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Schumann L, Hadwiger M, Eisemann N, Katalinic A. Lead-Time Corrected Effect on Breast Cancer Survival in Germany by Mode of Detection. Cancers (Basel) 2024; 16:1326. [PMID: 38611004 PMCID: PMC11010975 DOI: 10.3390/cancers16071326] [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: 01/23/2024] [Revised: 03/20/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024] Open
Abstract
(1) Background: Screen-detected breast cancer patients tend to have better survival than patients diagnosed with symptomatic cancer. The main driver of improved survival in screen-detected cancer is detection at earlier stage. An important bias is introduced by lead time, i.e., the time span by which the diagnosis has been advanced by screening. We examine whether there is a remaining survival difference that could be attributable to mode of detection, for example, because of higher quality of care. (2) Methods: Women with a breast cancer (BC) diagnosis in 2000-2022 were included from a population-based cancer registry from Schleswig-Holstein, Germany, which also registers the mode of cancer detection. Mammography screening was available from 2005 onwards. We compared the survival for BC detected by screening with symptomatic BC detection using Kaplan-Meier, unadjusted Cox regressions, and Cox regressions adjusted for age, grading, and UICC stage. Correction for lead time bias was carried out by assuming an exponential distribution of the period during which the tumor is asymptomatic but screen-detectable (sojourn time). We used a common estimate and two recently published estimates of sojourn times. (3) Results: The analysis included 32,169 women. Survival for symptomatic BC was lower than for screen-detected BC (hazard ratio (HR): 0.23, 95% confidence interval (CI): 0.21-0.25). Adjustment for prognostic factors and lead time bias with the commonly used sojourn time resulted in an HR of 0.84 (CI: 0.75-0.94). Using different sojourn times resulted in an HR of 0.73 to 0.90. (4) Conclusions: Survival for symptomatic BC was only one quarter of screen-detected tumors, which is obviously biased. After adjustment for lead-time bias and prognostic variables, including UICC stage, survival was 27% to 10% better for screen-detected BC, which might be attributed to BC screening. Although this result fits quite well with published results for other countries with BC screening, further sources for residual confounding (e.g., self-selection) cannot be ruled out.
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Affiliation(s)
- Laura Schumann
- Institute of Social Medicine and Epidemiology, University of Luebeck, 23562 Luebeck, Germany (N.E.); (A.K.)
| | - Moritz Hadwiger
- Institute of Social Medicine and Epidemiology, University of Luebeck, 23562 Luebeck, Germany (N.E.); (A.K.)
| | - Nora Eisemann
- Institute of Social Medicine and Epidemiology, University of Luebeck, 23562 Luebeck, Germany (N.E.); (A.K.)
| | - Alexander Katalinic
- Institute of Social Medicine and Epidemiology, University of Luebeck, 23562 Luebeck, Germany (N.E.); (A.K.)
- Institute of Cancer Epidemiology, University of Luebeck, 23562 Luebeck, Germany
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Vratanar B, Pohar Perme M. Evaluating cancer screening programs using survival analysis. Biom J 2023; 65:e2200344. [PMID: 37278228 DOI: 10.1002/bimj.202200344] [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] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/23/2023] [Accepted: 05/15/2023] [Indexed: 06/07/2023]
Abstract
The main purpose of cancer screening programs is to provide early treatment to patients that are diagnosed with cancer on a screening test, thus increasing their chances of survival. To test this hypothesis directly, one should compare the survival of screen-detected cases to the survival of their counterparts not included to the program. In this study, we develop a general notation and use it to formally define the comparison of interest. We explain why the naive comparison between screen-detected and interval cases is biased and show that the total bias that arises in this case can be decomposed as a sum of lead time bias, length time bias, and bias due to overdetection. With respect to the estimation, we show what can be estimated using existing methods. To fill in the missing gap, we develop a new nonparametric estimator that allows us to estimate the survival of the control group, that is, the survival of cancer cases that would be screen-detected among those not included to the program. By joining the proposed estimator with existing methods, we show that the contrast of interest can be estimated without neglecting any of the biases. Our approach is illustrated using simulations and empirical data.
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Affiliation(s)
- Bor Vratanar
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Maja Pohar Perme
- Institute for Biostatistics and Medical Informatics, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Duarte A, Corbett M, Melton H, Harden M, Palmer S, Soares M, Simmonds M. EarlyCDT Lung blood test for risk classification of solid pulmonary nodules: systematic review and economic evaluation. Health Technol Assess 2022; 26:1-184. [PMID: 36534989 PMCID: PMC9791464 DOI: 10.3310/ijfm4802] [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] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND EarlyCDT Lung (Oncimmune Holdings plc, Nottingham, UK) is a blood test to assess malignancy risk in people with solid pulmonary nodules. It measures the presence of seven lung cancer-associated autoantibodies. Elevated levels of these autoantibodies may indicate malignant disease. The results of the test might be used to modify the risk of malignancy estimated by existing risk calculators, including the Brock and Herder models. OBJECTIVES The objectives were to determine the diagnostic accuracy, clinical effectiveness and cost-effectiveness of EarlyCDT Lung; and to develop a conceptual model and identify evidence requirements for a robust cost-effectiveness analysis. DATA SOURCES MEDLINE (including Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily and Ovid MEDLINE), EMBASE, Cochrane Central Register of Controlled Trials, Science Citation Index, EconLit, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Health Technology Assessment database, NHS Economic Evaluation Database ( NHS EED ) and the international Health Technology Assessment database were searched on 8 March 2021. REVIEW METHODS A systematic review was performed of evidence on EarlyCDT Lung, including diagnostic accuracy, clinical effectiveness and cost-effectiveness. Study quality was assessed with the quality assessment of diagnostic accuracy studies-2 tool. Evidence on other components of the pulmonary nodule diagnostic pathway (computerised tomography surveillance, Brock risk, Herder risk, positron emission tomography-computerised tomography and biopsy) was also reviewed. When feasible, bivariate meta-analyses of diagnostic accuracy were performed. Clinical outcomes were synthesised narratively. A simulation study investigated the clinical impact of using EarlyCDT Lung. Additional reviews of cost-effectiveness studies evaluated (1) other diagnostic strategies for lung cancer and (2) screening approaches for lung cancer. A conceptual model was developed. RESULTS A total of 47 clinical publications on EarlyCDT Lung were identified, but only five cohorts (695 patients) reported diagnostic accuracy data on patients with pulmonary nodules. All cohorts were small or at high risk of bias. EarlyCDT Lung on its own was found to have poor diagnostic accuracy, with a summary sensitivity of 20.2% (95% confidence interval 10.5% to 35.5%) and specificity of 92.2% (95% confidence interval 86.2% to 95.8%). This sensitivity was substantially lower than that estimated by the manufacturer (41.3%). No evidence on the clinical impact of EarlyCDT Lung was identified. The simulation study suggested that EarlyCDT Lung might potentially have some benefit when considering intermediate risk nodules (10-70% risk) after Herder risk analysis. Two cost-effectiveness studies on EarlyCDT Lung for pulmonary nodules were identified; none was considered suitable to inform the current decision problem. The conceptualisation process identified three core components for a future cost-effectiveness assessment of EarlyCDT Lung: (1) the features of the subpopulations and relevant heterogeneity, (2) the way EarlyCDT Lung test results affect subsequent clinical management decisions and (3) how changes in these decisions can affect outcomes. All reviewed studies linked earlier diagnosis to stage progression and stage shift to final outcomes, but evidence on these components was sparse. LIMITATIONS The evidence on EarlyCDT Lung among patients with pulmonary nodules was very limited, preventing meta-analyses and economic analyses. CONCLUSIONS The evidence on EarlyCDT Lung among patients with pulmonary nodules is insufficient to draw any firm conclusions as to its diagnostic accuracy or clinical or economic value. FUTURE WORK Prospective cohort studies, in which EarlyCDT Lung is used among patients with identified pulmonary nodules, are required to support a future assessment of the clinical and economic value of this test. Studies should investigate the diagnostic accuracy and clinical impact of EarlyCDT Lung in combination with Brock and Herder risk assessments. A well-designed cost-effectiveness study is also required, integrating emerging relevant evidence with the recommendations in this report. STUDY REGISTRATION This study is registered as PROSPERO CRD42021242248. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 49. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Ana Duarte
- Centre for Health Economics, University of York, York UK
| | - Mark Corbett
- Centre for Reviews and Dissemination, University of York, York UK
| | - Hollie Melton
- Centre for Reviews and Dissemination, University of York, York UK
| | - Melissa Harden
- Centre for Reviews and Dissemination, University of York, York UK
| | - Stephen Palmer
- Centre for Health Economics, University of York, York UK
| | - Marta Soares
- Centre for Health Economics, University of York, York UK
| | - Mark Simmonds
- Centre for Reviews and Dissemination, University of York, York UK
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Goldfarb DG, Zeig‐Owens R, Kristjansson D, Li J, Brackbill RM, Farfel MR, Cone JE, Kahn AR, Qiao B, Schymura MJ, Webber MP, Dasaro CR, Lucchini RG, Todd AC, Prezant DJ, Hall CB, Boffetta P. Cancer survival among World Trade Center rescue and recovery workers: A collaborative cohort study. Am J Ind Med 2021; 64:815-826. [PMID: 34288025 PMCID: PMC8515734 DOI: 10.1002/ajim.23278] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 12/31/2022]
Abstract
BACKGROUND World Trade Center (WTC)-exposed responders may be eligible to receive no-cost medical monitoring and treatment for certified conditions, including cancer. The survival of responders with cancer has not previously been investigated. METHODS This study compared the estimated relative survival of WTC-exposed responders who developed cancer while enrolled in two WTC medical monitoring and treatment programs in New York City (WTC-MMTP responders) and WTC-exposed responders not enrolled (WTC-non-MMTP responders) to non-responders from New York State (NYS-non-responders), all restricted to the 11-southernmost NYS counties, where most responders resided. Parametric survival models estimated cancer-specific and all-cause mortality. Follow-up ended at death or on December 31, 2016. RESULTS From January 1, 2005 to December 31, 2016, there were 2,037 cancer cases and 303 deaths (248 cancer-related deaths) among WTC-MMTP responders, 564 cancer cases, and 143 deaths (106 cancer-related deaths) among WTC-non-MMTP responders, and 574,075 cancer cases and 224,040 deaths (158,645 cancer-related deaths) among the NYS-non-responder population. Comparing WTC-MMTP responders with NYS-non-responders, the cancer-specific mortality hazard ratio (HR) was 0.72 (95% confidence interval [CI] = 0.64-0.82), and all-cause mortality HR was 0.64 (95% CI = 0.58-0.72). The cancer-specific HR was 0.94 (95% CI = 0.78-1.14), and all-cause mortality HR was 0.93 (95% CI = 0.79-1.10) comparing WTC-non-MMTP responders to the NYS-non-responder population. CONCLUSIONS WTC-MMTP responders had lower mortality compared with NYS-non-responders, after controlling for demographic factors and temporal trends. There may be survival benefits from no-out-of-pocket-cost medical care which could have important implications for healthcare policy, however, other occupational and socioeconomic factors could have contributed to some of the observed survival advantage.
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Affiliation(s)
- David G. Goldfarb
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Environmental, Occupational and Geospatial Health SciencesCity University of New York Graduate School of Public Health and Health PolicyNew YorkNew YorkUSA
| | - Rachel Zeig‐Owens
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Dana Kristjansson
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Department of Genetics and BioinformaticsNorwegian Institute of Public HealthOsloNorway
- Center of Fertility and HealthNorwegian Institute of Public HealthOsloNorway
| | - Jiehui Li
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Robert M. Brackbill
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Mark R. Farfel
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - James E. Cone
- New York City Department of Health and Mental HygieneWorld Trade Center Health RegistryLong Island CityNew YorkUSA
| | - Amy R. Kahn
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Baozhen Qiao
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Maria J. Schymura
- New York State Department of HealthBureau of Cancer EpidemiologyAlbanyNew YorkUSA
| | - Mayris P. Webber
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Christopher R. Dasaro
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Roberto G. Lucchini
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Andrew C. Todd
- Department of Environmental Medicine and Public HealthIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - David J. Prezant
- Department of MedicineMontefiore Medical CenterNew YorkNew YorkUSA
- Fire Department of the City of New York (FDNY)BrooklynNew YorkUSA
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Charles B. Hall
- Department of Epidemiology and Population HealthAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Paolo Boffetta
- Department of Hematology and OncologyIcahn School of Medicine at Mount Sinai, Tisch Cancer InstituteNew YorkNew YorkUSA
- Stony Brook Cancer CenterStony Brook UniversityStony BrookNew YorkUSA
- Department of Medical and Surgical SciencesUniversity of BolognaBolognaItaly
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Cucchetti A, Garuti F, Pinna AD, Trevisani F. Length time bias in surveillance for hepatocellular carcinoma and how to avoid it. Hepatol Res 2016; 46:1275-1280. [PMID: 26879882 DOI: 10.1111/hepr.12672] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/15/2016] [Accepted: 02/09/2016] [Indexed: 12/13/2022]
Abstract
AIM Length time bias is a selection bias which can lead to an overestimation of survival of screening-detected cases caused by the relative excess of slower-growing tumors detected with respect to symptomatic cases. This leads to the incorrect perception that screening improves outcomes when it only selects tumors with a favorable biology. Data regarding this bias in surveillance for hepatocellular carcinoma (HCC) have never been provided. METHODS A semi-Markov model was developed to investigate this issue. An exponential tumor growth was applied. During its growth, tumor diagnosis "at surveillance appointments" was made when tumor attained a size equal to or above the size of tumors diagnosed in surveilled patients obtained from pertinent published reports, or "in-between appointments" (due to the development of symptoms) if tumor size attained the size of symptomatic diagnosis, derived from published reports; otherwise the tumor continued to grow until the time horizon had been reached. Tumor doubling time (DT) values were recorded according to the method of diagnosis. RESULTS In a theoretical cohort of 1000 patients submitted to semiannual surveillance, 72.5% will be diagnosed at a surveillance appointment and 18% because of symptom development, although under surveillance. Patients diagnosed with HCC at a surveillance appointment had a median tumor DT of 100 days (interquartile range, 68-143 days), whereas those diagnosed because of symptoms had a median DT of 42 days (interquartile range, 29-58 days) although under surveillance. CONCLUSION The surveillance propensity to detect slower-growth tumors is relevant, and practical suggestions to minimize this bias in longitudinal studies are provided.
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Affiliation(s)
- Alessandro Cucchetti
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Francesca Garuti
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Antonio Daniele Pinna
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
| | - Franco Trevisani
- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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- Department of Medical and Surgical Sciences, S.Orsola-Malpighi Hospital, Alma Mater Studiorum - University of Bologna, Bologna, Italy
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Cox AT, Cameron-Smith M, Folkes F, Sharma S, Boos C. Screening for cardiac disease in potential recruits to the British Army. J ROY ARMY MED CORPS 2015; 161:173-9. [DOI: 10.1136/jramc-2015-000532] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Anderson RT, Yang TC, Matthews SA, Camacho F, Kern T, Mackley HB, Kimmick G, Louis C, Lengerich E, Yao N. Breast cancer screening, area deprivation, and later-stage breast cancer in Appalachia: does geography matter? Health Serv Res 2014; 49:546-67. [PMID: 24117371 PMCID: PMC3976186 DOI: 10.1111/1475-6773.12108] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2013] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To model the relationship of an area-based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer (LSBC) across a diverse region of Appalachia. DATA SOURCE Central cancer registry data (2006-2008) from three Appalachian states were linked to Medicare claims and census data. STUDY DESIGN Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions. PRINCIPAL FINDINGS Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on LSBC. In the negative binomial regression model, predictors of LSBC included receipt of screening, area deprivation, supply of mammography centers, and female population aged>75 years. The most deprived counties had a 3.31 times greater rate of LSBC compared to the least deprived. Effect of screening on LSBC was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high-population counties. CONCLUSIONS Breast cancer screening and area deprivation are strongly associated with disparity in LBSC in Appalachia. The presence of geographically varying predictors of later stage tumors in Appalachia suggests the importance of place-based health care access and risk.
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Affiliation(s)
- Roger T Anderson
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Tse-Chang Yang
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Stephen A Matthews
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Fabian Camacho
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Teresa Kern
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Heath B Mackley
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Gretchen Kimmick
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Christopher Louis
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Eugene Lengerich
- Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth UniversityPO Box 980430, Richmond, VA 23298
- Department of Public Health Science, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Sociology, Center for Social and Demographic Analysis, University at Albany, State University of New YorkAlbany, NY
- Departments of Sociology and Anthropology, The Pennsylvania State UniversityUniversity Park, PA
- Division of Radiation Oncology, College of Medicine, The Pennsylvania State UniversityHershey, PA
- Department of Medicine, Duke University School of MedicineDurham, NC
- Department of Health Policy and Administration, The Pennsylvania State UniversityUniversity Park, PA
| | - Nengliang Yao
- Address correspondence to Nengliang Yao, Ph.D., Instructor, Department of Healthcare Policy and Research, College of Medicine, Virginia Commonwealth University, PO Box 980430, Richmond, VA 23298; e-mail:
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Youlden DR, Cramb SM, Dunn NAM, Muller JM, Pyke CM, Baade PD. The descriptive epidemiology of female breast cancer: an international comparison of screening, incidence, survival and mortality. Cancer Epidemiol 2012; 36:237-48. [PMID: 22459198 DOI: 10.1016/j.canep.2012.02.007] [Citation(s) in RCA: 463] [Impact Index Per Article: 38.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 02/22/2012] [Accepted: 02/26/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND This paper presents the latest international descriptive epidemiological data for invasive breast cancer amongst women, including incidence, survival and mortality, as well as information on mammographic screening programmes. RESULTS Almost 1.4 million women were diagnosed with breast cancer worldwide in 2008 and approximately 459,000 deaths were recorded. Incidence rates were much higher in more developed countries compared to less developed countries (71.7/100,000 and 29.3/100,000 respectively, adjusted to the World 2000 Standard Population) whereas the corresponding mortality rates were 17.1/100,000 and 11.8/100,000. Five-year relative survival estimates range from 12% in parts of Africa to almost 90% in the United States, Australia and Canada, with the differential linked to a combination of early detection, access to treatment services and cultural barriers. Observed improvements in breast cancer survival in more developed parts of the world over recent decades have been attributed to the introduction of population-based screening using mammography and the systemic use of adjuvant therapies. CONCLUSION The future worldwide breast cancer burden will be strongly influenced by large predicted rises in incidence throughout parts of Asia due to an increasingly "westernised" lifestyle. Efforts are underway to reduce the global disparities in survival for women with breast cancer using cost-effective interventions.
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Affiliation(s)
- Danny R Youlden
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Spring Hill, Qld 4004, Australia.
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Olsson A, Borgquist S, Butt S, Zackrisson S, Landberg G, Manjer J. Tumour-related factors and prognosis in breast cancer detected by screening. Br J Surg 2011; 99:78-87. [PMID: 22068957 DOI: 10.1002/bjs.7757] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2011] [Indexed: 11/08/2022]
Abstract
BACKGROUND Breast cancer detected by screening has an unexplained prognostic advantage beyond stage shift compared with cancers detected clinically. The aim was to investigate biological factors in invasive breast cancer, with reference to mode of detection and rate of death from breast cancer. METHODS Histology, oestrogen receptor α and β, progesterone receptor, human epidermal growth factor receptor (HER) 2, cyclin D1, p27, Ki-67 and perinodal growth were analysed in 466 tumours from a prospective cohort, the Malmö Diet and Cancer Study. Using logistic regression, odds ratios were calculated to investigate the relationship between tumour characteristics and mode of detection. The same tumour factors were analysed in relation to standard prognostic features. Death from breast cancer was analysed using Cox regression with adjustments for standard tumour factors; differences following adjustment were analysed by means of Freedman statistics. RESULTS None of the biological tumour characteristics varied with mode of detection of breast cancer. After adjustment for age, tumour size, axillary lymph node involvement (ALNI) and grade, women with cancer detected clinically had an increased risk of death from breast cancer (hazard ratio 2·48, 95 per cent confidence interval 1·34 to 4·59), corresponding to a 37·2 per cent difference compared with the unadjusted model. Additional adjustment for biological tumour factors studied caused only minor changes. CONCLUSION None of the biological tumour markers investigated explained the improved prognosis in breast cancer detected by screening. None of the factors was related to ALNI, suggesting that other mechanisms may be responsible for tumour spread.
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Affiliation(s)
- A Olsson
- Departments of Surgery and Cancer Study, Skåne University Hospital, Malmö, Sweden.
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Melanoma - The pieces of the puzzle finally start coming together! Mol Oncol 2011; 5:113-5. [DOI: 10.1016/j.molonc.2011.03.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Accepted: 03/25/2011] [Indexed: 11/17/2022] Open
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Eom BW, Ryu KW, Lee JH, Choi IJ, Kook MC, Cho SJ, Lee JY, Kim CG, Park SR, Lee JS, Kim YW. Oncologic effectiveness of regular follow-up to detect recurrence after curative resection of gastric cancer. Ann Surg Oncol 2010; 18:358-64. [PMID: 21042946 DOI: 10.1245/s10434-010-1395-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Indexed: 12/19/2022]
Abstract
BACKGROUND While clinicians routinely follow up gastric cancer patients after curative resection to detect recurrence, the effectiveness of regular follow-up has not been proven, and no consensus has been reached regarding follow-up programs. METHODS Of the 1,767 patients who underwent curative resection for gastric cancer from 2001 to 2004, 310 (17.5%) developed recurrence during follow-up. The oncologic effectiveness of follow-up was evaluated using recurrence detection rates during follow-up and survivals. Clinicopathologic characteristics, the detection tools used, and times lapsed between recurrence and previous examinations were also investigated. RESULTS Two hundred thirty-three (75.2%) of the 310 patients who developed recurrence were detected by regular follow-up (detected group). The frequencies of undifferentiated and diffuse-type recurrences were higher in patients with recurrence detected based on patient-initiated findings (undetected group) than in the detected group. Computed tomography and tumor markers were the first detection tools that yielded positive findings. Times between recurrence detection and previous examinations ranged from 2.8 to 5.3 months over the first 2 years. No difference in overall survival was found between the detected and undetected groups (log rank, P = 0.2). CONCLUSIONS The oncologic effectiveness of regular follow-up after curative resection for gastric cancer was found to be unsatisfactory. A large-scale randomized controlled trial is required to identify the effectiveness of regular follow-up in terms of its oncologic, functional, psychological, and economical aspects.
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Affiliation(s)
- Bang Wool Eom
- Gastric Cancer Branch, Research Institute & Hospital, National Cancer Center, Goyang-si, Gyeonggi-do, South Korea
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Summers RM. Polyp size measurement at CT colonography: what do we know and what do we need to know? Radiology 2010; 255:707-20. [PMID: 20501711 DOI: 10.1148/radiol.10090877] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Polyp size is a critical biomarker for clinical management. Larger polyps have a greater likelihood of being or of becoming an adenocarcinoma. To balance the referral rate for polypectomy against the risk of leaving potential cancers in situ, sizes of 6 and 10 mm are increasingly being discussed as critical thresholds for clinical decision making (immediate polypectomy versus polyp surveillance) and have been incorporated into the consensus CT Colonography Reporting and Data System (C-RADS). Polyp size measurement at optical colonoscopy, pathologic examination, and computed tomographic (CT) colonography has been studied extensively but the reported precision, accuracy, and relative sizes have been highly variable. Sizes measured at CT colonography tend to lie between those measured at optical colonoscopy and pathologic evaluation. The size measurements are subject to a variety of sources of error associated with image acquisition, display, and interpretation, such as partial volume averaging, two- versus three-dimensional displays, and observer variability. This review summarizes current best practices for polyp size measurement, describes the role of automated size measurement software, discusses how to manage the measurement uncertainties, and identifies areas requiring further research.
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Affiliation(s)
- Ronald M Summers
- Imaging Biomarkers and Computer-Aided Diagnosis Laboratory, Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, Bldg 10, Room 1C368X, MSC 1182, Bethesda, MD 20892-1182, USA.
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