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de Munck L, Eijkelboom AH, Otten JDM, Broeders MJM, Siesling S. Method of primary breast cancer detection and the disease-free interval, adjusting for lead time. J Natl Cancer Inst 2024; 116:370-378. [PMID: 37935443 PMCID: PMC10919328 DOI: 10.1093/jnci/djad230] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Little is known about the impact of screen-detected breast cancer compared with clinically detected breast cancer on the disease-free interval (ie, free from locoregional recurrences, distant metastasis, contralateral breast cancer). Moreover, it is thought that most studies overestimate the beneficial effect of screening, as they do not adjust for lead time. We investigated the association between method of breast cancer detection and disease-free interval, taking lead time into account. METHODS Women aged 50-76 years, diagnosed with breast cancer between 2005 and 2008 were selected from the Netherlands Cancer Registry. Women diagnosed in 2005 were divided into screen-detected and clinically detected cancer and had a follow-up of 10 years (2005 cohort). Women diagnosed in 2006-2008 were divided into screen-detected, interval, and nonscreen-related cancer and had a follow-up of 5 years (2006-2008 cohort). A previously published method was used to adjust for lead time. Analyses were repeated correcting for confounding variables instead of lead time. RESULTS The 2005 cohort included 6215 women. Women with screen-detected cancer had an improved disease-free interval compared with women with clinically detected cancer (hazard ratio [HR] = 0.77, 95% confidence interval [CI] = 0.68 to 0.87). The 2006-2008 cohort included 15 176 women. Women with screen-detected or interval cancer had an improved disease-free interval compared with women with nonscreen-related cancer (HR = 0.76, 95% CI = 0.66 to 0.88; HR = 0.88, 95% CI = 0.78 to 0.99, respectively). Correcting for confounders instead of lead time did not change associations. CONCLUSION Women with screen-detected cancer had an improved disease-free interval compared with women with a nonscreen-related or clinically detected cancer, after correction for lead time.
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Affiliation(s)
- Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
| | - Anouk H Eijkelboom
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
| | - Johannes D M Otten
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, the Netherlands
- Dutch Expert Centre for Screening, Nijmegen, the Netherlands
| | - Sabine Siesling
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, the Netherlands
- Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, the Netherlands
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Bar Y, Bar K, Itzhak I, Niselbaum CS, Dershowitz N, Shachar E, Weiss-Meilik A, Golan O, Wolf I, Menes T, Sonnenblick A. The impact of tumor detection method on genomic and clinical risk and chemotherapy recommendation in early hormone receptor positive breast cancer. Breast 2021; 60:78-85. [PMID: 34509707 PMCID: PMC8437822 DOI: 10.1016/j.breast.2021.09.002] [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: 04/12/2021] [Revised: 08/16/2021] [Accepted: 09/03/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Symptomatic breast cancers share aggressive clinico-pathological characteristics compared to screen-detected breast cancers. We assessed the association between the method of cancer detection and genomic and clinical risk, and its effect on adjuvant chemotherapy recommendations. PATIENTS AND METHODS Patients with early hormone receptor positive (HR+) HER2neu-negative (HER2-) breast cancer, and known OncotypeDX Breast Recurrence Score test were included. A natural language processing (NLP) algorithm was used to identify the method of cancer detection. The clinical and genomic risks of symptomatic and screen-detected tumors were compared. RESULTS The NLP algorithm identified the method of detection of 401 patients, with 216 (54%) diagnosed by routine screening, and the remainder secondary to symptoms. The distribution of OncotypeDX recurrence score (RS) varied between the groups. In the symptomatic group there were lower proportions of low RS (13% vs 23%) and higher proportions of high RS (24% vs. 13%) compared to the screen-detected group. Symptomatic tumors were significantly more likely to have a high clinical risk (59% vs 40%). Based on genomic and clinical risk and current guidelines, we found that women aged 50 and under, with a symptomatic cancer, had an increased probability of receiving adjuvant chemotherapy recommendation compared to women with screen-detected cancers (60% vs. 37%). CONCLUSIONS We demonstrated an association between the method of cancer detection and both genomic and clinical risk. Symptomatic breast cancer, especially in young women, remains a poor prognostic factor that should be taken into account when evaluating patient prognosis and determining adjuvant treatment plans.
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Affiliation(s)
- Yael Bar
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Kfir Bar
- School of Computer Science, The College of Management, Rishon LeZion, Israel; School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | - Itay Itzhak
- School of Computer Science, Tel Aviv University, Tel Aviv, Israel
| | | | | | - Eliya Shachar
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Orit Golan
- Radiology Department, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ido Wolf
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tehillah Menes
- Department of Surgery, Chaim Sheba Medical Center, Tel-Hashomer and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
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3
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Alanko J, Tanner M, Vanninen R, Auvinen A, Isola J. Triple-negative and HER2-positive breast cancers found by mammography screening show excellent prognosis. Breast Cancer Res Treat 2021; 187:267-274. [PMID: 33420595 PMCID: PMC8062374 DOI: 10.1007/s10549-020-06060-z] [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: 10/13/2020] [Accepted: 12/15/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Our purpose was to explore the prognosis of aggressive breast cancers of the HER2 oncogene amplification (HER2 +) and triple-negative (TN) subtypes detected by screening, as well as the prognosis of interval cancers (clinically due to symptoms between screening rounds) and cancers in screening nonparticipants. METHODS The study population comprised of 823 breast cancers in women aged 50-69 years from 2006-2014. Of these, 572 were found by screening mammography (69%), 170 were diagnosed between the screening rounds (21%), and 81 were diagnosed in women who did not participate in the screening program (10%). RESULTS The majority of all HER2 + (59%) and TN cancers (57%) in this age group were detected by screening. Screen-detected HER2 + tumors were small (median 12 mm), and node-negative (84%). During a median follow-up of eight years, the distant disease-free survival of screen-detected HER2 + and TN cancers was better than that of interval and nonparticipant cancers (age-adjusted HR = 0.16, 95% CI 0.03-0.81 and HR = 0.09, 95% CI 0.01-0.79, respectively). In nonparticipants, the distant disease-free survival of these cancers was worse than in participants (age-adjusted HR = 2.52, 95% CI 0.63-10.11 and HR = 5.30, 95% 1.16-24.29, respectively). CONCLUSION In the 50-69 age group, the majority of HER2 + and TN cancers can be found by a quality assured population-based mammography screening. Despite their generally aggressive behavior, after a median follow-up of 8 years, distant disease-free survival was over 90% of these cancers detected by screening. The worst prognosis of these cancers was in women who did not participate in screening.
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Affiliation(s)
- Johanna Alanko
- Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Screening Clinic of Terveystalo, Tampere University, Tampere, Finland.
| | - Minna Tanner
- Department of Oncology, Faculty of Medicine and Health Technology, Tampere University and Tays Cancer Centre, Tampere, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, School of Medicine, University of Eastern Finland, Kuopio University Hospital, Kuopio, Finland
| | - Anssi Auvinen
- Faculty of Social Sciences (Health Sciences), Tampere University, Tampere, Finland
| | - Jorma Isola
- Laboratory of Cancer Biology, Faculty of Medicine and Health Technology, Jilab Inc., Tampere University, Tampere, Finland
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4
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Zarcos-Pedrinaci I, Redondo M, Louro J, Rivas-Ruiz F, Téllez T, Pérez D, Medina Cano F, Machan K, Domingo L, Mar Vernet M, Padilla-Ruiz M, Castells X, Rueda A, Sala M. Impact of adjuvant chemotherapy on the survival of patients with breast cancer diagnosed by screening. Cancer Med 2019; 8:6662-6670. [PMID: 31549794 PMCID: PMC6825992 DOI: 10.1002/cam4.2488] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 07/08/2019] [Accepted: 07/25/2019] [Indexed: 01/04/2023] Open
Abstract
The aim of this study is to determine the survival of patients with breast cancer treated with adjuvant chemotherapy (ACh) after the diagnosis by screening, taking comorbidity into account. This multicenter cohort study examined a population of patients taking part in four national screening programs for the early detection of breast cancer (localized or locally advanced), during the period 2000‐2008. Of the 1248 cancers detected, 266 were prevalent (21.3%), 633 were incident (50.7%), and 349 were interval (27.9%). No significant differences were detected between the three groups in terms of the distribution of comorbidity according to the CCI. After a median follow‐up of 102 months, 22.1% of the patients with interval cancer had died. The corresponding figures for the incident and prevalent cancers were 10.4% and 7.9%, respectively (P < .001). The adjusted Cox regression analysis by the stage, CCI and group revealed no differences in the risk of recurrence between the different groups according to the ACh performed. However, there were significant differences in the overall survival; for the interval cancer group without ACh, the risk of death was higher (Hazard ratio: 2.5 [1.0‐6.2]) than for the other two groups. However, for the prevalent and incident groups that did not receive ACh, there was no greater risk of death. This study shows that adjuvant chemotherapy seems to benefit patients with interval breast cancer, who have a poorer prognosis than those with prevalent or incident cancer. However, the role of ACh is unclear with respect to prevalent and incident cancers when comorbidity is taken into account.
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Affiliation(s)
- Irene Zarcos-Pedrinaci
- Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Marbella, Spain.,Department of Oncohaematology, Costa del Sol Hospital, Marbella, Spain
| | - Maximino Redondo
- Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Marbella, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation, Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Francisco Rivas-Ruiz
- Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Marbella, Spain
| | - Teresa Téllez
- Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Marbella, Spain
| | - Diego Pérez
- Department of Oncohaematology, Costa del Sol Hospital, Marbella, Spain
| | - Francisco Medina Cano
- Department of Surgery, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Marbella, Spain
| | - Kenza Machan
- Department of Radiology, Costa del Sol Hospital, Marbella, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | | | - Maria Padilla-Ruiz
- Research Unit, Costa del Sol Hospital, Research Network on Health Services in Chronic Diseases (REDISSEC), University of Málaga, Marbella, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Antonio Rueda
- Department of Medical Oncology, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - María Sala
- Department of Epidemiology and Evaluation, Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
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Szukis HA, Qin B, Xing CY, Doose M, Xu B, Tsui J, Lin Y, Hirshfield KM, Ambrosone CB, Demissie K, Hong CC, Bandera EV, Llanos AAM. Factors Associated with Initial Mode of Breast Cancer Detection among Black Women in the Women's Circle of Health Study. JOURNAL OF ONCOLOGY 2019; 2019:3529651. [PMID: 31354818 PMCID: PMC6637674 DOI: 10.1155/2019/3529651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/07/2019] [Accepted: 06/23/2019] [Indexed: 11/21/2022]
Abstract
Mammogram-detected breast cancers have a better prognosis than those identified through clinical breast exam (CBE) or through self-detection, primarily because tumors detected by mammography are more likely to be smaller and do not involve regional nodes. In a sample of 1,322 Black women, aged 40-75 years, diagnosed with breast cancer between 2002 and 2016, we evaluated factors associated with CBE and self-detection versus screening mammogram as the initial mode of breast cancer detection, using multivariable logistic regression models. Compared with screening mammogram, history of routine screening mammogram (OR 0.20, 95% CI: 0.07, 0.54) and performance of breast self-examination (BSE) (OR 0.31, 95% CI: 0.13, 0.74) before diagnosis were associated with lower odds of CBE as the initial mode of detection, while performance of CBEs before diagnosis (OR 11.04, 95% CI: 2.24, 54.55) was positively associated. Lower body mass index (<25.0 kg/m2 vs. ≥35.0 kg/m2: OR 2.46, 95% CI: 1.52, 3.98), performance of BSEs before diagnosis (less than once per month: OR 4.08, 95% CI: 2.45, 6.78; at least monthly: OR 4.99, 95% CI: 3.13, 7.97), and larger tumor size (1.0-2.0 cm vs. <1.0 cm: OR 2.92, 95% CI: 1.84, 4.64; >2.0 cm vs. <1.0 cm: OR 6.41, 95% CI: 3.30, 12.46) were associated with increased odds of self-detection relative to screening mammogram. The odds of CBE and self-detection as initial modes of breast cancer detection among Black women are independently associated with breast care and breast cancer screening services before diagnosis and with larger tumors at diagnosis.
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Affiliation(s)
- Holly A. Szukis
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Bo Qin
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
| | - Cathleen Y. Xing
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Michelle Doose
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Baichen Xu
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
| | - Jennifer Tsui
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
- Department of Health Behavior, Society and Policy, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
| | - Yong Lin
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
- Biometrics Division, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
| | - Kim M. Hirshfield
- Division of Medical Oncology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Christine B. Ambrosone
- Division of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Kitaw Demissie
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
- Department of Epidemiology and Biostatistics, SUNY Downstate School of Public Health, Brooklyn, NY, USA
| | - Chi-Chen Hong
- Division of Cancer Prevention and Control, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Elisa V. Bandera
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
| | - Adana A. M. Llanos
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Piscataway, NJ, USA
- Cancer Prevention and Control, Rutgers Cancer Institute of New Jersey, 195 Little Albany Street, New Brunswick, NJ, USA
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Puvanesarajah S, Gapstur SM, Patel AV, Sherman ME, Flanders WD, Gansler T, Troester MA, Gaudet MM. Mode of detection and breast cancer mortality by follow-up time and tumor characteristics among screened women in Cancer Prevention Study-II. Breast Cancer Res Treat 2019; 177:679-689. [PMID: 31264062 DOI: 10.1007/s10549-019-05322-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 06/12/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE In a screened population, breast cancer-specific mortality is lower for screen-detected versus symptom-detected breast cancers; however, it is unclear whether this association varies by follow-up time and/or tumor characteristics. To further understand the prognostic utility of mode of detection, we examined its association with breast cancer-specific mortality, overall and by follow-up time, estrogen receptor status, tumor size, and grade. METHODS In the Cancer Prevention Study-II Nutrition Cohort, 3975 routinely screened women were diagnosed with invasive breast cancer (1992-2015). Among 2686 screen-detected and 1289 symptom-detected breast cancers, 206 and 209 breast cancer deaths, respectively, occurred up to 24 years post diagnosis. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from Cox proportional hazard regression models. RESULTS Controlling for prognostic factors, symptom detection was associated with higher risk of breast cancer-specific death up to 5 years after diagnosis (HR≤5years = 1.88, 95% CI 1.21-2.91) this association was attenuated in subsequent follow-up (HR>5years = 1.26, 95% CI 0.98-1.63). Within tumor characteristic strata, there was a 1.3-2.7-fold higher risk of breast cancer death associated with symptom-detected cancers ≤ 5 years of follow-up, although associations were only significant for women with tumors < 2 cm (HR≤5years = 2.42, 95% CI 1.19-4.93) and for women with grade 1 or 2 tumors (HR≤5years = 2.72, 95% CI 1.33-5.57). In subsequent follow-up, associations were closer to the null. CONCLUSIONS Screen detection is a powerful prognostic factor for short-term survival. Among women who survived at least 5 years after breast cancer diagnosis, other clinical factors may be more predictive of breast cancer survival.
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Affiliation(s)
- Samantha Puvanesarajah
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA.
| | - Susan M Gapstur
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - Alpa V Patel
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - Mark E Sherman
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - W Dana Flanders
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA.,Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Ted Gansler
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mia M Gaudet
- Behavioral and Epidemiology Research Group, American Cancer Society, 250 Williams Street, Atlanta, GA, 30303, USA
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Biological and prognostic differences between symptomatic colorectal carcinomas and those detected by screening. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:1876-1881. [PMID: 31189513 DOI: 10.1016/j.ejso.2019.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/16/2019] [Accepted: 05/23/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Few studies have been conducted to establish the relationship between colorectal cancer screening programmes and survival adjusting by stage and, to determine whether there are differences, at a biological level, between the tumours of asymptomatic and symptomatic patients. Accordingly, the aim of this study is to evaluate clinical, biological and survival differences between symptomatic colorectal tumours and those detected by screening. STUDY METHOD A prospective cohort study was performed of patients subjected to surgical intervention during the period 2010-2012, at different hospitals in Spain. In every case, clinical, pathological, biological and survival-related variables were obtained. RESULTS A total of 2634 patients from the CARESS-CCR cohort were analysed; of these, 220 were diagnosed through screening. The asymptomatic patients were younger, had a higher Body Mass Index (BMI), a lower degree of perineural invasion and a less advanced T stage and nodular stage, and the tumour was frequently located on the right side of the colon. All of these differences were statistically significant. The serum tumour marker carbohydrate antigen 19.9 (CA 19.9) was found more frequently in the symptomatic patients (p < 0.05). However, no significant differences were found regarding the markers of tumour biology: Ki67 (proliferation), CD105 (angiogenesis) and the Terminal deoxynucleotidyl transferase (TdT) dUTP Nick-End Labeling (TUNEL) assay (apoptosis). The patients with asymptomatic tumours had a lower mortality at five years than those diagnosed presenting symptoms. CONCLUSIONS The detection method employed influenced the survival of patients with colorectal cancer and there were no significant biological differences between the study groups.
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Aromaa-Häyhä A, Auvinen P, Sarkeala T, Heinävaara S, Lamminmäki A, Malila N, Kataja V. Improved diagnostics and change of tumour characteristics in breast cancer: a retrospective study over two decades. Acta Oncol 2018; 57:1331-1338. [PMID: 29882462 DOI: 10.1080/0284186x.2018.1479073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Generally, screen-detected cancers have more favourable tumour characteristics than clinically detected or symptomatic cancers. Less is known, whether the tumour characteristics of breast cancer have changed over time into more favourable in general and whether the changes have been similar in all ages. MATERIAL AND METHODS The aim of this study was to explore the change of breast cancer characteristics in parallel to the implementation of modern diagnostic methods in three age groups over four 5-year time periods between 1992 and 2011. The data from 942 primary breast cancers in one university hospital district in Finland were combined with data from the Finnish Cancer Registry and the Mass Screening Registry. The association of favourable tumour characteristics with time period, age group and diagnostic methods was explored. RESULTS The most discernible secular change was the increase in oestrogen (ER)-positive cancers in every consecutive time period. The risk for ER positivity in the second, third and fourth period was 2- to 2.71-fold compared to the first period. An increase in small tumours and node-negative tumours was detected during the most recent years of data collection. The secular changes were observed in all age groups; however, overall ER positivity was most frequent among women beyond screening age and small tumours among screening-aged women. The increase in small and node-negative tumours could partly be explained by the implementation of new radiological methods. CONCLUSIONS This study detected a secular change of tumour characteristics into more favourable irrespective of age group. If the trend continues, it seems that we are going to have a breast cancer population of mainly small ER-positive breast cancers in the future forcing to rethink the therapeutic approach.
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Affiliation(s)
| | - Päivi Auvinen
- Centre of Oncology, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| | | | | | | | - Nea Malila
- Finnish Cancer Registry, Helsinki, Finland
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Vesa Kataja
- Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
- Jyväskylä Central Hospital, Central Finland Health Care District, Jyväskylä, Finland
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9
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O’Cearbhaill RM, Hembrecht S, Devane LA, Rothwell J, Evoy D, Geraghty J, McCartan DP, McNally S, O’Doherty A, McDermott EW, Prichard RS. Breast screening in symptomatic women over 35 years of age: improvements in service efficiency. Ir J Med Sci 2018; 188:55-58. [DOI: 10.1007/s11845-018-1794-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/14/2018] [Indexed: 11/28/2022]
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10
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Shen SC, Ueng SH, Yang CK, Yu CC, Lo YF, Chang HK, Lin YC, Chen SC. Impact of Detection Method and Accompanying Ductal Carcinoma in Situ on Prognosis of T1a,bN0 Breast Cancer. J Cancer 2017; 8:2328-2335. [PMID: 28819437 PMCID: PMC5560152 DOI: 10.7150/jca.19293] [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: 01/22/2017] [Accepted: 04/01/2017] [Indexed: 11/05/2022] Open
Abstract
Background: T1a,bN0 breast cancer is not easily detected. Before mammography became widespread, most cases were discovered only after the development of symptoms. The presence of ductal carcinoma in situ (DCIS) affects the detectability of associated invasive cancer; however, the prognostic value of concomitant DCIS is controversial. This study compared the characteristics of screening-detected and symptom-detected T1a,bN0 breast cancer, and investigated the impact of accompanying DCIS on detection and prognosis. Patients and Methods: Data were collected from a single hospital between 2000 and 2009. Of 5,690 primary breast cancers patients, 438 met the criteria for T1a,bN0M0. Logistic regression models were used to identify prognostic indicators and their association with the detection method. Survival analyses were performed to estimate distant relapse-free survival (DRFS) and breast cancer-specific survival (BCSS). Results: Tumors in 79 and 359 patients were detected by screening and development of symptoms, respectively. Symptomatic cancer patients were younger, more likely to receive a mastectomy, and had larger accompanying DCIS lesions; their 10-year DRFS rates were worse than those of patients with screening-detected tumors (91.1% vs. 100% respectively, p=0.049). Patients with large accompanying DCIS (≥2 cm) had markedly worse 10-year DRFS (77.1% vs. 97.4%, p<0.001) and BCSS (94.3% vs. 98.9%, p<0.001). Conclusion: T1a,bN0 breast cancers detected owing to symptoms are more likely to have larger accompanying DCIS. T1a,bN0 patients with large accompanying DCIS have worse DRFS and BCSS. It is important to consider associated DCIS size when evaluating prognosis in T1a,bN0 breast cancer patients.
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Affiliation(s)
- Shih-Che Shen
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Chan-Keng Yang
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Chi-Chang Yu
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Yung-Feng Lo
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Hsien-Kun Chang
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Yung-Chang Lin
- Department of Oncology, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
| | - Shin-Cheh Chen
- Department of Surgery, Chang Gung Memorial Hospital, Chang Gung University Medical College, No. 5, Fu Hsing St., Guishan Dist., 33305, Taoyuan, Taiwan
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11
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Romero A, Torà-Rocamora I, Baré M, Barata T, Domingo L, Ferrer J, Torà N, Comas M, Merenciano C, Macià F, Castells X, Sala M. Prevalence of persistent pain after breast cancer treatment by detection mode among participants in population-based screening programs. BMC Cancer 2016; 16:735. [PMID: 27632982 PMCID: PMC5025583 DOI: 10.1186/s12885-016-2768-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Accepted: 09/06/2016] [Indexed: 01/04/2023] Open
Abstract
Background To date, the study of the risks and benefits of breast cancer screening has not included the onset of persistent pain after breast cancer treatment within the context of population-based screening programs. Our purpose was to investigate the prevalence of persistent pain and associated factors in women diagnosed with breast cancer (screening or interval) in the context of a population-based breast cancer screening program in Spain. Methods A total of 1,057 women participating in a population-based breast cancer screening program were diagnosed with breast cancer between 2000 and 2008. The women were treated surgically and followed-up to 2013. The risk of developing persistent pain was estimated through multivariate logistic regression analysis. Results Breast cancer was detected during routine screening in 732 women (69.3 %) and emerged as an interval cancer between two screening rounds in 325 (30.7 %). Persistent pain was present in 118 women (11.3 %). Women diagnosed through routine screening reported a higher prevalence of persistent pain (12.9 %) than those with interval cancers (7.8 %)(P < 0.05). Multivariate logistic regression analysis identified two other variables associated with persistent pain: having a Charlson index > =2 (Odds Ratio [OR]: 4.5 95 % Confidence Interval [CI]: 2.1-9.5) versus no comorbidities, and having undergone an axillary lymph node dissection (OR: 2.0 95 % CI: 1.0-4.0) versus sentinel lymph node biopsy. Conclusions The prevalence of persistent pain was relatively low. The detection mode was not related to the onset of persistent pain. The factors associated with persistent pain were a Charlson index > =2 and the performance of axillary lymph node dissection. Women treated for breast cancer are at risk for developing persistent pain regardless of the detection mode, especially those with comorbidities and those who have undergone axillary lymph node dissection.
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Affiliation(s)
- Anabel Romero
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain.
| | - Isabel Torà-Rocamora
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Marisa Baré
- Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí-UAB, Research Network on Health Services in Chronic Diseases (REDISSEC), Sabadell, Spain
| | - Teresa Barata
- General Directorate of Health Care Programmes, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain.,Agency for Health Quality and Assessment of Catalonia (AQuAS), Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
| | - Joana Ferrer
- Department of Radiology, Hospital de Santa Caterina, Salt, Girona, Spain
| | - Núria Torà
- Clinical Epidemiology and Cancer Screening, Corporació Sanitària Parc Taulí-UAB, Research Network on Health Services in Chronic Diseases (REDISSEC), Sabadell, Spain
| | - Mercè Comas
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Carmen Merenciano
- General Directorate of Health Care Programmes, Canary Islands Health Service, Las Palmas de Gran Canaria, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM-Hospital del Mar, Research Network on Health Services in Chronic Diseases (REDISSEC), Passeig Marítim 25-29, Barcelona, 08003, Spain
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12
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Breast cancer biology varies by method of detection and may contribute to overdiagnosis. Surgery 2016; 160:454-62. [DOI: 10.1016/j.surg.2016.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 03/04/2016] [Accepted: 03/31/2016] [Indexed: 11/19/2022]
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13
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Hofvind S, Holen Å, Román M, Sebuødegård S, Puig-Vives M, Akslen L. Mode of detection: an independent prognostic factor for women with breast cancer. J Med Screen 2015; 23:89-97. [PMID: 26582492 DOI: 10.1177/0969141315604006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 07/24/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To investigate breast cancer survival and risk of breast cancer death by detection mode (screen-detected, interval, and detected outside the screening programme), adjusting for prognostic and predictive tumour characteristics. METHODS Information about detection mode, prognostic (age, tumour size, histologic grade, lymph node status) and predictive factors (molecular subtypes based on immunohistochemical analyses of hormone receptor status (estrogen and progesterone) and Her2 status) were available for 8344 women in Norway aged 50-69 at diagnosis of breast cancer, 2005-2011. A total of 255 breast cancer deaths were registered by the end of 2011. Kaplan-Meier method was used to estimate six years breast cancer specific survival and Cox proportional hazard model to estimate hazard ratio (HR) for breast cancer death by detection mode, adjusting for prognostic and predictive factors. RESULTS Women with screen-detected cancer had favourable prognostic and predictive tumour characteristics compared with interval cancers and those detected outside the screening programme. The favourable characteristics were present for screen-detected cancers, also within the subtypes. Adjusted HR of dying from breast cancer was two times higher for women with symptomatic breast cancer (interval or outside the screening), using screen-detected tumours as the reference. CONCLUSIONS Detection mode is an independent prognostic factor for women diagnosed with breast cancer. Information on detection mode might be relevant for patient management to avoid overtreatment.
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Affiliation(s)
- Solveig Hofvind
- Department of Screening - Cancer Registry of Norway, Oslo Oslo and Akershus University College of Applied Sciences - Department of Radiography
| | - Åsne Holen
- Department of Screening - Cancer Registry of Norway, Oslo
| | - Marta Román
- Department of Screening - Cancer Registry of Norway, Oslo National Advisory Unit for Women's Health - Oslo University Hospital
| | | | - Montse Puig-Vives
- Epidemiology Unit and Girona Cancer Registry (UERCG)/University of Girona, Economics Campus Montilivi, Spain
| | - Lars Akslen
- University of Bergen Centre for Cancer Biomarkers CCBIO, Department of Clinical Medicine, Section for Pathology, Norway/Haukeland University Hospital, Department of Pathology, Bergen, Norway
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14
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Mortel M, Rauscher GH, Murphy AM, Hoskins K, Warnecke RB. Racial and Ethnic Disparity in Symptomatic Breast Cancer Awareness despite a Recent Screen: The Role of Tumor Biology and Mammography Facility Characteristics. Cancer Epidemiol Biomarkers Prev 2015. [PMID: 26199340 DOI: 10.1158/1055-9965.epi-15-0305] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In a racially and ethnically diverse sample of recently diagnosed urban patients with breast cancer, we examined associations of patient, tumor biology, and mammography facility characteristics on the probability of symptomatic discovery of their breast cancer despite a recent prior screening mammogram. METHODS In the Breast Cancer Care in Chicago study, self-reports at interview were used to define patients as having a screen-detected breast cancer or having symptomatic awareness despite a recent screening mammogram (SADRS), in the past 1 or 2 years. Patients with symptomatic breast cancer who did not report a recent prior screen were excluded from these analyses. Characteristics associated with more aggressive disease [estrogen receptor (ER)- and progesterone receptor (PR)-negative status and higher tumor grade] were abstracted from medical records. Mammogram facility characteristics that might indicate aspects of screening quality were defined and controlled for in some analyses. RESULTS SADRS was more common among non-Hispanic black and Hispanic than among non-Hispanic white patients (36% and 42% vs. 25%, respectively, P = 0.0004). SADRS was associated with ER/PR-negative and higher-grade disease. Patients screened at sites that relied on dedicated radiologists and sites that were breast imaging centers of excellence were less likely to report SADRS. Tumor and facility factors together accounted for two thirds of the disparity in SADRS (proportion mediated = 70%, P = 0.02). CONCLUSION Facility resources and tumor aggressiveness explain much of the racial/ethnic disparity in symptomatic breast cancer among recently screened patients. IMPACT A more equitable distribution of high-quality screening would ameliorate but not eliminate this disparity.
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Affiliation(s)
- Mylove Mortel
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois.
| | | | - Kent Hoskins
- Department of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Richard B Warnecke
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
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15
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Singh D, Malila N, Pokhrel A, Anttila A. Association of symptoms and breast cancer in population-based mammography screening in Finland. Int J Cancer 2014; 136:E630-7. [PMID: 25160029 PMCID: PMC4312922 DOI: 10.1002/ijc.29170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 08/14/2014] [Accepted: 08/19/2014] [Indexed: 11/30/2022]
Abstract
The study purpose was to assess association of symptoms at screening visits with detection of breast cancer among women aged 50–69 years during the period 2006–2010. Altogether 1.2 million screening visits were made and symptoms (lump, retraction, secretion etc.) were reported either by women or radiographer. Breast cancer risk was calculated for each symptom separately using logistic regression [odds ratio (OR)] and 95% confidence intervals (CIs). Of the 1,198,410 screening visits symptoms were reported in 298,220 (25%) visits. Breast cancer detection rate for women with and without symptoms was 7.8 per 1,000 and 4.7 per 1,000 screening visits, respectively, whereas lump detected 32 cancers per 1,000 screens. Women with lump or retraction had an increased risk of breast cancer, OR = 6.47, 95% CI 5.89−7.09 and OR = 2.19, 95% CI 1.92–2.49, respectively. The sensitivity of symptoms in detecting breast carcinoma was 35.5% overall. Individual symptoms sensitivity and specificity ranged from, 0.66 to 14.8% and 87.4 to 99.7%, respectively. Of 5,541 invasive breast cancers, 1,993 (36%) reported symptoms at screen. Breast cancer risk among women with lump or retraction was higher in large size tumors (OR = 9.20, 95% CI 8.08–10.5) with poorly differentiated grades (OR = 5.91, 95% CI 5.03–6.94) and regional lymph nodes involvement (OR = 6.47, 95% CI 5.67–7.38). This study was done in a setting where breast tumors size is generally small, and symptoms sensitivity and specificity in diagnosing breast tumors were limited. Importance of breast cancer symptoms in the cancer prevention and control strategy needs to be evaluated also in other settings.
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Affiliation(s)
- Deependra Singh
- School of Health Sciences, University of Tampere, Tampere, Finland
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16
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Mathews M, Ryan D, Gadag V, West R. Use of screening tests, diagnosis wait times, and wait-related satisfaction in breast and prostate cancer. ACTA ACUST UNITED AC 2014; 21:e441-8. [PMID: 24940104 DOI: 10.3747/co.21.1843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Understanding factors relating to the perception of wait time by patients is key to improving the patient experience. METHODS We surveyed 122 breast and 90 prostate cancer patients presenting at clinics or listed on the cancer registry in Newfoundland and Labrador and reviewed their charts. We compared the wait time (first visit to diagnosis) and the wait-related satisfaction for breast and prostate cancer patients who received regular screening tests and whose cancer was screening test-detected ("screen/screen"); who received regular screening tests and whose cancer was symptomatic ("screen/symptomatic"); who did not receive regular screening tests and whose cancer was screen test-detected ("no screen/screen"); and who did not receive regular screening tests and whose cancer was symptomatic ("no screen/symptomatic"). RESULTS Although there were no group differences with respect to having a long wait (greater than the median of 47.5 days) for breast cancer patients (47.8% screen/screen, 54.7% screen/symptomatic, 50.0% no screen/ screen, 40.0% no screen/symptomatic; p = 0.814), a smaller proportion of the screen/symptomatic patients were satisfied with their wait (72.5% screen/ screen, 56.4% screen/symptomatic, 100% no screen/ screen, 90.9% no screen/symptomatic; p = 0.048). A larger proportion of screen/symptomatic prostate cancer patients had long waits (>104.5 days: 41.3% screen/screen, 92.0% screen/symptomatic, 46.0% no screen/screen, 40.0% no screen/symptomatic; p = 0.011) and a smaller proportion of screen/ symptomatic patients were satisfied with their wait (71.2% screen/screen, 30.8% screen/symptomatic, 76.9% no screen/screen, 90.9% no screen/symptomatic; p = 0.008). CONCLUSIONS Diagnosis-related wait times and satisfaction were poorest among patients who received regular screening tests but whose cancer was not detected by those tests.
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Affiliation(s)
- M Mathews
- Division of Community Health and Humanities, Memorial University, St. John's, NL
| | - D Ryan
- Division of Community Health and Humanities, Memorial University, St. John's, NL
| | - V Gadag
- Division of Community Health and Humanities, Memorial University, St. John's, NL
| | - R West
- Division of Community Health and Humanities, Memorial University, St. John's, NL
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17
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Canavan J, Truong PT, Smith SL, Lu L, Lesperance M, Olivotto IA. Local recurrence in women with stage I breast cancer: declining rates over time in a large, population-based cohort. Int J Radiat Oncol Biol Phys 2014; 88:80-6. [PMID: 24331653 DOI: 10.1016/j.ijrobp.2013.10.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 09/30/2013] [Accepted: 10/01/2013] [Indexed: 12/19/2022]
Abstract
PURPOSE To evaluate whether local recurrence (LR) risk has changed over time among women with stage I breast cancer treated with breast-conserving therapy. METHODS AND MATERIALS Subjects were 5974 women aged ≥50 years diagnosis with pT1N0 breast cancer from 1989 to 2006, treated with breast-conserving surgery and radiation therapy. Clinicopathologic characteristics, treatment, and LR outcomes were compared among 4 cohorts stratified by year of diagnosis: 1989 to 1993 (n=1077), 1994 to 1998 (n=1633), 1999 to 2002 (n=1622), and 2003 to 2006 (n=1642). Multivariable analysis was performed, with year of diagnosis as a continuous variable. RESULTS Median follow-up time was 8.6 years. Among patients diagnosed in 1989 to 1993, 1994 to 1998, 1999 to 2002, and 2003 to 2006, the proportions of grade 1 tumors increased (16% vs 29% vs 40% vs 39%, respectively, P<.001). Surgical margin clearance rates increased from 82% to 93% to 95% and 88%, respectively (P<.001). Over time, the proportions of unknown estrogen receptor (ER) status decreased (29% vs 10% vs 1.2% vs 0.5%, respectively, P<.001), whereas ER-positive tumors increased (56% vs 77% vs 86% vs 86%, respectively, P<.001). Hormone therapy use increased (23% vs 23% vs 62% vs 73%, respectively, P<.001), and chemotherapy use increased (2% vs 5% vs 10% vs 13%, respectively, P<.001). The 5-year cumulative incidence rates of LR over the 4 time periods were 2.8% vs 1.7% vs 0.9% vs 0.8%, respectively (Gray's test, P<.001). On competing risk multivariable analysis, year of diagnosis was significantly associated with decreased LR (hazard ratio, 0.92 per year, P=.0003). Relative to grade 1 histology, grades 2, 3, and unknown were associated with increased LR. Hormone therapy use was associated with reduced LR. CONCLUSION Significant changes in the multimodality management of stage I breast cancer have occurred over the past 2 decades. More favorable-risk tumors were diagnosed, and margin clearance and systemic therapy use increased. These changes contributed to the observed declining LR rates among patients treated with breast-conserving therapy.
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Affiliation(s)
- Joycelin Canavan
- Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia, Canada.
| | - Pauline T Truong
- Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia, Canada
| | - Sally L Smith
- Radiation Therapy Program and Breast Cancer Outcomes Unit, British Columbia Cancer Agency, Vancouver Island Centre, University of British Columbia, Victoria, British Columbia, Canada
| | - Linghong Lu
- Department of Mathematics and Statistics, University of Victoria, British Columbia, Canada
| | - Mary Lesperance
- Department of Mathematics and Statistics, University of Victoria, British Columbia, Canada
| | - Ivo A Olivotto
- Department of Radiation Oncology, Tom Baker Cancer Centre, University of Calgary
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