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George S. Being sick to a cancer patient: pathways of delay in help seeking and diagnosis of cancer in India. JOURNAL OF SOCIAL AND ECONOMIC DEVELOPMENT 2022; 25:52-69. [PMID: 36466373 PMCID: PMC9685046 DOI: 10.1007/s40847-022-00221-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 06/03/2023]
Abstract
There is evidence that cancer mortality and morbidity could be reduced when the disease is diagnosed and treated at an early stage. The paper examines the pathways of delay of cancer diagnosis in an Indian setting. It draws on a qualitative study conducted among cancer survivors and family members of cancer patients in the city of Bengaluru, South India. The results show that a substantial part of the delay occurred at the stage of initial formal help seeking wherein patient and family-led, disease-related and systemic factors together played a major role. Patient-led factors included trivialisation and normalisation of symptoms as part of general fatigue and aging; unrealistic risk perceptions that linked causality of cancer merely to heredity and behavioural risk factors; fear of being diagnosed as cancer patient; gender related reasons including family's gender performance expectation, lower agency of women to seek help and lower prioratisation of women's health in the household and access related issues including financial constraints and unavailability of specialised hospitals nearby. Disease-related factors included the presence of comorbidity, cancer's mimicking of symptoms of other diseases and absence of distinguishable symptoms at the initial stage for certain types of cancers. The practitioner-led and system-led factors such as trivialisation of symptoms by general practitioners, non cancer-specific referrals, and lack of cancer screening facilities accounted for a major part of delay after the formal help seeking. The paper argues that the mere knowledge of cancer symptoms did not always lead to early diagnosis due to the interplay of these factors. The ongoing cancer prevention and control interventions in India need to be informed of these micro level factors while developing strategies to prevent avoidable delays in cancer diagnosis.
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Affiliation(s)
- Sobin George
- Centre for the Study of Social Change and Development, Institute for Social and Economic Change, Bengaluru, India
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2
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Alnowami MR, Abolaban FA, Taha E. A wrapper-based feature selection approach to investigate potential biomarkers for early detection of breast cancer. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2022. [DOI: 10.1016/j.jrras.2022.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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3
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Comparison of the diagnostic performance of Magnetic Resonance Imaging (MRI), ultrasound and mammography for detection of breast cancer based on tumor type, breast density and patient's history: A review. Radiography (Lond) 2022; 28:848-856. [DOI: 10.1016/j.radi.2022.01.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 02/07/2023]
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BRCA Variations Risk Assessment in Breast Cancers Using Different Artificial Intelligence Models. Genes (Basel) 2021; 12:genes12111774. [PMID: 34828379 PMCID: PMC8623958 DOI: 10.3390/genes12111774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/08/2021] [Accepted: 11/08/2021] [Indexed: 01/03/2023] Open
Abstract
Artificial intelligence provides modelling on machines by simulating the human brain using learning and decision-making abilities. Early diagnosis is highly effective in reducing mortality in cancer. This study aimed to combine cancer-associated risk factors including genetic variations and design an artificial intelligence system for risk assessment. Data from a total of 268 breast cancer patients have been analysed for 16 different risk factors including genetic variant classifications. In total, 61 BRCA1, 128 BRCA2 and 11 both BRCA1 and BRCA2 genes associated breast cancer patients’ data were used to train the system using Mamdani’s Fuzzy Inference Method and Feed-Forward Neural Network Method as the model softwares on MATLAB. Sixteen different tests were performed on twelve different subjects who had not been introduced to the system before. The rates for neural network were 99.9% for training success, 99.6% for validation success and 99.7% for test success. Despite neural network’s overall success was slightly higher than fuzzy logic accuracy, the results from developed systems were similar (99.9% and 95.5%, respectively). The developed models make predictions from a wider perspective using more risk factors including genetic variation data compared with similar studies in the literature. Overall, this artificial intelligence models present promising results for BRCA variations’ risk assessment in breast cancers as well as a unique tool for personalized medicine software.
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Lee J, Park HY, Kim WW, Park CS, Lee RK, Kim HJ, Kim WH, Lee SW, Jeong SY, Chae YS, Lee SJ, Park JY, Park JY, Jung JH. Value of accurate diagnosis for metastatic supraclavicular lymph nodes in breast cancer: assessment with neck US, CT, and 18F-FDG PET/CT. ACTA ACUST UNITED AC 2021; 27:323-328. [PMID: 34003120 DOI: 10.5152/dir.2021.20190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
PURPOSE Neck ultrasonography (US), computed tomography (CT), and 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) are all known to be useful imaging modalities for detecting supraclavicular lymph node (SCN) metastasis in breast cancer. The authors compared the diagnostic values of neck US, CT, and PET/CT in the detection of SCN metastasis in breast cancer. METHODS SCN metastases identified in neck US, CT, or PET/CT during follow-up visits of patients with breast cancer were pathologically confirmed with the use of US-guided fine-needle aspiration cytology. The clinicopathological factors of the patients were analyzed, and the statistical parameters including sensitivity, specificity, positive and negative predictive values, false-positive and false-negative rates, and accuracy of neck US, CT, and PET/CT were compared. RESULTS Among 32 cases of suspicious SCNs, 24 were pathologically confirmed as metastasis of breast cancer. The sensitivity of US + CT was 91.7%, which was the same as that of PET/CT, while the sensitivity rates of US alone and CT alone were 87.5% and 83.3%, respectively. Accuracy was 99.8% in PET/CT alone and 98.1% in US + CT. The false-negative rate was 0.1% in US + PET/CT, while it was 0.2% in PET/CT and US + CT, 0.3% in US alone and 0.4% in CT alone. CONCLUSION PET/CT can be the first choice for detecting SCN metastases in breast cancer. However, if PET/CT is unavailable for any reason, US + CT could be a good second option to avoid false-negative results.
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Affiliation(s)
- Jeeyeon Lee
- Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ho Yong Park
- Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Wan Wook Kim
- Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Chan Sub Park
- Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ryu Kyung Lee
- Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Hye Jung Kim
- Department of Radiology, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Won Hwa Kim
- Department of Radiology, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Sang Woo Lee
- Department of Nuclear Medicine, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Shin Young Jeong
- Department of Nuclear Medicine, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Yee Soo Chae
- Department of Hemato-Oncology, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Soo Jung Lee
- Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea;Department of Hemato-Oncology, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Ji Young Park
- Department of Pathology, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jee-Young Park
- Department of Pathology, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Jin Hyang Jung
- Department of Surgery, Kyungpook National University School of Medicine, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
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Boujemaa S, Bosmans H, Bentayeb F. Mammography Dose Survey Using International Quality Standards. J Med Imaging Radiat Sci 2019; 50:529-535. [PMID: 31420271 DOI: 10.1016/j.jmir.2019.07.003] [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: 11/01/2018] [Revised: 07/02/2019] [Accepted: 07/02/2019] [Indexed: 10/26/2022]
Abstract
Digital mammography is the current standard for breast cancer screening. The absence of any dosimetric data, the quality standards, and the fear of radiation detriment, sometimes, hampers the smooth introduction of this technology and the launch of breast cancer screening programmes. As the breast cancer screening programmes are in development in Morocco, quality standards have been set in this study, so that any new breast cancer screening service could get started with their first analysis. The purpose of this study was to report the first Moroccan breast dose and to test quality standards compared with European guidelines. A dosimetric study is conducted by calculating mean glandular dose (MGD) for patients' breasts and polymethyl methacrylate (PMMA) for each thickness from recorded radiographic factors and X-ray tube (output and half-value layer) measurements using Dance's model for a digital mammography system. This is carried out to determine the correlation between phantom and patient measurements. The mean MGD for patient data was 1.02 ± 0.5 mGy and the compressed breast thickness was 55 ± 14 mm. For compressed breast thickness range of 50-60 mm, the MGD was 0.94 ± 0.3 mGy and the dose calculated with PMMA phantom for the same range thickness was 1.33 mGy. The results of MGD as a function of PMMA thickness is lower than the achievable limit curve proposed in the European guidelines. The average doses, which depend on the technical parameters of the mammography equipment, are in line with values obtained in European guidelines. In addition, an investigation is needed throughout the Moroccan territory, in the sense of optimization of radiological practices and techniques in mammographic centres aligning with the international recommendations.
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Affiliation(s)
| | - Hilde Bosmans
- Medical Imaging Research Center, Department of Radiology, University Hospitals Leuven, Leuven, Belgium
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Arrospide A, Rue M, van Ravesteyn NT, Comas M, Soto-Gordoa M, Sarriugarte G, Mar J. Economic evaluation of the breast cancer screening programme in the Basque Country: retrospective cost-effectiveness and budget impact analysis. BMC Cancer 2016; 16:344. [PMID: 27251556 PMCID: PMC4888560 DOI: 10.1186/s12885-016-2386-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 05/25/2016] [Indexed: 01/21/2023] Open
Abstract
Background Breast cancer screening in the Basque Country has shown 20 % reduction of the number of BC deaths and an acceptable overdiagnosis level (4 % of screen detected BC). The aim of this study was to evaluate the breast cancer early detection programme in the Basque Country in terms of retrospective cost-effectiveness and budget impact from 1996 to 2011. Methods A discrete event simulation model was built to reproduce the natural history of breast cancer (BC). We estimated for lifetime follow-up the total cost of BC (screening, diagnosis and treatment), as well as quality-adjusted life years (QALY), for women invited to participate in the evaluated programme during the 15-year period in the actual screening scenario and in a hypothetical unscreened scenario. An incremental cost-effectiveness ratio was calculated with the use of aggregated costs. Besides, annual costs were considered for budget impact analysis. Both population level and single-cohort analysis were performed. A probabilistic sensitivity analysis was applied to assess the impact of parameters uncertainty. Results The actual screening programme involved a cost of 1,127 million euros and provided 6.7 million QALYs over the lifetime of the target population, resulting in a gain of 8,666 QALYs for an additional cost of 36.4 million euros, compared with the unscreened scenario. Thus, the incremental cost-effectiveness ratio was 4,214€/QALY. All the model runs in the probabilistic sensitivity analysis resulted in an incremental cost-effectiveness ratio lower than 10,000€/QALY. The screening programme involved an increase of the annual budget of the Basque Health Service by 5.2 million euros from year 2000 onwards. Conclusions The BC screening programme in the Basque Country proved to be cost-effective during the evaluated period and determined an affordable budget impact. These results confirm the epidemiological benefits related to the centralised screening system and support the continuation of the programme. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2386-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Arantzazu Arrospide
- Gipuzkoa AP-OSI Research Unit, Integrated Health Organization Alto Deba, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain. .,Aging and Chronicity Health Services Research Group, BIODONOSTIA Research Institute, Paseo Dr Beguiristain s/n, 20014, Donostia, Gipuzkoa, Spain. .,REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas - Spanish Health Services Research on Chronic Patients Network), Bilbao, Bizkaia, Spain.
| | - Montserrat Rue
- REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas - Spanish Health Services Research on Chronic Patients Network), Bilbao, Bizkaia, Spain.,Basic Medical Sciences department, Biomedical Research Institute of Lleida, University of Lleida, Avda. Rovira Roure 80, 25198, Lleida, Spain
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus University Medical Center Rotterdam, Dr Molewaterplein 50, 3015, GE, Rotterdam, The Netherlands
| | - Merce Comas
- REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas - Spanish Health Services Research on Chronic Patients Network), Bilbao, Bizkaia, Spain.,Evaluation and Epidemiology Department, Hospital del Mar - IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, 08003, Barcelona, Spain
| | - Myriam Soto-Gordoa
- Gipuzkoa AP-OSI Research Unit, Integrated Health Organization Alto Deba, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain
| | - Garbiñe Sarriugarte
- Breast Cancer Early Detection Programme, Public Health Division of Bizkaia, Basque Government, Alameda Rekalde 39, 48008, Bilbao, Bizkaia, Spain
| | - Javier Mar
- Gipuzkoa AP-OSI Research Unit, Integrated Health Organization Alto Deba, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain.,Aging and Chronicity Health Services Research Group, BIODONOSTIA Research Institute, Paseo Dr Beguiristain s/n, 20014, Donostia, Gipuzkoa, Spain.,REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas - Spanish Health Services Research on Chronic Patients Network), Bilbao, Bizkaia, Spain.,Health Management Service, Integrated Health Organization Alto Deba, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain
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García-Fernández A, Barco I, Fraile M, Lain JM, Carmona A, Gonzalez S, Pessarrodona A, Giménez N, García-Font M. Factors predictive of mortality in a cohort of women surgically treated for breast cancer from 1997 to 2014. Int J Gynaecol Obstet 2016; 134:212-6. [PMID: 27233816 DOI: 10.1016/j.ijgo.2016.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/05/2016] [Accepted: 04/27/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine whether previously reported factors predictive of breast cancer mortality are effectively linked with mortality, particularly breast-cancer-specific mortality. METHODS In a prospective study, clinical, surgical, and follow-up data were assessed for consecutive patients with breast cancer who underwent surgery between 1997 and 2014 at two centers in Barcelona, Spain. Predictors of mortality were assessed by multivariate analysis. RESULTS Overall, 2134 patients were treated for 2206 breast tumors. Overall mortality was 15.0% (n=319), and breast-cancer-specific mortality was 9.0% (n=191). On multivariate analysis, the most significant factors associated with breast-cancer-specific mortality were clinical stage, inmunohistochemical profile, locoregional relapse, and lymphovascular invasion (all P<0.001). Age at onset, participation in the mass-screening program, histologic grade, and multicentricity were not significant. Patients with three or more positive axillary nodes sustained a specific mortality significantly higher than did node-negative patients or those with fewer than three positive nodes. CONCLUSION Factors predictive of breast cancer mortality were clinical stage, locoregional relapse, molecular classification, lymphovascular invasion, and neoadjuvant chemotherapy. As a single factor, nodal disease becomes relevant only when three or more lymph nodes are involved.
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Affiliation(s)
- Antonio García-Fernández
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain.
| | - Israel Barco
- Breast Unit, Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Manel Fraile
- Nuclear Medicine Department, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - José M Lain
- Breast Unit, Department of Gynecology, Hospital of Terrassa, Health Consortium of Terrassa, Terrassa, Spain
| | - Ana Carmona
- Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Sonia Gonzalez
- Department of Hemato-Oncology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Antoni Pessarrodona
- Department of Gynecology, University Hospital of Mútua Terrassa, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain
| | - Nuria Giménez
- Research Unit, Research Foundation Mútua Terrassa, University of Barcelona, Terrassa, Spain; Laboratory of Toxicology, Universitat Autònoma de Barcelona, Barcelona, Spain
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Arrospide A, Rue M, van Ravesteyn NT, Comas M, Larrañaga N, Sarriugarte G, Mar J. Evaluation of health benefits and harms of the breast cancer screening programme in the Basque Country using discrete event simulation. BMC Cancer 2015; 15:671. [PMID: 26459293 PMCID: PMC4603694 DOI: 10.1186/s12885-015-1700-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Accepted: 10/07/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since the breast cancer screening programme in the Basque Country (BCSPBC) was started in 1996, more than 400,000 women aged 50 to 69 years have been invited to participate. Based on epidemiological observations and simulation techniques it is possible to extend observed short term data into anticipated long term results. The aim of this study was to assess the effectiveness of the programme through 2011 by quantifying the outcomes in breast cancer mortality, life-years gained, false positive results, and overdiagnosis. METHODS A discrete event simulation model was constructed to reproduce the natural history of breast cancer (disease-free, pre-clinical, symptomatic, and disease-specific death) and the actual observed characteristics of the screening programme during the evaluated period in the Basque women population. Goodness-of-fit statistics were applied for model validation. The screening effects were measured as differences in benefits and harms between the screened and unscreened populations. Breast cancer mortality reduction and life-years gained were considered as screening benefits, whereas, overdiagnosis and false positive results were assessed as harms. Results for a single cohort were also obtained. RESULTS The screening programme yielded a 16 % reduction in breast cancer mortality and a 10 % increase in the incidence of breast cancer through 2011. Almost 2 % of all the women in the programme had a false positive result during the evaluation period. When a single cohort was analysed, the number of deaths decreased by 13 %, and 4 % of screen-detected cancers were overdiagnosed. Each woman with BC detected by the screening programme gained 2.5 life years due to early detection corrected by lead time. CONCLUSIONS Fifteen years after the screening programme started, this study supports an important decrease in breast cancer mortality due to the screening programme, with reasonable risk of overdiagnosis and false positive results, and sustains the continuation of the breast cancer screening programme in the Basque population.
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Affiliation(s)
- Arantzazu Arrospide
- Gipuzkoa AP-OSI Research Unit, Integrated Health Organization Alto Deba, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain.
- Public Health Division of Gipuzkoa, BIODONOSTIA Research Institute, Paseo Dr Beguiristain s/n, 20014, Donostia, Gipuzkoa, Spain.
- REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas - Spanish Health Services Research on Chronic Patients Network), Bilbao, Spain.
| | - Montserrat Rue
- REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas - Spanish Health Services Research on Chronic Patients Network), Bilbao, Spain.
- Basic Medical Sciences department, Biomedical Research Institute of Lleida, University of Lleida, Avda. Rovira Roure 80, 25198, Lleida, Spain.
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus University Medical Center Rotterdam, Dr Molewaterplein 50, 3015 GE, Rotterdam, The Netherlands.
| | - Merce Comas
- REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas - Spanish Health Services Research on Chronic Patients Network), Bilbao, Spain.
- Evaluation and Epidemiology Department, Hospital del Mar - IMIM (Hospital del Mar Medical Research Institute), Passeig Maritim 25-29, 08003, Barcelona, Spain.
| | - Nerea Larrañaga
- Public Health Division of Gipuzkoa, BIODONOSTIA Research Institute, Paseo Dr Beguiristain s/n, 20014, Donostia, Gipuzkoa, Spain.
- CIBER of Epidemiology and Public Heath, C/Monforte de Lemos 3-5, 28029, Madrid, Spain.
| | - Garbiñe Sarriugarte
- Breast Cancer Early Detection Programme, Public Health Division of Bizkaia, Basque Government, Alameda Rekalde 39, 48008, Bilbao, Bizkaia, Spain.
| | - Javier Mar
- Gipuzkoa AP-OSI Research Unit, Integrated Health Organization Alto Deba, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain.
- Public Health Division of Gipuzkoa, BIODONOSTIA Research Institute, Paseo Dr Beguiristain s/n, 20014, Donostia, Gipuzkoa, Spain.
- REDISSEC (Red de Investigación en Servicios de Salud en Enfermedades Crónicas - Spanish Health Services Research on Chronic Patients Network), Bilbao, Spain.
- Health Management Service, Integrated Health Organization Alto Deba, Avda Navarra 16, 20500, Arrasate-Mondragón, Gipuzkoa, Spain.
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Koleva-Kolarova RG, Zhan Z, Greuter MJW, Feenstra TL, De Bock GH. Simulation models in population breast cancer screening: A systematic review. Breast 2015; 24:354-63. [PMID: 25906671 DOI: 10.1016/j.breast.2015.03.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 03/17/2015] [Accepted: 03/24/2015] [Indexed: 11/15/2022] Open
Abstract
The aim of this review was to critically evaluate published simulation models for breast cancer screening of the general population and provide a direction for future modeling. A systematic literature search was performed to identify simulation models with more than one application. A framework for qualitative assessment which incorporated model type; input parameters; modeling approach, transparency of input data sources/assumptions, sensitivity analyses and risk of bias; validation, and outcomes was developed. Predicted mortality reduction (MR) and cost-effectiveness (CE) were compared to estimates from meta-analyses of randomized control trials (RCTs) and acceptability thresholds. Seven original simulation models were distinguished, all sharing common input parameters. The modeling approach was based on tumor progression (except one model) with internal and cross validation of the resulting models, but without any external validation. Differences in lead times for invasive or non-invasive tumors, and the option for cancers not to progress were not explicitly modeled. The models tended to overestimate the MR (11-24%) due to screening as compared to optimal RCTs 10% (95% CI - 2-21%) MR. Only recently, potential harms due to regular breast cancer screening were reported. Most scenarios resulted in acceptable cost-effectiveness estimates given current thresholds. The selected models have been repeatedly applied in various settings to inform decision making and the critical analysis revealed high risk of bias in their outcomes. Given the importance of the models, there is a need for externally validated models which use systematical evidence for input data to allow for more critical evaluation of breast cancer screening.
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Affiliation(s)
- Rositsa G Koleva-Kolarova
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Zhuozhao Zhan
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Marcel J W Greuter
- University of Groningen, University Medical Center Groningen, Department of Radiology, PO Box 30.001, 9700RB Groningen, The Netherlands.
| | - Talitha L Feenstra
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands; RIVM, PO Box 1, 3720BA Bilthoven, The Netherlands.
| | - Geertruida H De Bock
- University of Groningen, University Medical Center Groningen, Department of Epidemiology, PO Box 30.001, 9700RB Groningen, The Netherlands.
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Comas M, Arrospide A, Mar J, Sala M, Vilaprinyó E, Hernández C, Cots F, Martínez J, Castells X. Budget impact analysis of switching to digital mammography in a population-based breast cancer screening program: a discrete event simulation model. PLoS One 2014; 9:e97459. [PMID: 24832200 PMCID: PMC4022526 DOI: 10.1371/journal.pone.0097459] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 04/20/2014] [Indexed: 11/18/2022] Open
Abstract
Objective To assess the budgetary impact of switching from screen-film mammography to full-field digital mammography in a population-based breast cancer screening program. Methods A discrete-event simulation model was built to reproduce the breast cancer screening process (biennial mammographic screening of women aged 50 to 69 years) combined with the natural history of breast cancer. The simulation started with 100,000 women and, during a 20-year simulation horizon, new women were dynamically entered according to the aging of the Spanish population. Data on screening were obtained from Spanish breast cancer screening programs. Data on the natural history of breast cancer were based on US data adapted to our population. A budget impact analysis comparing digital with screen-film screening mammography was performed in a sample of 2,000 simulation runs. A sensitivity analysis was performed for crucial screening-related parameters. Distinct scenarios for recall and detection rates were compared. Results Statistically significant savings were found for overall costs, treatment costs and the costs of additional tests in the long term. The overall cost saving was 1,115,857€ (95%CI from 932,147 to 1,299,567) in the 10th year and 2,866,124€ (95%CI from 2,492,610 to 3,239,638) in the 20th year, representing 4.5% and 8.1% of the overall cost associated with screen-film mammography. The sensitivity analysis showed net savings in the long term. Conclusions Switching to digital mammography in a population-based breast cancer screening program saves long-term budget expense, in addition to providing technical advantages. Our results were consistent across distinct scenarios representing the different results obtained in European breast cancer screening programs.
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Affiliation(s)
- Mercè Comas
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- * E-mail:
| | - Arantzazu Arrospide
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Gipuzkoa Oeste Research Unit, Hospital Alto Deba, Arrasate, Spain
| | - Javier Mar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Gipuzkoa Oeste Research Unit, Hospital Alto Deba, Arrasate, Spain
| | - Maria Sala
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Ester Vilaprinyó
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Basic Medical Sciences Department, Biomedical Research Institute of Lleida (IRBLLEIDA)-University of Lleida, Lleida, Spain
| | - Cristina Hernández
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Francesc Cots
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- Management Control Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Juan Martínez
- Radiology Department, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, Hospital del Mar, Barcelona; IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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Vilaprinyo E, Forné C, Carles M, Sala M, Pla R, Castells X, Domingo L, Rue M. Cost-effectiveness and harm-benefit analyses of risk-based screening strategies for breast cancer. PLoS One 2014; 9:e86858. [PMID: 24498285 PMCID: PMC3911927 DOI: 10.1371/journal.pone.0086858] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 12/16/2013] [Indexed: 12/29/2022] Open
Abstract
The one-size-fits-all paradigm in organized screening of breast cancer is shifting towards a personalized approach. The present study has two objectives: 1) To perform an economic evaluation and to assess the harm-benefit ratios of screening strategies that vary in their intensity and interval ages based on breast cancer risk; and 2) To estimate the gain in terms of cost and harm reductions using risk-based screening with respect to the usual practice. We used a probabilistic model and input data from Spanish population registries and screening programs, as well as from clinical studies, to estimate the benefit, harm, and costs over time of 2,624 screening strategies, uniform or risk-based. We defined four risk groups, low, moderate-low, moderate-high and high, based on breast density, family history of breast cancer and personal history of breast biopsy. The risk-based strategies were obtained combining the exam periodicity (annual, biennial, triennial and quinquennial), the starting ages (40, 45 and 50 years) and the ending ages (69 and 74 years) in the four risk groups. Incremental cost-effectiveness and harm-benefit ratios were used to select the optimal strategies. Compared to risk-based strategies, the uniform ones result in a much lower benefit for a specific cost. Reductions close to 10% in costs and higher than 20% in false-positive results and overdiagnosed cases were obtained for risk-based strategies. Optimal screening is characterized by quinquennial or triennial periodicities for the low or moderate risk-groups and annual periodicity for the high-risk group. Risk-based strategies can reduce harm and costs. It is necessary to develop accurate measures of individual risk and to work on how to implement risk-based screening strategies.
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Affiliation(s)
- Ester Vilaprinyo
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain
- Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain
| | - Carles Forné
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain
- Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain
| | - Misericordia Carles
- Economics Department and Research Centre on Industrial and Public Economics (CREIP), Rovira i Virgili University, Reus, Catalonia, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain
- Health Services Research Network in Chronic Diseases (REDISSEC), Spain
| | - Roger Pla
- Surgery Department, Rovira i Virgili University, Reus, Catalonia, Spain
- General and Digestive Surgery Department, Joan XXIII Teaching Hospital, Tarragona, Catalonia, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain
- Health Services Research Network in Chronic Diseases (REDISSEC), Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, Institut Municipal d'Investigació Mèdica-Parc de Salut Mar, Mar Teaching Hospital, Barcelona, Catalonia, Spain
| | - Montserrat Rue
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA), Lleida, Catalonia, Spain
- Basic Medical Sciences Department, University of Lleida, Lleida, Catalonia, Spain
- Health Services Research Network in Chronic Diseases (REDISSEC), Spain
- * E-mail:
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13
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Vilaprinyo E, Puig T, Rue M. Contribution of early detection and adjuvant treatments to breast cancer mortality reduction in Catalonia, Spain. PLoS One 2012; 7:e30157. [PMID: 22272292 PMCID: PMC3260221 DOI: 10.1371/journal.pone.0030157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 12/11/2011] [Indexed: 11/24/2022] Open
Abstract
Background Reductions in breast cancer (BC) mortality in Western countries have been attributed to the use of screening mammography and adjuvant treatments. The goal of this work was to analyze the contributions of both interventions to the decrease in BC mortality between 1975 and 2008 in Catalonia. Methodology/Principal Findings A stochastic model was used to quantify the contribution of each intervention. Age standardized BC mortality rates for calendar years 1975–2008 were estimated in four hypothetical scenarios: 1) Only screening, 2) Only adjuvant treatment, 3) Both interventions, and 4) No intervention. For the 30–69 age group, observed Catalan BC mortality rates per 100,000 women-year rose from 29.4 in 1975 to 38.3 in 1993, and afterwards continuously decreased to 23.2 in 2008. If neither of the two interventions had been used, in 2008 the estimated BC mortality would have been 43.5, which, compared to the observed BC mortality rate, indicates a 46.7% reduction. In 2008 the reduction attributable to screening was 20.4%, to adjuvant treatments was 15.8% and to both interventions 34.1%. Conclusions/Significance Screening and adjuvant treatments similarly contributed to reducing BC mortality in Catalonia. Mathematical models have been useful to assess the impact of interventions addressed to reduce BC mortality that occurred over nearly the same periods.
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Affiliation(s)
- Ester Vilaprinyo
- Evaluation and Clinical Epidemiology Department, Parc de Salut Mar, Barcelona, Catalonia, Spain
| | - Teresa Puig
- Department of Clinical Epidemiology and Public Health, Hospital de la Santa Creu i Sant Pau IIB-Sant Pau, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Catalonia, Spain
| | - Montserrat Rue
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA)-University of Lleida, Lleida, Catalonia, Spain
- * E-mail:
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Puigpinós-Riera R, Serral G, Pons-Vigués M, Palència L, Rodríguez-Sanz M, Borrell C. Evolution of Inequalities in Breast and Cervical Cancer Screening in Barcelona: Population Surveys 1992, 2001, and 2006. J Womens Health (Larchmt) 2011; 20:1721-7. [DOI: 10.1089/jwh.2010.2478] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rosa Puigpinós-Riera
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Departament de Salut Pública, Facultat de Medicina, Universitat de Barcelona, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Gemma Serral
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Mariona Pons-Vigués
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
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Breast cancer risk assessment: positive predictive value of family history as a predictor of risk. Menopause 2011; 18:621-4. [PMID: 21343830 DOI: 10.1097/gme.0b013e3182027963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the practical usefulness of family history as a tool for breast cancer risk assessment. METHODS Women from the Raloxifene Use for The Heart trial (N = 10,048), which consisted of postmenopausal women with or at high risk for coronary artery disease, were included in this post hoc analysis. The breast cancer risk score at baseline was calculated using the National Cancer Institute's Breast Cancer Risk Assessment tool. The positive predictive value of family history as a predictor of risk was determined for several risk thresholds. RESULTS Almost all (99.6%) women with a family history of breast cancer are found to be at high risk using the National Cancer Institute's accepted cutoff point of at least 1.66%, and almost 98% of women with a family history of breast cancer belong to the high-risk group when the cutoff point for risk score is 2%. CONCLUSIONS Family history alone as a high-risk predictor is associated with a high positive predictive value at commonly used cutoff points based on the risk estimates from the traditional Gail model. Although more complex models of breast cancer risk should still be used as the standard for assessment, screening using family history seems to be a first step in beginning the discussion with women.
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Uhry Z, Hédelin G, Colonna M, Asselain B, Arveux P, Exbrayat C, Guldenfelds C, Soler-Michel P, Molinié F, Trétarre B, Rogel A, Courtial I, Danzon A, Guizard A, Ancelle-Park R, Eilstein D, Duffy S. Modelling the effect of breast cancer screening on related mortality using French data. Cancer Epidemiol 2011; 35:235-42. [DOI: 10.1016/j.canep.2010.10.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 04/22/2010] [Accepted: 10/31/2010] [Indexed: 11/29/2022]
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Carles M, Vilaprinyo E, Cots F, Gregori A, Pla R, Román R, Sala M, Macià F, Castells X, Rue M. Cost-effectiveness of early detection of breast cancer in Catalonia (Spain). BMC Cancer 2011; 11:192. [PMID: 21605383 PMCID: PMC3125279 DOI: 10.1186/1471-2407-11-192] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 05/23/2011] [Indexed: 11/10/2022] Open
Abstract
Background Breast cancer (BC) causes more deaths than any other cancer among women in Catalonia. Early detection has contributed to the observed decline in BC mortality. However, there is debate on the optimal screening strategy. We performed an economic evaluation of 20 screening strategies taking into account the cost over time of screening and subsequent medical costs, including diagnostic confirmation, initial treatment, follow-up and advanced care. Methods We used a probabilistic model to estimate the effect and costs over time of each scenario. The effect was measured as years of life (YL), quality-adjusted life years (QALY), and lives extended (LE). Costs of screening and treatment were obtained from the Early Detection Program and hospital databases of the IMAS-Hospital del Mar in Barcelona. The incremental cost-effectiveness ratio (ICER) was used to compare the relative costs and outcomes of different scenarios. Results Strategies that start at ages 40 or 45 and end at 69 predominate when the effect is measured as YL or QALYs. Biennial strategies 50-69, 45-69 or annual 45-69, 40-69 and 40-74 were selected as cost-effective for both effect measures (YL or QALYs). The ICER increases considerably when moving from biennial to annual scenarios. Moving from no screening to biennial 50-69 years represented an ICER of 4,469€ per QALY. Conclusions A reduced number of screening strategies have been selected for consideration by researchers, decision makers and policy planners. Mathematical models are useful to assess the impact and costs of BC screening in a specific geographical area.
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Affiliation(s)
- Misericordia Carles
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA)-University of Lleida, Catalonia, Spain
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Gobrane HLB, Hajjem S, Aounallah-Skhiri H, Achour N, Hsairi M. Mortalité par cancer en Tunisie : calcul des années de vies perdues. SANTE PUBLIQUE 2011. [DOI: 10.3917/spub.111.0031] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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