMICs. Eighteen of these studies concluded that mammography screening was a cost-effective strategy. Most studies (71%) were conducted in upper-middle-income countries (Upper MICs). The quality of the studies varied from low to good. Important factors determining cost-effectiveness are the target age group (eg, 50-59 years), the screening interval (eg, biennial or triennial), as well as any combination with other breast cancer control strategies (eg, combination with treatment strategy for breast cancer patients). Conclusions Mammography screening appeared to be a cost-effective strategy in LMICs, particularly in Upper MICs. More studies conducted in lower-middle-income and low-income countries are needed to better understand the cost-effectiveness of mammography screening in these regions.
Collapse
Affiliation(s)
- Ajeng V Icanervilia
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Radiology, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Jurjen van der Schans
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands
| | - Qi Cao
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adriana C de Carvalho
- Regenerative Medicine Center Utrecht, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Kathya Cordova-Pozo
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Institute of Management Research, Radboud University, the Netherlands
| | - Jarir At Thobari
- Clinical Epidemiology and Biostatistics Unit (CEBU), Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.,Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, the Netherlands.,Department of Pharmacology & Therapy, Universitas Airlangga, Surabaya, Indonesia.,Center of Excellence in Higher Education for Pharmaceutical Care Innovation, Universitas Padjadjaran, Bandung, Indonesia
| | - Antoinette DI van Asselt
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.,Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| |
Collapse
|
28
|
Crook T, Leonard R, Mokbel K, Thompson A, Michell M, Page R, Vaid A, Mehrotra R, Ranade A, Limaye S, Patil D, Akolkar D, Datta V, Fulmali P, Apurwa S, Schuster S, Srinivasan A, Datar R. Accurate Screening for Early-Stage Breast Cancer by Detection and Profiling of Circulating Tumor Cells. Cancers (Basel) 2022; 14:3341. [PMID: 35884402 PMCID: PMC9316476 DOI: 10.3390/cancers14143341] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/04/2022] [Accepted: 07/07/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The early detection of breast cancer (BrC) is associated with improved survival. We describe a blood-based breast cancer detection test based on functional enrichment of breast-adenocarcinoma-associated circulating tumor cells (BrAD-CTCs) and their identification via multiplexed fluorescence immunocytochemistry (ICC) profiling for GCDFP15, GATA3, EpCAM, PanCK, and CD45 status. METHODS The ability of the test to differentiate BrC cases (N = 548) from healthy women (N = 9632) was evaluated in a case-control clinical study. The ability of the test to differentiate BrC cases from those with benign breast conditions was evaluated in a prospective clinical study of women (N = 141) suspected of BrC. RESULTS The test accurately detects BrAD-CTCs in breast cancers, irrespective of age, ethnicity, disease stage, grade, or hormone receptor status. Analytical validation established the high accuracy and reliability of the test under intended use conditions. The test detects and differentiates BrC cases from healthy women with 100% specificity and 92.07% overall sensitivity in a case-control study. In a prospective clinical study, the test shows 93.1% specificity and 94.64% overall sensitivity in differentiating breast cancer cases (N = 112) from benign breast conditions (N = 29). CONCLUSION The findings reported in this manuscript support the clinical potential of this test for blood-based BrC detection.
Collapse
Affiliation(s)
- Timothy Crook
- Department of Oncology, The London Clinic, London W1G 6BW, UK
| | - Robert Leonard
- Department of Oncology, Cromwell Hospital, London SW5 0TU, UK;
| | - Kefah Mokbel
- The London Breast Institute, Princess Grace Hospital, London W1U 5NY, UK;
| | - Alastair Thompson
- Division of Surgical Oncology, Baylor College of Medicine, Houston, TX 77030, USA;
| | - Michael Michell
- National Breast Screening Training Centre, King’s College Hospital, London SE5 9RS, UK;
| | - Raymond Page
- Department of Biomedical Engineering, Worcester Polytechnic Institute, Worcester, MA 01609, USA;
| | - Ashok Vaid
- Department of Medical and Haemato Oncology, Medanta-The Medicity, Gurugram 122001, India;
| | - Ravi Mehrotra
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA;
| | | | - Sewanti Limaye
- Department of Medical and Precision Oncology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai 400004, India;
| | - Darshana Patil
- Department of Research and Innovations, Datar Cancer Genetics, Nasik 422010, India; (D.P.); (D.A.); (V.D.); (P.F.); (S.A.); (A.S.); (R.D.)
| | - Dadasaheb Akolkar
- Department of Research and Innovations, Datar Cancer Genetics, Nasik 422010, India; (D.P.); (D.A.); (V.D.); (P.F.); (S.A.); (A.S.); (R.D.)
| | - Vineet Datta
- Department of Research and Innovations, Datar Cancer Genetics, Nasik 422010, India; (D.P.); (D.A.); (V.D.); (P.F.); (S.A.); (A.S.); (R.D.)
| | - Pradip Fulmali
- Department of Research and Innovations, Datar Cancer Genetics, Nasik 422010, India; (D.P.); (D.A.); (V.D.); (P.F.); (S.A.); (A.S.); (R.D.)
| | - Sachin Apurwa
- Department of Research and Innovations, Datar Cancer Genetics, Nasik 422010, India; (D.P.); (D.A.); (V.D.); (P.F.); (S.A.); (A.S.); (R.D.)
| | - Stefan Schuster
- Department of Research and Innovations, Datar Cancer Genetics Europe GmbH, 95488 Eckersdorf, Germany;
| | - Ajay Srinivasan
- Department of Research and Innovations, Datar Cancer Genetics, Nasik 422010, India; (D.P.); (D.A.); (V.D.); (P.F.); (S.A.); (A.S.); (R.D.)
| | - Rajan Datar
- Department of Research and Innovations, Datar Cancer Genetics, Nasik 422010, India; (D.P.); (D.A.); (V.D.); (P.F.); (S.A.); (A.S.); (R.D.)
| |
Collapse
|
29
|
Moran P, Cullinan J. Is mammography screening an effective public health intervention? Evidence from a natural experiment. Soc Sci Med 2022; 305:115073. [PMID: 35660698 DOI: 10.1016/j.socscimed.2022.115073] [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: 01/06/2022] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Population-based breast screening programmes aim to improve clinical outcomes, alleviate health inequalities, and reduce healthcare costs. However, while screening can bring about immediate changes in mode of presentation and stage at diagnosis of breast cancer cases, the benefits and harms of these programmes can only be observed at a population level, and only over a long enough timeframe for the cascade of events triggered by screening to culminate in disease-specific mortality reductions. In this paper we exploit a natural experiment resulting from the phased geographic rollout of a national mammography screening programme to examine the impact of screening on breast cancer outcomes from both a patient cohort and a population perspective. Using data on 33,722 breast cancer cases over the period 1994-2011, we employ a difference-in-differences research design using ten-year follow-up data for cases diagnosed before and after the introduction of the programme in screened and unscreened regions. We conclude that although the programme produced the intended intermediate effects on breast cancer presentation and incidence, these failed to translate into significant decreases in overall population-level mortality, though screening may have helped to reduce socioeconomic disparities in late stage breast cancer incidence.
Collapse
Affiliation(s)
- Patrick Moran
- School of Medicine, Trinity College Dublin, College Green, Dublin 2, Ireland.
| | - John Cullinan
- School of Business & Economics, National University of Ireland Galway, University Road, Galway, Ireland.
| |
Collapse
|
30
|
Luo C, Wang L, Zhang Y, Lu M, Lu B, Cai J, Chen H, Dai M. Advances in breast cancer screening modalities and status of global screening programs. Chronic Dis Transl Med 2022; 8:112-123. [PMID: 35774423 PMCID: PMC9215717 DOI: 10.1002/cdt3.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/18/2022] [Indexed: 12/03/2022] Open
Abstract
Breast cancer (BC) is the most prevalent malignancy worldwide, and a continued upward trend has been predicted in the coming decades. Screening in selected targeted populations, which is effective in reducing cancer‐related mortality, has been widely implemented in many countries. This review summarizes the advances in BC screening techniques, organized or opportunistic BC screening programs across different countries, and screening modalities recommended by different academic authorities. Mammography is the most widely used and effective technique for BC screening. Other complementary techniques include ultrasound, clinical breast examination, and magnetic resonance imaging. Novel screening tests, including digital breast tomosynthesis and liquid biopsies, are still under development. Globally, the implementation status of BC screening programs is uneven, which is reflected by differences in screening modes, techniques, and population coverage. The recommended optimal screening strategies varied according to the authoritative guidelines. The effectiveness of current screening programs is influenced by several factors, including low detection rate, high false‐positive rate, and unsatisfactory coverage and uptake rates. Exploration of accurate BC risk prediction models and the development of risk‐stratified screening strategies are highly warranted in future research. Mammography is the most widely used and most effective technique; other complementary techniques include ultrasound, clinical breast examination, and magnetic resonance imaging. Globally, the implementation status of breast cancer screening programs is uneven, which is reflected by differences in screening modes, techniques, and examination coverage. Combining effective risk prediction models and advanced screening techniques for risk‐stratified screening strategies may be the future direction.
Collapse
Affiliation(s)
- Chenyu Luo
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Le Wang
- Department of Cancer Prevention Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital) Hangzhou Zhejiang China
| | - Yuhan Zhang
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Ming Lu
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Bin Lu
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Jie Cai
- Department of General Surgery, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Hongda Chen
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| | - Min Dai
- Medical Research Center, Peking Union Medical College Hospital Chinese Academy of Medical Sciences and Peking Union Medical College Beijing China
| |
Collapse
|
31
|
Jani C, Salcicciol I, Rupal A, Al Omari O, Goodall R, Salciccioli JD, Marshall DC, Hanbury G, Singh H, Weissmann L, Shalhoub J. Trends in Breast Cancer Mortality Between 2001 and 2017: An Observational Study in the European Union and the United Kingdom. JCO Glob Oncol 2021; 7:1682-1693. [PMID: 34910553 PMCID: PMC8691519 DOI: 10.1200/go.21.00288] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 09/13/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Breast cancer is the most common cancer in women worldwide, representing 25.4% of the newly diagnosed cases in 2018. The past two decades have seen advancements in screening technologies, guidelines, and newer modalities of treatment. Our study reports and compares trends in breast cancer mortality in the European Union and the United Kingdom. MATERIALS AND METHODS We used the WHO Mortality Database. We extracted breast cancer mortality data from 2001 to 2017 on the basis of the International Classification of Diseases, 10th revision system. Crude mortality rates were dichotomized by sex and reported by year. We computed age-standardized death rates (ASDRs) per 100,000 population using the world standard population. Breast cancer mortality trends were compared using joinpoint regression analysis. RESULTS We analyzed data from 24 EU countries, including the United Kingdom. For women, breast cancer mortality was observed to be downtrending in all countries except Croatia, France, and Poland. For the most recent female data, the highest ASDR for breast cancer was identified in Croatia (19.29 per 100,000), and the lowest ASDR was noted in Spain (12.8 per 100,000). Denmark had the highest change in ASDR and the highest estimated annual percentage change of -3.2%. For men, breast cancer mortality decreased in 18 countries, with the largest relative reduction observed in Denmark with an estimated annual percentage change of -27.5%. For the most recent male data, the highest ASDR for breast cancer was identified in Latvia (0.54 per 100,000). CONCLUSION Breast cancer mortality rates have down trended in most EU countries between 2001 and 2017 for both men and women. Given the observational nature of this study, causality to the observed trends cannot be reliably ascribed. However, possible contributing factors should be considered and subject to further study.
Collapse
Affiliation(s)
- Chinmay Jani
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
| | | | - Arashdeep Rupal
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Omar Al Omari
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Richard Goodall
- Department of Surgery and Cancer, Imperial College of London, London, United Kingdom
| | - Justin D. Salciccioli
- Harvard Medical School, Boston, MA
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, MA
| | - Dominic C. Marshall
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Georgina Hanbury
- Department of Surgery and Cancer, Imperial College of London, London, United Kingdom
| | - Harpreet Singh
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
| | - Lisa Weissmann
- Department of Medicine, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
- Harvard Medical School, Boston, MA
- Division of Hematology-Oncology, Mount Auburn Hospital/Beth Israel Lahey Health, Cambridge, MA
| | - Joseph Shalhoub
- Department of Surgery and Cancer, Imperial College of London, London, United Kingdom
- Imperial Vascular Unit, Imperial College Healthcare NHS Trust, London, United Kingdom
| |
Collapse
|
32
|
Molassiotis A, Tyrovolas S, Giné-Vázquez I, Yeo W, Aapro M, Herrstedt J. Organized breast cancer screening not only reduces mortality from breast cancer but also significantly decreases disability-adjusted life years: analysis of the Global Burden of Disease Study and screening programme availability in 130 countries. ESMO Open 2021; 6:100111. [PMID: 33892452 PMCID: PMC8085709 DOI: 10.1016/j.esmoop.2021.100111] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/06/2021] [Indexed: 01/28/2023] Open
Abstract
Background Multiple studies over the past 4 decades have shown the significant benefit of breast cancer screening (BCS) in reducing mortality rates from breast cancer (BC). However, significant debate exists about the role of BCS in this regard, with some studies also showing no benefit in terms of mortality along with issues such as overdiagnosis, health care utilisation costs, psychological distress or overtreatment. To date, no BCS study has focused on disability. Hence the aim of this study is to evaluate the relative contribution of BCS approaches to age-standardized mortality and disability-adjusted life years (DALYs) rates along with other related risk factors, from a country-level perspective. Patients and methods This study created a country-dataset by merging information from the Global Burden of Disease study regarding female age-standardized BC mortality, DALYs rates and other risk factors with the BCS programme availability at the national or regional level (versus no or only pilot such programme), BCS type (mammography, digital screening, breast self-examination and clinical breast examination) and other BCS-related information among 130 countries. Mixed-effect multilevel regression models were run to examine the associations of interest. Results The most important factor predictive of lower mortality was the more advanced type of BCS programme availability [mammography: −4.16, 95% CI −6.76 to −1.55; digital mammography/ultrasound: −3.64, 95% CI −6.59 to −0.70] when compared with self- or clinical breast examinations. High levels of low-density lipoprotein cholesterol (LDL-c) and smoking were also related to higher mortality and DALYs from BC. In terms of BC DALYs, BCS had a 21.9 to 22.3-fold increase in the magnitude of effect compared with that in terms of mortality. Data on mortality and DALYs in relation to BCS programmes were also calculated for high-, middle- and low-income countries. Conclusions These data further support the positive effects of BCS in relation to age-standardized BC mortality rates, and for the first time show the impact of BCS on DALYs too. Additional factors, such as diabetes, high levels of LDL-c or smoking seemed to be related to BC mortality and disability, and could be considered as additional components of possible interventions to be used alongside BCS to optimize the BCS benefit on patients. A key factor predictive of lower age-standardized BC mortality was breast cancer screening (BCS). This was the case with national-level BCS programmes as well as the availability of different types of BCS. LDL-c and smoking among others, were related to mortality and disability. BCS with mammography or digital screening was related to less age-standardized BC disability. These data support, for the first time, the relation of BCS on disability.
Collapse
Affiliation(s)
- A Molassiotis
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong.
| | - S Tyrovolas
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - I Giné-Vázquez
- Research, Innovation and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - W Yeo
- Department of Clinical Oncology, Chinese University of Hong Kong, Shatin, Hong Kong
| | - M Aapro
- Centre du Sein, Genolier Cancer Center, Genolier, Switzerland
| | - J Herrstedt
- Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde and Næstved, Denmark; University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
33
|
Pelullo CP, Cantore F, Lisciotto A, Di Giuseppe G, Pavia M. Organized Breast and Cervical Cancer Screening: Attendance and Determinants in Southern Italy. Cancers (Basel) 2021; 13:cancers13071578. [PMID: 33808101 PMCID: PMC8036794 DOI: 10.3390/cancers13071578] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Although the effectiveness of screening in reducing the mortality of breast and cervical cancer in the EU is established, the impact of these cancers continues to be substantial among women. The aims of this study were to evaluate the attendance to breast and cervical cancer screening and the role of related determinants in an area of Southern Italy. Only 49.7% of the sample reported to have undergone mammography in the previous two years, 27.7% within an organized program and 22% as an opportunistic procedure. The attendance to cervical cancer screening interval of three years was reported by 56.1% of women, 16.1% within an organized program and 40% as an opportunistic procedure. A very low attendance was thus detected for both breast and cervical cancer organized screening programs. A strong commitment to the promotion of these programs is urgently needed, also to support their role in the reduction of inequalities of attendance of disadvantaged women. Abstract The aims of this study were to evaluate the attendance to breast and cervical cancer screening and the related determinants in a low attendance area. A cross-sectional study was conducted among mothers of students attending secondary schools and university courses in Campania region, Southern Italy. Only 49.7% of the eligible women reported to have undergone mammography in the previous two years. Unemployed women, unsatisfied about their health status, with a family history of breast cancer, and having visited a physician in the previous 12 months were significantly more likely to have undergone mammography in the previous two years within an organized screening program. The attendance to cervical cancer screening in the interval of three years was reported to be 56.1% of women. Having a lower than graduation degree, being smokers, and having visited a physician in the previous 12 months were significant predictors of having had a Pap-smear in the previous three years in an organized screening program. In this study a very low attendance was found to both breast and cervical cancer organized screening programs. A strong commitment to their promotion is urgently needed, also to reduce inequalities of attendance of disadvantaged women.
Collapse
|
34
|
Castellano CR, Aguilar Angulo PM, Hernández LC, González-Carrato PSC, González RG, Alvarez J, Chacón JI, Ruiz J, Fuentes Guillén MÁ, Gutiérrez Ávila G. Breast cancer mortality after eight years of an improved screening program using digital breast tomosynthesis. J Med Screen 2021; 28:456-463. [PMID: 33775181 PMCID: PMC8573629 DOI: 10.1177/09691413211002556] [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] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To assess screening quality metrics and to describe mortality rates eight years after redesign of breast cancer screening and diagnosis pathways, and the introduction of digital breast tomosynthesis. SETTING Breast Unit of the Toledo Health Area in the region of Castilla-La Mancha (Spain). METHODS We recorded screening metrics and mortality data following the introduction of digital breast tomosynthesis in 2011 for screening and diagnosis pathways. We then compared the mortality between Toledo Health Area and the rest of Castilla-La Mancha, where digital breast tomosynthesis is not available. RESULTS All screening quality metrics improved following the introduction of digital breast tomosynthesis. The cancer detection rate significantly increased from 2.3 (95% confidence interval (CI): 1.9-3.6) to 4.5 per 1000 women (95% CI: 3.2-5.2) on average between the periods 2005-2009 and 2015-2018, while the recall rate significantly decreased from 7.0% (95% CI: 6.8%-8.2%) to 2.6% (95% CI: 2.0%-3.6%). Comparing breast cancer mortality rates for 2014-2018 in the Toledo Health Area with the rest of Castilla-La Mancha, which had similar cancer treatment access and management protocols but without digital breast tomosynthesis, the crude mortality rate was 17.79 (95% CI: 15.38 -20.19) vs. 24.76 per 100,000 (95% CI: 26.12-23.39), respectively. The cumulative risk of death was also significantly lower for the Toledo Health Area than for Castilla-La Mancha. CONCLUSION The introduction of digital breast tomosynthesis improved screening quality indicators. Breast cancer mortality simultaneously decreased with respect to the rest of Castilla-La Mancha. Further research is needed to assess the long-term results, and the role that the redesign may have played in reducing mortality.
Collapse
Affiliation(s)
| | | | | | | | | | - Justo Alvarez
- Breast Unit - Surgery Service, Virgen de la Salud Hospital, Toledo, Spain
| | | | - Juan Ruiz
- Breast Unit - Anatomic Pathology Service, Virgen de la Salud Hospital, Toledo, Spain
| | | | | |
Collapse
|
35
|
Furtunescu F, Bohiltea RE, Voinea S, Georgescu TA, Munteanu O, Neacsu A, Pop CS. Breast cancer mortality gaps in Romanian women compared to the EU after 10 years of accession: Is breast cancer screening a priority for action in Romania? (Review of the Statistics). Exp Ther Med 2021; 21:268. [PMID: 33603875 DOI: 10.3892/etm.2021.9699] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 11/06/2020] [Indexed: 02/06/2023] Open
Abstract
Breast cancer remains the most common cause of morbidity and mortality by cancer in females worldwide, even though it is largely preventable through population screening. Despite notable progress in the last years in the EU, breast cancer screening programs still maintain wide variations among countries and socio-economic groups. This statistical review aimed to investigate the breast cancer-related health gaps in Romanian women compared to the average EU female population after 10 years of accession (2007-2016). We evaluated breast cancer-related deaths, age-standardized mortality rates and contribution of breast cancer to life expectancy. Trends and percentage changes were compared between Romania and EU-27 for breast cancer, all cancer and all causes of mortality. We found a higher increase of breast cancer deaths in Romania, an increasing trend of mortality (opposite to EU) and a contribution to life expectancy at birth that increased gradually from 0.45 to 0 48 years. All these health gaps compared to EU are aggravated by the fact that no population screening for breast cancer is organized in the country. The opportunities for organizing such a program are consistent, but they should be increased in the future, in order to control the health gap between Romania and EU.
Collapse
Affiliation(s)
- Florentina Furtunescu
- Department of Public Health and Management, Faculty of Medicine, 'Carol Davila' University of Medicine and Pharmacy, 050463 Bucharest, Romania
| | - Roxana Elena Bohiltea
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania
| | - Silviu Voinea
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 'Prof. Dr. Alexandru Trestioreanu Oncology Institute', 050474 Bucharest, Romania
| | | | - Octavian Munteanu
- Department of Obstetrics and Gynecology, University Emergency Hospital Bucharest, 050098 Bucharest, Romania.,Anatomy, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Adrian Neacsu
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Sfantul Ioan' Emergency Clinical Hospital, 042122 Bucharest, Romania
| | - Corina Silvia Pop
- Department of Internal Medicine and Gastroenterology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine and Gastroenterology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| |
Collapse
|
36
|
Gonciar D, Mocan L, Zlibut A, Mocan T, Agoston-Coldea L. Cardiotoxicity in HER2-positive breast cancer patients. Heart Fail Rev 2021; 26:919-935. [PMID: 33405000 DOI: 10.1007/s10741-020-10072-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2020] [Indexed: 01/22/2023]
Abstract
Due to the recent advances in diagnosis and management of patients with HER2-positive breast cancer, especially through novel HER2-targeted agents, cardiotoxicity becomes an emerging problem. Although chemotherapy significantly increases survival, the risk of cardiovascular disease development is high and still underestimated and could imply treatment discontinuation. Frequently, due to lack of rigorous diagnosis strategies, cardiotoxicity assessment is delayed, and, moreover, the efficacy of current therapy options in restoring heart function is questionable. For a comprehensive risk assessment, it is vital to characterize the clinical spectrum of HER2-targeted agents and anthracyclines, as well as their pathogenic pathways involved in cardiotoxicity. Advanced cardiovascular multimodal imaging and circulating biomarkers plays primary roles in early assessing cardiotoxicity and also in guiding specific preventive measures. Even though the knowledge in this field is rapidly expanding, there are still questions that arise regarding the optimal approach in terms of timing and methods. The aim of the current review aims to providean overview of currently available data.
Collapse
Affiliation(s)
- Diana Gonciar
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Lucian Mocan
- 3rd Surgery Department, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Nanomedicine, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Alexandru Zlibut
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Teodora Mocan
- Physiology Department, Iuliu Hațieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Department of Nanomedicine, Regional Institute of Gastroenterology and Hepatology, Cluj-Napoca, Romania
| | - Lucia Agoston-Coldea
- 2nd Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
| |
Collapse
|
37
|
Gorin SNS, Jimbo M, Heizelman R, Harmes KM, Harper DM. The future of cancer screening after COVID-19 may be at home. Cancer 2020; 127:498-503. [PMID: 33170520 DOI: 10.1002/cncr.33274] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/24/2020] [Accepted: 09/27/2020] [Indexed: 12/11/2022]
Abstract
LAY SUMMARY During the coronavirus disease 2019 (COVID-19) pandemic, cancer screening decreased precipitously; home screening for colorectal cancer diminished less than that for colonoscopy and breast and cervical cancer screening. The authors have highlighted approaches for home cancer screening in addition to telemedicine.
Collapse
Affiliation(s)
| | - Masahito Jimbo
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Robert Heizelman
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Kathryn M Harmes
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan
| | - Diane M Harper
- Department of Family Medicine, University of Michigan School of Medicine, Ann Arbor, Michigan.,Department of Obstetrics and Gynecology, University of Michigan School of Medicine, Ann Arbor, Michigan.,Department of Women's Studies, College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, Michigan.,Hub Research Capacity Core, Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
38
|
Li C, Liu Y, Xue D, Chan CWH. Effects of nurse-led interventions on early detection of cancer: A systematic review and meta-analysis. Int J Nurs Stud 2020; 110:103684. [PMID: 32702568 DOI: 10.1016/j.ijnurstu.2020.103684] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/28/2020] [Accepted: 06/06/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Early detection of cancer serves an important strategy for cancer control, but its uptake rate remains relatively limited. Nurse-led interventions may have potential benefits for the early detection of cancer, but the evidence remains unclear. OBJECTIVES Synthesise the evidence on the impact of nurse-led interventions on early cancer detection. The primary outcome was early cancer detection uptake rate. Secondary outcomes were cancer knowledge, early detection beliefs, diagnosed precancerous lesions and early-stage cancers. DESIGN A systematic review and meta-analysis of randomised controlled trails. DATA SOURCES Eight English language databases (British Nursing Index, Cochrane Central Register of Controlled Trials, CINAHL Complete, EMBASE, Ovid Emcare, Medline, Scopus, Web of Science Core Collection) and three Chinese language databases (Chinese Biomedical Literature Databases, China Journal Net, and Wanfang Data) were searched from inception date to September 2019. Grey literature and reference lists of included studies were also examined. REVIEW METHODS Two reviewers independently assessed eligibility, extracted data and evaluated methodological quality using the Cochrane risk of bias (RoB 2.0) tool. Meta-analyses and descriptive analyses were used. Subgroup analyses were conducted for study settings and intervention types. RESULTS Ten studies examined the effects of nurse-led interventions, including education, patient reminders, counselling, and patient navigation, on early detection of breast or cervical cancer, colorectal cancer, and lung cancer. Nurse-led interventions improved the uptake rates of mammography [risk ratio (RR) = 1.97; 95% confidence interval (CI): 1.17-3.33; p = 0.01], clinical breast examination (RR = 2.16; 95% CI: 1.02-4.59; p = 0.05), regular breast self-examination (RR = 2.01; 95% CI: 1.54-2.63; p < 0.001), and colonoscopy (RR = 1.90; 95% CI: 1.57-2.30; p < 0.001), but not of faecal blood occult tests. Subgroup analyses showed significantly improved mammography and clinical breast examination uptake rates for interventions conducted at health centres, and that patient navigation had better effects on improving colonoscopy uptake rates than did counselling. The intervention also improved cancer knowledge, early detection beliefs, and cases of detected precancerous lesions. CONCLUSIONS Nurse-led interventions may improve early cancer detection uptake rates, cancer knowledge, early detection beliefs, and cases of detected precancerous lesions. The effects of nurse-led interventions conducted in home settings on improving mammography and clinical breast examination uptake rates may need further exploration. Patient navigation may be superior to counselling in improving colonoscopy uptake rates. Social media may be an option for delivering early cancer detection guidance, but needs to be further explored. Tweetable abstract: Nurse-led interventions have potential effects on promoting early detection of cancer.
Collapse
Affiliation(s)
- Caixia Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China.
| | - Yunhong Liu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China.
| | - Dandan Xue
- The School of Nursing, Chongqing Medical University, ChongQing, China.
| | - Carmen W H Chan
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Esther Lee Building, Shatin, N.T., Hong Kong, China.
| |
Collapse
|