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Engler C, Nogueira MS. Analysis of the relationship between global breast density and maximum points of breast density in a sample of Brazilian women. Appl Radiat Isot 2023; 194:110703. [PMID: 36724612 DOI: 10.1016/j.apradiso.2023.110703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 01/25/2023] [Accepted: 01/25/2023] [Indexed: 01/27/2023]
Abstract
Maximum points of breast density have been strongly associated with breast cancer masking than global breast density, which is a widely used measure today. The objective of this work was to verify the correlation between two measures of global breast density (VBDGLOBAL and DABGLOBAL) and a measure of maximum point breast density (VBDMP). Mammographic images of 4.020 patients were analyzed using the Volpara software, which calculated or extracted the variables needed for the study from the DICOM header. Two-tailed partial correlation tests were performed between the variable VBDGLOBAL with VBDMP and DABGLOBAL with VBDMP in the following contexts: keeping PA and CBT constant, keeping only CBT constant, and keeping only PA constant. The Pearson test was also used to verify the bivariate correlation between VBDGLOBAL with VBDMP and DABGLOBAL with VBDMP. For the two-tailed partial correlation tests between VBDGLOBAL with VBDMP, keeping the CBT and PA variables constant resulted in r = 0.845 (p < 0.05). When kept constant only the CBT, r = 0.875 (p < 0.05), and keeping only the PA constant r = 0.866 (p < 0.05). Pearson's test showed r = 0.883 (p < 0.05). For the two-tailed partial correlation tests between the DABGLOBAL with VBDMP quantities, the results were r = 0.675 (p < 0.05), r = 0.725 (p < 0.05) and r = 0.701 (p < 0.05) for constant CBT and PA, constant CBT and constant PA, respectively, while the Pearson test resulted in r = 0.738 (p < 0.05). We conclude that a woman who has high global breast density is also highly likely to have maximum points of breast density.
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Affiliation(s)
- Camila Engler
- Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN), 31270-901, Belo Horizonte, MG, Brazil.
| | - Maria S Nogueira
- Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN), 31270-901, Belo Horizonte, MG, Brazil
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2
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De Schepper M, Vincent-Salomon A, Christgen M, Van Baelen K, Richard F, Tsuda H, Kurozumi S, Brito MJ, Cserni G, Schnitt S, Larsimont D, Kulka J, Fernandez PL, Rodríguez-Martínez P, Olivar AA, Melendez C, Van Bockstal M, Kovacs A, Varga Z, Wesseling J, Bhargava R, Boström P, Franchet C, Zambuko B, Matute G, Mueller S, Berghian A, Rakha E, van Diest PJ, Oesterreich S, Derksen PWB, Floris G, Desmedt C. Results of a worldwide survey on the currently used histopathological diagnostic criteria for invasive lobular breast cancer. Mod Pathol 2022; 35:1812-1820. [PMID: 35922548 PMCID: PMC9708574 DOI: 10.1038/s41379-022-01135-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 12/24/2022]
Abstract
Invasive lobular carcinoma (ILC) represents the second most common subtype of breast cancer (BC), accounting for up to 15% of all invasive BC. Loss of cell adhesion due to functional inactivation of E-cadherin is the hallmark of ILC. Although the current world health organization (WHO) classification for diagnosing ILC requires the recognition of the dispersed or linear non-cohesive growth pattern, it is not mandatory to demonstrate E-cadherin loss by immunohistochemistry (IHC). Recent results of central pathology review of two large randomized clinical trials have demonstrated relative overdiagnosis of ILC, as only ~60% of the locally diagnosed ILCs were confirmed by central pathology. To understand the possible underlying reasons of this discrepancy, we undertook a worldwide survey on the current practice of diagnosing BC as ILC. A survey was drafted by a panel of pathologists and researchers from the European lobular breast cancer consortium (ELBCC) using the online tool SurveyMonkey®. Various parameters such as indications for IHC staining, IHC clones, and IHC staining procedures were questioned. Finally, systematic reporting of non-classical ILC variants were also interrogated. This survey was sent out to pathologists worldwide and circulated from December 14, 2020 until July, 1 2021. The results demonstrate that approximately half of the institutions use E-cadherin expression loss by IHC as an ancillary test to diagnose ILC and that there is a great variability in immunostaining protocols. This might cause different staining results and discordant interpretations. As ILC-specific therapeutic and diagnostic avenues are currently explored in the context of clinical trials, it is of importance to improve standardization of histopathologic diagnosis of ILC diagnosis.
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Affiliation(s)
- Maxim De Schepper
- grid.5596.f0000 0001 0668 7884Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Anne Vincent-Salomon
- grid.440907.e0000 0004 1784 3645Diagnostic and Theranostic Medicine Division, Institut Curie, PSL Research University, Paris, France
| | - Matthias Christgen
- grid.10423.340000 0000 9529 9877Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Karen Van Baelen
- grid.5596.f0000 0001 0668 7884Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - François Richard
- grid.5596.f0000 0001 0668 7884Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Hitoshi Tsuda
- grid.416620.7Department of Basic Pathology, National Defense Medical College Hospital, Tokorozawa, Saitama Japan
| | - Sasagu Kurozumi
- grid.411731.10000 0004 0531 3030Department of Breast Surgery, International University of Health and Welfare, Narita, Chiba Japan
| | - Maria Jose Brito
- grid.421010.60000 0004 0453 9636Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Gabor Cserni
- grid.9008.10000 0001 1016 9625Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary & Department of Pathology, Albert Szent-Györgyi Medical Center, University of Szeged, Szeged, Hungary
| | - Stuart Schnitt
- grid.38142.3c000000041936754XBrigham and Women’s Hospital, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA USA
| | - Denis Larsimont
- grid.418119.40000 0001 0684 291XDepartment of Pathology, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Janina Kulka
- grid.11804.3c0000 0001 0942 9821Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Pest Hungary
| | - Pedro Luis Fernandez
- grid.7080.f0000 0001 2296 0625Hospital German Trias i Pujol, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Paula Rodríguez-Martínez
- grid.7080.f0000 0001 2296 0625Hospital German Trias i Pujol, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Ana Aula Olivar
- grid.411295.a0000 0001 1837 4818University Hospital Doctor Josep Trueta, Girona, Spain
| | - Cristina Melendez
- grid.411295.a0000 0001 1837 4818University Hospital Doctor Josep Trueta, Girona, Spain
| | - Mieke Van Bockstal
- grid.48769.340000 0004 0461 6320Department of Pathology, Cliniques universitaires Saint-Luc Bruxelles, Woluwé-Saint-Lambert, Brussels, Belgium
| | - Aniko Kovacs
- grid.1649.a000000009445082XDepartment of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Zsuzsanna Varga
- grid.412004.30000 0004 0478 9977Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Jelle Wesseling
- grid.430814.a0000 0001 0674 1393Divisions of Molecular Pathology and Diagnostic Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Rohit Bhargava
- grid.411487.f0000 0004 0455 1723Department of Pathology, UPMC Magee-Womens Hospital, Pittsburgh, PA USA
| | - Pia Boström
- grid.410552.70000 0004 0628 215XDepartment of Pathology, Turku University Hospital and University of Turku, Turku, Finland
| | - Camille Franchet
- grid.488470.7Institut Claudius Regaud, Institut Universitaire du Cancer Toulouse - Oncopole, Toulouse, France
| | - Blessing Zambuko
- grid.7621.20000 0004 0635 5486Department of Pathology, Sir Ketumile Masire Teaching Hospital, University of Botswana, Gaborone, Botswana
| | - Gustavo Matute
- grid.412249.80000 0004 0487 2295Clínica Universitaria Bolivariana, Universidad Pontificia Bolivariana, Medellín, Colombia
| | - Sophie Mueller
- grid.10423.340000 0000 9529 9877Institute of Pathology, Hannover Medical School, Hannover, Germany
| | - Anca Berghian
- grid.418189.d0000 0001 2175 1768Department of Biopathology, Centre Henri Becquerel, Rouen, France
| | - Emad Rakha
- grid.240404.60000 0001 0440 1889Department of Histopathology, Nottingham University Hospital NHS Trust, City Hospital Campus Hucknall Road, Nottingham, UK
| | - Paul J. van Diest
- grid.7692.a0000000090126352Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Steffi Oesterreich
- grid.460217.60000 0004 0387 4432Women’s Cancer Research Center, UPMC Hillman Cancer Center, Magee-Womens Research Institute, Pittsburgh, PA USA
| | - Patrick W. B. Derksen
- grid.7692.a0000000090126352Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Giuseppe Floris
- Department of Pathology, University Hospitals Leuven, UZ Leuven, Leuven, Belgium.
| | - Christine Desmedt
- Laboratory for Translational Breast Cancer Research, Department of Oncology, KU Leuven, Leuven, Belgium.
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Breast cancer incidence by age at discovery of mammographic abnormality in women participating in French organized screening campaigns. Public Health 2021; 202:121-130. [PMID: 34952431 DOI: 10.1016/j.puhe.2021.11.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/04/2021] [Accepted: 11/14/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Statistical modeling was already predicted the occurrence/prognosis of breast cancer from previous radiological findings. This study predicts the breast cancer risk by the age at discovery of mammographic abnormality in the French breast cancer screening program. STUDY DESIGN This was a cohort study. METHODS The study included 261,083 women who meet the inclusion criteria: aged 50-74 years, living in French departments (Ain, Doubs, Haute-Saône, Jura, Territoire-de-Belfort, and Yonne), with at least two mammograms between January 1999 and December 2017, of which the first was 'normal/benign'. The incidence of each abnormality (microcalcifications, spiculated mass, obscured mass, architectural distortion, and asymmetric density) was first estimated, then the breast cancer risk was predicted secondly according to the age at discovery of each mammographic abnormality, using an actuarial life table and a Cox model. RESULTS Overall breast cancer (6326 cases) incidence was 3.3 (3.0; 3.1)/1000 person-years. The breast cancer incidence increased proportionally with the discovery age of the speculated mass and microcalcifications. The incidence was twice as high when the spiculated mass age of discovery was ≥70 (12.2 [10.4; 14.4]) compared with age 50-54 years (5.8 [5.1; 6.7]). Depending on the spiculated mass discovery age, the breast cancer risk increased by at least 40% between the age groups 55-59 years (1.4 [1.0; 1.8]) and ≥70 years (2.4 [1.9; 3.3]). Whatever the abnormality, the incidence of breast cancer was higher when it was present in only one breast. CONCLUSION The study highlights a stable incidence of breast cancer between successive mammograms, an increased risk of breast cancer with the finding age of spiculated mass and microcalcifications. The reduced delay between the abnormality discovery date and the breast cancer diagnosis date would justify a specific follow-up protocol after the finding of these two abnormalities.
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Steponaviciene L, Briediene R, Vanseviciute R, Smailyte G. Trends in Breast Cancer Incidence and Stage Distribution Before and During the Introduction of the Mammography Screening Program in Lithuania. Cancer Control 2019; 26:1073274818821096. [PMID: 30808202 PMCID: PMC6327347 DOI: 10.1177/1073274818821096] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The aim of this study was to analyze the incidence trends of localized and advanced breast cancer (BC) before and during the implementation of the mammography screening program (MSP) in Lithuania. Methods: The study period was divided into 2 intervals: the prescreening period (1998-2005) and implementation period (2006-2012). Analysis was performed for 3 age-groups: 0 to 49 years, 50 to 69 (target population), and older than 70. Results: In all age-groups, the incidence of localized BC has shown a steady increase, while the incidence of advanced stage BC has decreased. In the target population, during the study period, the stage I BC incidence increased statistically significantly by 10.3% per year (from 3.3 per 100 000 in 1998 to 12.2 per 100 000 in 2012). The increase in localized BC was faster in the period before the implementation of the MSP than during the implementation in 2006 to 2012 (10.3% and 5.7%). A slightly statistically significant decrease was observed for advanced BC during the study period (−1.1% per year), while during the implementation of the MSP, significant changes were not seen. Conclusions: The results of our study indicate that the implementation of the MSP in Lithuania did not significantly influence trends of localized and advanced BC. Changes observed during the study period, including the prescreening and screening introduction periods, may reflect the general trends in the awareness of BC and improvements in diagnostics.
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Affiliation(s)
- Laura Steponaviciene
- 1 Laboratory of cancer epidemiology, National Cancer Institute, Vilnius, Lithuania.,2 Department of Public Health, Institute of Health Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
| | - Ruta Briediene
- 3 Department of Radiology, National Cancer Institute, Vilnius, Lithuania.,4 Department of Radiology, Medical Physics and Nuclear Medicine, Vilnius University, Vilnius, Lithuania
| | - Rasa Vanseviciute
- 5 Department of Consulting Clinic, National Cancer Institute, Vilnius, Lithuania
| | - Giedre Smailyte
- 1 Laboratory of cancer epidemiology, National Cancer Institute, Vilnius, Lithuania.,2 Department of Public Health, Institute of Health Sciences of the Faculty of Medicine of Vilnius University, Vilnius, Lithuania
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5
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Luiten JD, Voogd AC, Tjan-Heijnen VC, Wesseling J, Luiten EJ, Duijm LE. Utility of diagnostic breast excision biopsies during two decades of screening mammography. Breast 2019; 46:157-162. [DOI: 10.1016/j.breast.2019.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 01/19/2023] Open
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Steponaviciene L, Vincerzevskiene I, Briediene R, Urbonas V, Vanseviciute-Petkeviciene R, Smailyte G. Breast Cancer Screening Program in Lithuania: Interval Cancers and Program Sensitivity After 7 Years of Mammography Screening. Cancer Control 2019; 26:1073274819874122. [PMID: 31502471 PMCID: PMC6755864 DOI: 10.1177/1073274819874122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 06/23/2019] [Accepted: 07/31/2019] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE Analysis of interval cancers is critical in determining the sensitivity of screening and represents an objective measure of the quality of mammography screening program (MSP). METHODS Period analyzed: from 2006 to 2012. The rate of screen-detected, interval cancers and program sensitivity were measured. A comparison of screen-detected and interval cancers was performed. RESULTS During the period of the study, 429 473 women were screened and 1297 were found to have cancer. The overall screen-detected cancer rate was 30.2 per 10 000 women screened. Four hundred thirty-one case of interval cancers have occurred during the period of the study. The interval cancer ratio (ICR) was 0.25. Overall sensitivity of MSP amounted to 75.1%. Slightly lower sensitivity was found among the youngest age-group, especially for those with lobular cancers. Interval cancers were bigger in size, more often with metastases in lymph nodes, than screen-detected cancers, but these differences were not statistically significant. CONCLUSIONS Overall program sensitivity in Lithuania is about 75%, ICR is 0.25, and these parameters are comparable to other European countries.
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Affiliation(s)
- Laura Steponaviciene
- Laboratory of Cancer Epidemiology, National Cancer Institute,
Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences of the
Faculty of Medicine of Vilnius University, Lithuania
| | - Ieva Vincerzevskiene
- Laboratory of Cancer Epidemiology, National Cancer Institute,
Vilnius, Lithuania
| | - Ruta Briediene
- Department of Radiology, National Cancer Institute, Vilnius,
Lithuania
- Department of Radiology, Medical Physics and Nuclear Medicine,
Vilnius University, Vilnius, Lithuania
| | - Vincas Urbonas
- Laboratory of Clinical Oncology, National Cancer Institute, Vilnius,
Lithuania
| | | | - Giedre Smailyte
- Laboratory of Cancer Epidemiology, National Cancer Institute,
Vilnius, Lithuania
- Department of Public Health, Institute of Health Sciences of the
Faculty of Medicine of Vilnius University, Lithuania
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7
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Tumour characteristics of bilateral screen-detected cancers and bilateral interval cancers in women participating at biennial screening mammography. Eur J Radiol 2018; 108:215-221. [PMID: 30396659 DOI: 10.1016/j.ejrad.2018.09.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 09/20/2018] [Accepted: 09/21/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND Unilateral interval breast cancers show less favourable prognostic features than unilateral screen-detected cancers, but data on tumour characteristics of bilateral interval cancers in a systematically screened population are sparse. Therefore, we compared tumour characteristics of bilateral interval cancers with those of bilateral screen-detected cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all recalled women and of all women who presented with interval breast cancer. In women with synchronous bilateral breast cancer, the tumour with the highest tumour stage was defined as the index cancer. For comparison of data between both groups Fisher exact test and Chi-square test were used. RESULTS Synchronous bilateral cancer was diagnosed in 2.2% of screen-detected cancers (64/2947) and in 3.2% of interval cancers (24/753) (P = 0.1). Index tumours of bilateral screen-detected cancers and interval cancers showed similar characteristics, except for a larger proportion of T-stage 2 or worse (T2+) cancers among interval cancers (16/24 (66.7%) versus 23/58 (39.7%) (P = 0.03). Index cancers, compared to contralateral cancers, were less frequently stage T1 in both bilateral screen-detected cancers and bilateral interval cancers (35/64 (60.3%) versus 40/64 (88.9%) (P = 0.001) and 8/24 (33.3%) versus 18/24 (85.7%) (P < 0.001), respectively). In bilateral screen-detected cancers, contralateral cancers were more often stage 1a-c (P < 0.001) compared to index cancers. In bilateral index cancers, index cancers were more often of the lobular subtype (P < 0.001). CONCLUSION Index cancers of bilateral screen-detected cancers and bilateral interval cancers show significant differences in tumour size, whereas nodal status, receptor status and final surgical treatment are comparable. In bilateral screen-detected cancer, index cancers had a significantly higher tumour stage. In bilateral screen-detected cancer, index cancers were more often the ductal invasive subtype compared to contralateral cancers.
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Broeders MJM, Allgood P, Duffy SW, Hofvind S, Nagtegaal ID, Paci E, Moss SM, Bucchi L. The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review. BMC Cancer 2018; 18:860. [PMID: 30176813 PMCID: PMC6122725 DOI: 10.1186/s12885-018-4666-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 07/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Observational studies have reported conflicting results on the impact of mammography service screening programmes on the advanced breast cancer rate (ABCR), a correlation that was firmly established in randomized controlled trials. We reviewed and summarized studies of the effect of service screening programmes in the European Union on ABCR and discussed their limitations. Methods The PubMed database was searched for English language studies published between 01-01-2000 and 01–06-2018. After inspection of titles and abstracts, 220 of the 8644 potentially eligible papers were considered relevant. Their abstracts were reviewed by groups of two authors using predefined criteria. Fifty studies were selected for full paper review, and 22 of these were eligible. A theoretical framework for their review was developed. Review was performed using a ten-point checklist of the methodological caveats in the analysis of studies of ABCR and a standardised assessment form designed to extract quantitative and qualitative information. Results Most of the evaluable studies support a reduction in ABCR following the introduction of screening. However, all studies were challenged by issues of design and analysis which could at least potentially cause bias, and showed considerable variation in the estimated effect. Problems were observed in duration of follow-up time, availability of reliable reference ABCR, definition of advanced stage, temporal variation in the proportion of unknown-stage cancers, and statistical approach. Conclusions We conclude that much of the current controversy on the impact of service screening programmes on ABCR is due to observational data that were gathered and/or analysed with methodological approaches which could not capture stage effects in full. Future research on this important early indicator of screening effectiveness should focus on establishing consensus in the correct methodology. Electronic supplementary material The online version of this article (10.1186/s12885-018-4666-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M J M Broeders
- Radboud Institute for Health Sciences, Radboud university medical center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands. .,Dutch Expert Centre for Screening, Nijmegen, The Netherlands.
| | - P Allgood
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - S W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - S Hofvind
- Cancer Registry of Norway, Oslo, Norway
| | - I D Nagtegaal
- Department of Pathology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E Paci
- Retired, Clinical and Descriptive Epidemiology Unit, Cancer Research and Prevention Institute (ISPO), Florence, Italy
| | - S M Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - L Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori, IRST, IRCCS), Meldola, Forli, Italy
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9
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van Bommel RMG, Voogd AC, Nederend J, Setz-Pels W, Louwman MWJ, Strobbe LJ, Venderink D, Tjan-Heijnen VCG, Duijm LEM. Incidence and tumour characteristics of bilateral and unilateral interval breast cancers at screening mammography. Breast 2018; 38:101-106. [PMID: 29306176 DOI: 10.1016/j.breast.2017.12.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/23/2017] [Accepted: 12/26/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Detected by screening mammography, bilateral breast cancer has a different pathological profile compared to unilateral breast cancer. We investigated the incidence of bilateral interval breast cancers and compared their characteristics with those of unilateral interval breast cancers. METHODS We included all 468,720 screening mammograms of women who underwent biennial screening mammography in the South of the Netherlands between January 2005 and January 2015. We collected breast imaging reports, biopsy results and surgical reports of all referred women and of all women who presented with interval breast cancer. The tumour with the highest tumour stage (index cancer) was used for comparison with unilateral interval cancers. RESULTS A total of 753 interval cancers were detected, of which 24 (3.2%) were bilateral. Among the invasive interval cancers, bilateral cancers more frequently showed a lobular histology than unilateral cancers (37.5% (9/24) vs. 16.1% (111/691), P = .01). There is a trend towards a larger proportion of bilateral than unilateral interval cancers graded 1 (45.8% (11/24) vs. 27.8% (192/691), P = .08). There were no other statistically significant differences in tumour characteristics. Also, the proportion of interval cancers showing significant mammographic abnormalities at the latest screen was comparable for unilateral and bilateral interval cancers (23.0% vs. 25.0%, P = .9). DISCUSSION Bilateral interval cancers comprise a small proportion of all interval cancers. Except of a higher proportion of invasive lobular cancers and a more favourable histological grade of invasive cancers, tumour characteristics are comparable for bilateral and unilateral interval breast cancers.
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Affiliation(s)
- Rob M G van Bommel
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands.
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, GROW, P Debyelaan 1, 6229 HA, Maastricht, The Netherlands; Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Wikke Setz-Pels
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ, Eindhoven, The Netherlands
| | - Marieke W J Louwman
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), PO Box 19079, 3501 DB, Utrecht, The Netherlands
| | - Luc J Strobbe
- Department of Surgery, Canisius-Wilhelmina Hospital, PO Box 9015, 6500 GS, Nijmegen, The Netherlands
| | - Dick Venderink
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Vivianne C G Tjan-Heijnen
- Department of Internal Medicine, Division of Medical Oncology, GROW, Maastricht University Medical Centre, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg Door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Dutch Reference Centre for Screening, PO Box 6873, 6503GJ, Nijmegen, The Netherlands
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10
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Autier P, Boniol M. Mammography screening: A major issue in medicine. Eur J Cancer 2017; 90:34-62. [PMID: 29272783 DOI: 10.1016/j.ejca.2017.11.002] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 11/03/2017] [Indexed: 01/20/2023]
Abstract
Breast cancer mortality is declining in most high-income countries. The role of mammography screening in these declines is much debated. Screening impacts cancer mortality through decreasing the incidence of number of advanced cancers with poor prognosis, while therapies and patient management impact cancer mortality through decreasing the fatality of cancers. The effectiveness of cancer screening is the ability of a screening method to curb the incidence of advanced cancers in populations. Methods for evaluating cancer screening effectiveness are based on the monitoring of age-adjusted incidence rates of advanced cancers that should decrease after the introduction of screening. Likewise, cancer-specific mortality rates should decline more rapidly in areas with screening than in areas without or with lower levels of screening but where patient management is similar. These two criteria have provided evidence that screening for colorectal and cervical cancer contributes to decreasing the mortality associated with these two cancers. In contrast, screening for neuroblastoma in children was discontinued in the early 2000s because these two criteria were not met. In addition, overdiagnosis - i.e. the detection of non-progressing occult neuroblastoma that would not have been life-threatening during the subject's lifetime - is a major undesirable consequence of screening. Accumulating epidemiological data show that in populations where mammography screening has been widespread for a long time, there has been no or only a modest decline in the incidence of advanced cancers, including that of de novo metastatic (stage IV) cancers at diagnosis. Moreover, breast cancer mortality reductions are similar in areas with early introduction and high penetration of screening and in areas with late introduction and low penetration of screening. Overdiagnosis is commonplace, representing 20% or more of all breast cancers among women invited to screening and 30-50% of screen-detected cancers. Overdiagnosis leads to overtreatment and inflicts considerable physical, psychological and economic harm on many women. Overdiagnosis has also exerted considerable disruptive effects on the interpretation of clinical outcomes expressed in percentages (instead of rates) or as overall survival (instead of mortality rates or stage-specific survival). Rates of radical mastectomies have not decreased following the introduction of screening and keep rising in some countries (e.g. the United States of America (USA)). Hence, the epidemiological picture of mammography screening closely resembles that of screening for neuroblastoma. Reappraisals of Swedish mammography trials demonstrate that the design and statistical analysis of these trials were different from those of all trials on screening for cancers other than breast cancer. We found compelling indications that these trials overestimated reductions in breast cancer mortality associated with screening, in part because of the statistical analyses themselves, in part because of improved therapies and underreporting of breast cancer as the underlying cause of death in screening groups. In this regard, Swedish trials should publish the stage-specific breast cancer mortality rates for the screening and control groups separately. Results of the Greater New York Health Insurance Plan trial are biased because of the underreporting of breast cancer cases and deaths that occurred in women who did not participate in screening. After 17 years of follow-up, the United Kingdom (UK) Age Trial showed no benefit from mammography screening starting at age 39-41. Until around 2005, most proponents of breast screening backed the monitoring of changes in advanced cancer incidence and comparative studies on breast cancer mortality for the evaluation of breast screening effectiveness. However, in an attempt to mitigate the contradictions between results of mammography trials and population data, breast-screening proponents have elected to change the criteria for the evaluation of cancer screening effectiveness, giving precedence to incidence-based mortality (IBM) and case-control studies. But practically all IBM studies on mammography screening have a strong ecological component in their design. The two IBM studies done in Norway that meet all methodological requirements do not document significant reductions in breast cancer mortality associated with mammography screening. Because of their propensity to exaggerate the health benefits of screening, case-control studies may demonstrate that mammography screening could reduce the risk of death from diseases other than breast cancer. Numerous statistical model approaches have been conducted for estimating the contributions of screening and of patient management to reductions in breast cancer mortality. Unverified assumptions are needed for running these models. For instance, many models assume that if screening had not occurred, the majority of screen-detected asymptomatic cancers would have progressed to symptomatic advanced cancers. This assumption is not grounded in evidence because a large proportion of screen-detected breast cancers represent overdiagnosis and hence non-progressing tumours. The accumulation of population data in well-screened populations diminishes the relevance of model approaches. The comparison of the performance of different screening modalities - e.g. mammography, digital mammography, ultrasonography, magnetic resonance imaging (MRI), three-dimensional tomosynthesis (TDT) - concentrates on detection rates, which is the ability of a technique to detect more cancers than other techniques. However, a greater detection rate tells little about the capacity to prevent interval and advanced cancers and could just reflect additional overdiagnosis. Studies based on the incidence of advanced cancers and on the evaluation of overdiagnosis should be conducted before marketing new breast-imaging technologies. Women at high risk of breast cancer (i.e. 30% lifetime risk and more), such as women with BRCA1/2 mutations, require a close breast surveillance. MRI is the preferred imaging method until more radical risk-reduction options are eventually adopted. For women with an intermediate risk of breast cancer (i.e. 10-29% lifetime risk), including women with extremely dense breast at mammography, there is no evidence that more frequent mammography screening or screening with other modalities actually reduces the risk of breast cancer death. A plethora of epidemiological data shows that, since 1985, progress in the management of breast cancer patients has led to marked reductions in stage-specific breast cancer mortality, even for patients with disseminated disease (i.e. stage IV cancer) at diagnosis. In contrast, the epidemiological data point to a marginal contribution of mammography screening in the decline in breast cancer mortality. Moreover, the more effective the treatments, the less favourable are the harm-benefit balance of screening mammography. New, effective methods for breast screening are needed, as well as research on risk-based screening strategies.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at IPRI, International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, 69130 Ecully Lyon, France; International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France.
| | - Mathieu Boniol
- University of Strathclyde Institute of Global Public Health at IPRI, International Prevention Research Institute, Espace Européen, Building G, Allée Claude Debussy, 69130 Ecully Lyon, France; International Prevention Research Institute (iPRI), 95 Cours Lafayette, 69006 Lyon, France
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Autier P, Boniol M, Koechlin A, Pizot C, Boniol M. Effectiveness of and overdiagnosis from mammography screening in the Netherlands: population based study. BMJ 2017; 359:j5224. [PMID: 29208760 PMCID: PMC5712859 DOI: 10.1136/bmj.j5224] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective To analyse stage specific incidence of breast cancer in the Netherlands where women have been invited to biennial mammography screening since 1989 (ages 50-69) and 1997 (ages 70-75), and to assess changes in breast cancer mortality and quantified overdiagnosis.Design Population based study.Setting Mammography screening programme, the Netherlands.Participants Dutch women of all ages, 1989 to 2012.Main outcome measures Stage specific age adjusted incidence of breast cancer from 1989 to 2012. The extra numbers of in situ and stage 1 breast tumours associated with screening were estimated by comparing rates in women aged 50-74 with those in age groups not invited to screening. Overdiagnosis was estimated after subtraction of the lead time cancers. Breast cancer mortality reductions and overdiagnosis during 2010-12 were computed without (scenario 1) and with (scenario 2) a cohort effect on mortality secular trends.Results The incidence of stage 2-4 breast cancers in women aged 50 or more was 168 per 100 000 in 1989 and 166 per 100 000 in 2012. Screening would be associated with a 5% mortality reduction in scenario 1 and with no influence on mortality in scenario 2. In both scenarios, improved treatments would be associated with 28% reductions in mortality. Overdiagnosis has steadily increased over time with the extension of screening to women aged 70-75 and with the introduction of digital mammography. After deduction of clinical lead time cancers, 33% of cancers found in women invited to screening in 2010-12 and 59% of screen detected cancers would be overdiagnosed.Conclusions The Dutch mammography screening programme seems to have little impact on the burden of advanced breast cancers, which suggests a marginal effect on breast cancer mortality. About half of screen detected breast cancers would represent overdiagnosis.
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Affiliation(s)
- Philippe Autier
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
| | - Magali Boniol
- International Prevention Research Institute, Lyon, France
| | - Alice Koechlin
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
| | - Cécile Pizot
- International Prevention Research Institute, Lyon, France
| | - Mathieu Boniol
- University of Strathclyde Institute of Global Public Health at iPRI, Allée Claude Debussy, 69130 Ecully, Lyon, France
- International Prevention Research Institute, Lyon, France
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Trends in incidence and tumour grade in screen-detected ductal carcinoma in situ and invasive breast cancer. Breast Cancer Res Treat 2017; 166:307-314. [PMID: 28748346 DOI: 10.1007/s10549-017-4412-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 07/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE In a biennial screening mammography programme, we analysed the trends in incidence of screen-detected DCIS and invasive breast cancers in the era of screen-film mammography (SFM) screening, the period of the transition to full-field digital mammography (FFDM) screening and the period of FFDM screening. We also investigated a possible association between the incidence and grading of screen-detected DCIS and invasive breast cancer. METHODS In the southern part of the Netherlands, FFDM screening gradually replaced SFM screening between May 2009 and April 2010. We included a consecutive series of 484, 422 screens obtained between July 2005 and July 2015 and divided these screens into three groups; SFM-only cohort, transition cohort and FFDM-only cohort. RESULTS A total of 3059 referred women were diagnosed with DCIS (n = 623) or invasive breast cancer (n = 2436). The majority of DCIS were high-grade (48.2%), whereas the majority of the invasive breast cancers were low-grade (45.4%) or intermediate-grade (41.6%). The cancer detection rate (CDR) per 1000 screened women showed the same distribution by grade in both groups. The transition to FFDM was characterised by an increased overall detection rate of invasive cancers. CONCLUSIONS Screening mammography detects mostly high-grade DCIS and low- or intermediate-grade invasive cancers. The grade distribution as well as the CDR in the years after the introduction of FFDM remained stable compared to the era of SFM screening. By diagnosing and treating high-grade DCIS, which otherwise may develop into high-grade invasive carcinoma, our findings provide new evidence for the beneficial value of screening mammography programmes.
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Reduction in advanced breast cancer after introduction of a mammography screening program in Tyrol/Austria. Breast 2017; 33:178-182. [DOI: 10.1016/j.breast.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 11/21/2022] Open
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Puliti D, Bucchi L, Mancini S, Paci E, Baracco S, Campari C, Canuti D, Cirilli C, Collina N, Conti GM, Di Felice E, Falcini F, Michiara M, Negri R, Ravaioli A, Sassoli De' Bianchi P, Serafini M, Zorzi M, Caldarella A, Cataliotti L, Zappa M. Advanced breast cancer rates in the epoch of service screening: The 400,000 women cohort study from Italy. Eur J Cancer 2017; 75:109-116. [PMID: 28222306 DOI: 10.1016/j.ejca.2016.12.030] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/07/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND The objective of this study was to evaluate if mammography screening attendance is associated with a reduction in late-stage breast cancer incidence. METHODS The cohort included over 400,000 Italian women who were first invited to participate in regional screening programmes during the 1990s and were followed for breast cancer incidence for 13 years. We obtained individual data on their exposure to screening and correlated this with total and stage-specific breast cancer incidence. Socio-economic status and pre-screening incidence data were used to assess the presence of self-selection bias. RESULTS Overall, screening attendance was associated with a 10% excess risk of in situ and invasive breast cancer (IRR = 1.10; 95% confidence interval (CI): 1.06-1.14), which dropped to 5% for invasive cancers only (IRR = 1.05; 95% CI: 1.01-1.09). There were significant reductions among attenders for specific cancer stages; we observed a 39% reduction for T2 or larger (IRR = 0.61; 95% CI: 0.57-0.66), 19% for node positives (IRR = 0.81; 95% CI: 0.76-0.86) and 28% for stage II and higher (IRR = 0.72; 95% CI: 0.68-0.76). Our data suggest that the presence of self-selection bias is limited and, overall, invited women experienced a 17% reduction of advanced cancers compared with pre-screening rates. CONCLUSIONS Comparing attenders' and non-attenders' stage-specific breast cancer incidence, we have estimated that screening attendance is associated with a reduction of nearly 30% for stages II+.
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Affiliation(s)
- Donella Puliti
- ISPO - Cancer Research and Prevention Institute, Clinical Epidemiology, Florence 50141, Italy
| | - Lauro Bucchi
- Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Meldola, Forlì 47014, Italy
| | - Silvia Mancini
- Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Meldola, Forlì 47014, Italy
| | - Eugenio Paci
- ISPO - Cancer Research and Prevention Institute, Clinical Epidemiology, Florence 50141, Italy
| | | | - Cinzia Campari
- Planning and Control Staff, Local Health Unit, Reggio Emilia 42122, Italy; Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia 42122, Italy
| | - Debora Canuti
- Screening Center - Romagna Local Health Unit, Ravenna 48121, Italy
| | - Claudia Cirilli
- Unit of Epidemiology and Risk Communication, Local Health Unit, Modena 41126, Italy
| | - Natalina Collina
- Unit of Epidemiology, Health Promotion and Risk Communication, Department of Public Health, Bologna Local Health Authority, Bologna 40121, Italy
| | | | - Enza Di Felice
- Planning and Control Staff, Local Health Unit, Reggio Emilia 42122, Italy; Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia 42122, Italy
| | - Fabio Falcini
- Screening Center - Romagna Local Health Unit, Ravenna 48121, Italy
| | - Maria Michiara
- Medical Oncology Unit and Cancer Registry of Parma Province, University Hospital of Parma, 43100 Parma, Italy
| | - Rossella Negri
- Mammography Screening Center, Local Health Unit, Modena 41124, Italy
| | - Alessandra Ravaioli
- Romagna Cancer Registry, Romagna Cancer Institute (IRST) IRCCS, Meldola, Forlì 47014, Italy
| | | | - Monica Serafini
- Screening Center - Romagna Local Health Unit, Ravenna 48121, Italy
| | - Manuel Zorzi
- Veneto Cancer Registry, Veneto Region, Padua 35131, Italy
| | - Adele Caldarella
- ISPO - Cancer Research and Prevention Institute, Clinical Epidemiology, Florence 50141, Italy
| | - Luigi Cataliotti
- Breast Centres Certification and Senonetwork Italia Onlus, Florence 50129, Italy
| | - Marco Zappa
- ISPO - Cancer Research and Prevention Institute, Clinical Epidemiology, Florence 50141, Italy.
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Quantification of masking risk in screening mammography with volumetric breast density maps. Breast Cancer Res Treat 2017; 162:541-548. [PMID: 28161786 PMCID: PMC5332492 DOI: 10.1007/s10549-017-4137-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 01/30/2017] [Indexed: 11/27/2022]
Abstract
Purpose Fibroglandular tissue may mask breast cancers, thereby reducing the sensitivity of mammography. Here, we investigate methods for identification of women at high risk of a masked tumor, who could benefit from additional imaging. Methods The last negative screening mammograms of 111 women with interval cancer (IC) within 12 months after the examination and 1110 selected normal screening exams from women without cancer were used. From the mammograms, volumetric breast density maps were computed, which provide the dense tissue thickness for each pixel location. With these maps, three measurements were derived: (1) percent dense volume (PDV), (2) percent area where dense tissue thickness exceeds 1 cm (PDA), and (3) dense tissue masking model (DTMM). Breast density was scored by a breast radiologist using BI-RADS. Women with heterogeneously and extremely dense breasts were considered at high masking risk. For each masking measure, mammograms were divided into a high- and low-risk category such that the same proportion of the controls is at high masking risk as with BI-RADS. Results Of the women with IC, 66.1, 71.9, 69.2, and 63.0% were categorized to be at high masking risk with PDV, PDA, DTMM, and BI-RADS, respectively, against 38.5% of the controls. The proportion of IC at high masking risk is statistically significantly different between BI-RADS and PDA (p-value 0.022). Differences between BI-RADS and PDV, or BI-RADS and DTMM, are not statistically significant. Conclusion Measures based on density maps, and in particular PDA, are promising tools to identify women at high risk for a masked cancer.
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Abstract
The risk of breast cancer (BC) overdiagnosis attributed to mammography screening is an unresolved issue, complicated by heterogeneity in the methodology of quantifying its magnitude, and both political and scientific elements surrounding interpretation of the evidence on this phenomenon. Evidence from randomized trials and also from observational studies shows that mammography screening reduces the risk of BC death; similarly, these studies provide sufficient evidence that overdiagnosis represents a serious harm from population breast screening. For both these outcomes of screening, BC mortality reduction and overdiagnosis, estimates of magnitude vary between studies however overdiagnosis estimates are associated with substantial uncertainty. The trade-off between the benefit and the collective harms of BC screening, including false-positives and overdiagnosis, is more finely balanced than initially recognized, however the snapshot of evidence presented on overdiagnosis does not mean that breast screening is worthless. Future efforts should be directed towards (a) ensuring that any changes in the implementation of BC screening optimize the balance between benefit and harms, including assessing how planned or actual changes modify the risk of overdiagnosis; (b) informing women of all the outcomes that may affect them when they participate in screening using well-crafted and balanced information; and (c) investing in research that will help define and reduce the ensuing overtreatment of screen-detected BC.
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Affiliation(s)
- Nehmat Houssami
- Sydney School of Public Health, Sydney Medical School, University of Sydney, Sydney 2006, Australia
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Molinié F, Delacour-Billon S, Tretarre B, Delafosse P, Seradour B, Colonna M. Breast cancer incidence: Decreasing trend in large tumours in women aged 50-74. J Med Screen 2016; 24:189-194. [PMID: 27810986 DOI: 10.1177/0969141316672894] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective A decrease in advanced breast cancer incidence is considered an early indicator of breast cancer mortality reduction in a screening programme. We describe trends in breast cancer incidence according to tumour size and age in three French administrative areas, where an organized screening programme was implemented during the 1990s. Methods Our study included all 28,092 invasive breast cancers diagnosed from 2000 to 2010 in women living in three areas (Hérault, Isère, Loire-Atlantique). Age, year of diagnosis, and size of tumour at diagnosis was provided by the three area cancer registries. Poisson regression models were fitted to estimate changes in incidence over time, after adjustment for age and administrative area. Results From 2000 to 2010, the incidence rate of large (tumour size >20 mm) breast cancer linearly decreased in women aged 50-74 (target age of the screening programme) from 108.4 to 84.1/100,000 (annual percent change = -1.9%, p < 0.001). No change in large breast cancer incidence rate was found in women aged 20-49, or older than 74. Conclusions A decreasing trend in incidence of large tumour size breast cancer in the target age of the screening programme is demonstrated for the first time in France. The overall 20.9% linear decrease over 11 years in these three areas is encouraging and should be closely monitored and extended to other areas of France, where the screening programme was generally implemented only in 2004.
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Affiliation(s)
| | | | | | | | - Brigitte Seradour
- 4 Breast Cancer Organized screening in Bouches du Rhône ARCADES, Marseille, France
| | - Marc Colonna
- 3 Isère Cancer Registry, CHU de Grenoble, La Tronche, France
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Simbrich A, Wellmann I, Heidrich J, Heidinger O, Hense HW. Trends in advanced breast cancer incidence rates after implementation of a mammography screening program in a German population. Cancer Epidemiol 2016; 44:44-51. [PMID: 27470937 DOI: 10.1016/j.canep.2016.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/04/2016] [Accepted: 07/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Mammography screening programs (MSPs) aim to detect early-stage breast cancers in order to decrease the incidence of advanced-stage breast cancers and to reduce breast cancer mortality. We analyzed the time trends of advanced-stage breast cancer incidence rates in the target population before and after implementation of the MSP in a region of northwestern Germany. METHODS The MSP in the Münster district started in October 2005. A total of 13,874 women with an incident invasive breast cancer (BC) was identified by the population-based epidemiological cancer registry between 2000 and 2013 in the target group 50-69 years. Multiple imputation methods were used to replace missing data on tumor stages (10.4%). The incidence rates for early-stage (UICC I) and advanced-stage (UICC II+) BC were determined, and Poisson regression analyses were performed to assess trends over time. RESULTS The incidence rates for UICC I breast cancers increased during the step-up introduction of the MSP and remained elevated thereafter. By contrast, after increasing from 2006 to 2008, the incidence rates of UICC II+ breast cancers decreased to levels below the pre-screening period. Significantly decreasing UICC II+ incidence rates were limited to the age group 55-69 years and reached levels that were significantly lower than incidence rates in the pre-screening period. DISCUSSION The incidence rates of advanced-stage breast cancers decreased in the age groups from 55 years to the upper age limit for screening eligibility, but not in the adjacent age groups. The findings are consistent with MSP lead time effects and seem to indicate that the MSP lowers advanced-stage breast cancer rates in the target population.
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Affiliation(s)
- Alexandra Simbrich
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Ina Wellmann
- Institute of Epidemiology and Social Medicine, University of Münster, Germany
| | - Jan Heidrich
- Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany
| | - Oliver Heidinger
- Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Münster, Germany; Epidemiological Cancer Registry North Rhine-Westphalia, Münster, Germany.
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Characteristics and prognosis of interval cancers after biennial screen-film or full-field digital screening mammography. Breast Cancer Res Treat 2016; 158:471-83. [DOI: 10.1007/s10549-016-3882-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
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Christgen M, Steinemann D, Kühnle E, Länger F, Gluz O, Harbeck N, Kreipe H. Lobular breast cancer: Clinical, molecular and morphological characteristics. Pathol Res Pract 2016; 212:583-97. [DOI: 10.1016/j.prp.2016.05.002] [Citation(s) in RCA: 82] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 04/11/2016] [Accepted: 05/04/2016] [Indexed: 01/20/2023]
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Tesser CD, d'Ávila TLDC. [Why reconsider the recommendation of breast cancer screening?]. CAD SAUDE PUBLICA 2016; 32:S0102-311X2016000500706. [PMID: 27253456 DOI: 10.1590/0102-311x00095914] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 09/09/2015] [Indexed: 11/22/2022] Open
Abstract
The aim of this article was to discuss the recommendation of mammogram screening for breast cancer and its technical basis. The first part discusses criteria for the decision, which should be consistent with high-quality scientific evidence. The second part discusses over-diagnosis (the greatest harm of screening) and its meaning in questioning the natural history of disease model. The third part summarizes studies on the efficacy, effectiveness, and harms of screening, showing that the latter (especially over-diagnosis and false-positives) are significant, shedding doubt on the balance between harms and benefits. In conclusion, the recommendation of mammogram screening at any age should be reconsidered by Brazilian health authorities.
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Affiliation(s)
- Charles Dalcanale Tesser
- Universidade Federal de Santa Catarina, Florianópolis, Brasil., Universidade Federal de Santa Catarina, Universidade Federal de Santa Catarina, Florianópolis , Brazil
| | - Thiago Luiz de Campos d'Ávila
- Universidade Federal de Santa Catarina, Florianópolis, Brasil., Universidade Federal de Santa Catarina, Universidade Federal de Santa Catarina, Florianópolis , Brazil.,Secretaria Municipal de Saúde de Florianópolis, Florianópolis, Brasil., Secretaria Municipal de Saúde de Florianópolis, Secretaria Municipal de Saúde de Florianópolis, Florianópolis , Brazil
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Armaroli P, Villain P, Suonio E, Almonte M, Anttila A, Atkin WS, Dean PB, de Koning HJ, Dillner L, Herrero R, Kuipers EJ, Lansdorp-Vogelaar I, Minozzi S, Paci E, Regula J, Törnberg S, Segnan N. European Code against Cancer, 4th Edition: Cancer screening. Cancer Epidemiol 2015; 39 Suppl 1:S139-52. [PMID: 26596722 DOI: 10.1016/j.canep.2015.10.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 12/23/2022]
Abstract
In order to update the previous version of the European Code against Cancer and formulate evidence-based recommendations, a systematic search of the literature was performed according to the methodology agreed by the Code Working Groups. Based on the review, the 4th edition of the European Code against Cancer recommends: "Take part in organized cancer screening programmes for: Bowel cancer (men and women); Breast cancer (women); Cervical cancer (women)." Organized screening programs are preferable because they provide better conditions to ensure that the Guidelines for Quality Assurance in Screening are followed in order to achieve the greatest benefit with the least harm. Screening is recommended only for those cancers where a demonstrated life-saving effect substantially outweighs the potential harm of examining very large numbers of people who may otherwise never have, or suffer from, these cancers, and when an adequate quality of the screening is achieved. EU citizens are recommended to participate in cancer screening each time an invitation from the national or regional screening program is received and after having read the information materials provided and carefully considered the potential benefits and harms of screening. Screening programs in the European Union vary with respect to the age groups invited and to the interval between invitations, depending on each country's cancer burden, local resources, and the type of screening test used For colorectal cancer, most programs in the EU invite men and women starting at the age of 50-60 years, and from then on every 2 years if the screening test is the guaiac-based fecal occult blood test or fecal immunochemical test, or every 10 years or more if the screening test is flexible sigmoidoscopy or total colonoscopy. Most programs continue sending invitations to screening up to the age of 70-75 years. For breast cancer, most programs in the EU invite women starting at the age of 50 years, and not before the age of 40 years, and from then on every 2 years until the age of 70-75 years. For cervical cancer, if cytology (Pap) testing is used for screening, most programs in the EU invite women starting at the age of 25-30 years and from then on every 3 or 5 years. If human papillomavirus testing is used for screening, most women are invited starting at the age of 35 years (usually not before age 30 years) and from then on every 5 years or more. Irrespective of the test used, women continue participating in screening until the age of 60 or 65 years, and continue beyond this age unless the most recent test results are normal.
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Affiliation(s)
- Paola Armaroli
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Patricia Villain
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Eero Suonio
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1NY, United Kingdom
| | - Peter B Dean
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Harry J de Koning
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Lena Dillner
- Department of Infectious Disease, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Eugenio Paci
- ISPO-Cancer Prevention and Research Institute, Occupational and Environmental Epidemiology Unit, Ponte Nuovo - Padiglione Mario Fiori, Via delle Oblate 2, 50141 Florence, Italy
| | - Jaroslaw Regula
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Gastroenterology, 02-781 Warsaw, Poland
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm Regional Cancer Centre, PO Box 6909, S-102 39 Stockholm, Sweden
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy.
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Wolters R, Wischhusen J, Stüber T, Weiss CR, Krockberger M, Bartmann C, Blettner M, Janni W, Kreienberg R, Schwentner L, Novopashenny I, Wischnewsky M, Wöckel A, Diessner J. Guidelines are advantageous, though not essential for improved survival among breast cancer patients. Breast Cancer Res Treat 2015; 152:357-66. [PMID: 26105798 DOI: 10.1007/s10549-015-3484-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Accepted: 06/19/2015] [Indexed: 11/29/2022]
Abstract
The purpose of this retrospective multicenter study was to resolve the pseudo-paradox that the clinical outcome of women affected by breast cancer has improved during the last 20 years irrespective of whether they were treated in accordance with clinical guidelines or not. This retrospective German multicenter study included 9061 patients with primary breast cancer recruited from 1991 to 2009. We formed subgroups for the time intervals 1991-2000 (TI1) and 2001-2009 (TI2). In these subgroups, the risk of recurrence (RFS) and overall survival (OS) were compared between patients whose treatment was either 100% guideline-conforming or, respectively, non-guideline-conforming. The clinical outcome of all patients significantly improved in TI2 compared to TI1 [RFS: p < 0.001, HR = 0.57, 95% CI (0.49-0.67); OS: p < 0.001, HR = 0.76, 95% (CI 0.66-0.87)]. OS and RFS of guideline non-adherent patients also improved in TI2 compared to TI. Comparing risk profiles, determined by Nottingham Prognostic Score reveals a significant (p = 0.001) enhancement in the time cohort TI2. Furthermore, the percentage of guideline-conforming systemic therapy (endocrine therapy and chemotherapy) significantly increased (p < 0.001) in the time cohort TI2 to TI for the non-adherent group. The general improvement of clinical outcome of patients during the last 20 years is also valid in the subgroup of women who received treatments, which deviated from the guidelines. The shift in risk profiles as well as medical advances are major reasons for this improvement. Nevertheless, patients with 100% guideline-conforming therapy always had a better outcome compared to patients with guideline non-adherent therapy.
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Affiliation(s)
- Regine Wolters
- Faculty of Mathematics and Computer Science, University of Bremen, Universitätsallee GW1, 28359, Bremen, Germany
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25
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Digital mammography screening in Germany: Impact of age and histological subtype on program sensitivity. Breast 2015; 24:191-6. [DOI: 10.1016/j.breast.2014.12.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/30/2022] Open
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Natal C, Caicoya M, Prieto M, Tardón A. [Breast cancer incidence related with a population-based screening program]. Med Clin (Barc) 2015; 144:156-60. [PMID: 25194975 DOI: 10.1016/j.medcli.2014.04.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 04/15/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To compare breast cancer cumulative incidence, time evolution and stage at diagnosis between participants and non-participant women in a population-based screening program. METHODS Cohort study of breast cancer incidence in relation to participation in a population screening program. The study population included women from the target population of the screening program. The source of information for diagnostics and stages was the population-based cancer registry. The analysis period was 1999-2010. RESULTS The Relative Risk for invasive, in situ, and total cancers diagnosed in participant women compared with non-participants were respectively 1.16 (0.94-1.43), 2.98 (1.16-7.62) and 1.22 (0.99-1.49). The Relative Risk for participants versus non-participants was 2.47 (1.55-3.96) for diagnosis at stagei, 2.58 (1.67-3.99) for T1 and 2.11 (1.38-3.23) for negative lymph node involvement. The cumulative incidence trend had two joint points in both arms, with an Annual Percent of Change of 92.3 (81.6-103.5) between 1999-2001, 18.2 (16.1-20.3) between 2001-2005 and 5.9 (4.0-7.8) for the last period in participants arm, and 72.6 (58.5-87.9) between 1999-2001, 12.6 (7.9-17.4) between 2001-2005, and 8.6 (6.5-10.6) in the last period in the non-participant arm. CONCLUSIONS Participating in the breast cancer screening program analyzed increased the in situ cumulative cancer incidence, but not the invasive and total incidence. Diagnoses were earlier in the participant arm.
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Affiliation(s)
- Carmen Natal
- Servicio de Salud del Principado de Asturias, Oviedo, Asturias, España.
| | - Martín Caicoya
- Consejería de Sanidad del Principado de Asturias, Oviedo, Asturias, España
| | - Miguel Prieto
- Consejería de Sanidad del Principado de Asturias, Oviedo, Asturias, España
| | - Adonina Tardón
- Instituto Universitario de Oncología, Universidad de Oviedo, Oviedo, Asturias, España
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27
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Tamura N, Tsuda H, Yoshida M, Hojo T, Akashi-Tanaka S, Kinoshita T, Sugihara K. Clinicopathological predictive factors for ipsilateral and contralateral events following initial surgery to treat ductal carcinoma in situ. Breast Cancer 2015; 23:510-8. [PMID: 25666939 PMCID: PMC4839035 DOI: 10.1007/s12282-015-0595-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 01/28/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Ipsilateral breast tumor recurrence (IBTR) after partial breast resection and contralateral breast tumor recurrence (CBTR) have been shown to occur relatively frequently in patients with ductal carcinoma in situ (DCIS). However, there is only limited data from Japanese institutes to support this. METHODS Of 301 consecutive DCIS patients, 179 patients underwent a mastectomy, and the other 122 underwent partial resection in the National Cancer Center Hospital, Tokyo, with a median follow-up period of 2,106 days. We reviewed clinicopathological parameters including age, menopausal status, body mass index, family history (FH) of breast cancer, tumor size, histological subtype, nuclear grade (NG), hormone receptor (HR) and human epidermal growth factor receptor 2 (HER2) status, treatment, and the surgical margin status of partially resected specimens. The risk associated with each of these parameters for IBTR in 122 patients who underwent partial resections, and for CBTR in a total of 301 patients were calculated using Cox proportional hazard general linear models. RESULTS Of the 122 patients who underwent partial breast resection, IBTR occurred in 7 (5.7%). The risk of IBTR was higher or tended to be higher in younger patients or those with lower NG tumors, but did not change significantly with respect to margin status or irradiation. Amongst the entire cohort of 301 patients, CBTR occurred in 18 cases (6.0%). CBTR occurred significantly more frequently in patients with a FH of breast cancer and with HR+/HER2- subtype tumors by univariate analyses, and tumor subtype was an independent risk factor for CBTR by multivariate analysis. CONCLUSIONS The local recurrence rate was low following partial resection of DCIS. Younger age was a risk factor for IBTR, whereas the HR+/HER2- tumor subtype and a FH of breast cancer were risk factors for CBTR.
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Affiliation(s)
- Nobuko Tamura
- Department of Breast and Endocrine Surgery, Toranomon Hospital, Tokyo, Japan.,Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan.,Surgical Oncology Division, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hitoshi Tsuda
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan. .,Department of Basic Pathology, National Defense Medical College, Namiki 3-2, Tokorozawa, Saitama, 359-8513, Japan.
| | - Masayuki Yoshida
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, Tokyo, Japan
| | - Takashi Hojo
- Breast Surgery Division, National Cancer Center Hospital, Tokyo, Japan
| | - Sadako Akashi-Tanaka
- Division of breast Surgical Oncology, Showa University School of Medicine, Tokyo, Japan
| | | | - Kenichi Sugihara
- Surgical Oncology Division, Tokyo Medical and Dental University, Tokyo, Japan
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28
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Histopathological characterization of ulcerated breast cancer and comparison to their non-ulcerated counterparts. Tumour Biol 2014; 36:3423-8. [DOI: 10.1007/s13277-014-2977-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 12/11/2014] [Indexed: 10/24/2022] Open
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29
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Tabár L, Yen AMF, Wu WYY, Chen SLS, Chiu SYH, Fann JCY, Ku MMS, Smith RA, Duffy SW, Chen THH. Insights from the Breast Cancer Screening Trials: How Screening Affects the Natural History of Breast Cancer and Implications for Evaluating Service Screening Programs. Breast J 2014; 21:13-20. [DOI: 10.1111/tbj.12354] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- László Tabár
- Department of Mammography; Central Hospital; Falun Sweden
| | | | - Wendy Yi-Ying Wu
- Graduate Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | | | - Sherry Yueh-Hsia Chiu
- Department and Graduate Institute of Health Care Management; Chang Gung University; Taoyuan Taiwan
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management; College of Healthcare Management; Kainan University; Taoyuan Taiwan
| | - May Mei-Sheng Ku
- Graduate Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | | | - Stephen W Duffy
- Centre for Cancer Prevention; Wolfson Institute of Preventive Medicine; Queen Mary University of London; London UK
| | - Tony Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
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30
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de Glas NA, de Craen AJM, Bastiaannet E, Op 't Land EG, Kiderlen M, van de Water W, Siesling S, Portielje JEA, Schuttevaer HM, de Bock GTH, van de Velde CJH, Liefers GJ. Effect of implementation of the mass breast cancer screening programme in older women in the Netherlands: population based study. BMJ 2014; 349:g5410. [PMID: 25224469 PMCID: PMC4164134 DOI: 10.1136/bmj.g5410] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the incidence of early stage and advanced stage breast cancer before and after the implementation of mass screening in women aged 70-75 years in the Netherlands in 1998. DESIGN Prospective nationwide population based study. SETTING National cancer registry, the Netherlands. PARTICIPANTS Patients aged 70-75 years with a diagnosis of invasive or ductal carcinoma in situ breast cancer between 1995 and 2011 (n=25,414). Incidence rates were calculated using population data from Statistics Netherlands. MAIN OUTCOME MEASURE Incidence rates of early stage (I, II, or ductal carcinoma in situ) and advanced stage (III and IV) breast cancer before and after implementation of screening. Hypotheses were formulated before data collection. RESULTS The incidence of early stage tumours significantly increased after the extension for implementation of screening (248.7 cases per 100,000 women before screening up to 362.9 cases per 100,000 women after implementation of screening, incidence rate ratio 1.46, 95% confidence interval 1.40 to 1.52, P<0.001). However, the incidence of advanced stage breast cancers decreased to a far lesser extent (58.6 cases per 100,000 women before screening to 51.8 cases per 100,000 women after implementation of screening, incidence rate ratio 0.88, 0.81 to 0.97, P<0.001). CONCLUSIONS The extension of the upper age limit to 75 years has only led to a small decrease in incidence of advanced stage breast cancer, while that of early stage tumours has strongly increased.
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Affiliation(s)
- Nienke A de Glas
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Anton J M de Craen
- Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Esther Bastiaannet
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Ester G Op 't Land
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands
| | - Mandy Kiderlen
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Willemien van de Water
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands Department of Gerontology and Geriatrics, Leiden University Medical Centre, Leiden, Netherlands
| | - Sabine Siesling
- Department of Research, Comprehensive Cancer Centre the Netherlands, Utrecht, Netherlands
| | | | | | - Geertruida Truuske H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Cornelis J H van de Velde
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands
| | - Gerrit-Jan Liefers
- Department of Surgery, Leiden University Medical Centre, PO Box 9600, Postzone K6-R, 2300 RC, Leiden, Netherlands
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Román M, Rué M, Sala M, Ascunce N, Baré M, Baroja A, De la Vega M, Galcerán J, Natal C, Salas D, Sánchez-Jacob M, Zubizarreta R, Castells X. Trends in detection of invasive cancer and ductal carcinoma in situ at biennial screening mammography in Spain: a retrospective cohort study. PLoS One 2013; 8:e83121. [PMID: 24376649 PMCID: PMC3871523 DOI: 10.1371/journal.pone.0083121] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2013] [Accepted: 10/31/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Breast cancer incidence has decreased in the last decade, while the incidence of ductal carcinoma in situ (DCIS) has increased substantially in the western world. The phenomenon has been attributed to the widespread adaption of screening mammography. The aim of the study was to evaluate the temporal trends in the rates of screen detected invasive cancers and DCIS, and to compare the observed trends with respect to hormone replacement therapy (HRT) use along the same study period. METHODS Retrospective cohort study of 1,564,080 women aged 45-69 years who underwent 4,705,681 screening mammograms from 1992 to 2006. Age-adjusted rates of screen detected invasive cancer, DCIS, and HRT use were calculated for first and subsequent screenings. Poisson regression was used to evaluate the existence of a change-point in trend, and to estimate the adjusted trends in screen detected invasive breast cancer and DCIS over the study period. RESULTS The rates of screen detected invasive cancer per 100.000 screened women were 394.0 at first screening, and 229.9 at subsequent screen. The rates of screen detected DCIS per 100.000 screened women were 66.8 at first screen and 43.9 at subsequent screens. No evidence of a change point in trend in the rates of DCIS and invasive cancers over the study period were found. Screen detected DCIS increased at a steady 2.5% per year (95% CI: 1.3; 3.8), while invasive cancers were stable. CONCLUSION Despite the observed decrease in breast cancer incidence in the population, the rates of screen detected invasive cancer remained stable during the study period. The proportion of DCIS among screen detected breast malignancies increased from 13% to 17% throughout the study period. The rates of screen detected invasive cancer and DCIS were independent of the decreasing trend in HRT use observed among screened women after 2002.
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MESH Headings
- Aged
- Breast Neoplasms/diagnosis
- Breast Neoplasms/diagnostic imaging
- Breast Neoplasms/epidemiology
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/diagnostic imaging
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/diagnostic imaging
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Early Detection of Cancer/trends
- Female
- Hormone Replacement Therapy/statistics & numerical data
- Humans
- Incidence
- Mammography
- Mass Screening/statistics & numerical data
- Middle Aged
- Retrospective Studies
- Spain/epidemiology
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Affiliation(s)
- Marta Román
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
| | - Montse Rué
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Basic Medical Sciences Department, Biomedical Research Institut of Lleida (IRBLLEIDA)-University of Lleida, Lleida, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nieves Ascunce
- Navarra Breast Cancer Screening Programme, Public Health Institute, Pamplona, Navarra, Spain
| | - Marisa Baré
- Oficina Tècnica de Cribratge, Corporació Sanitaria Parc Taulí-Institut Universitari Parc Taulí-UAB, Sabadell, Barcelona, Spain
| | - Araceli Baroja
- La Rioja Breast Cancer Screening Programme, Fundacion Rioja Salud, Logroño, La Rioja, Spain
| | - Mariola De la Vega
- Dirección General de Programas Asistenciales, Consejería de Sanidad, Servicio Canario de Salud, Tenerife, Santa Cruz de Tenerife, Spain
| | - Jaume Galcerán
- Foundation Society for Cancer Research and Prevention, Pere Virgili Health Research Institute, Reus, Tarragona, Spain
| | - Carmen Natal
- Program & Analysis Unit, Health Office, Oviedo, Principado de Asturias, Spain
| | - Dolores Salas
- General Directorate Public Health & Centre for Public Health Research, Valencia, Comunidad Valenciana, Spain
| | - Mercedes Sánchez-Jacob
- Servicio de Promoción de la Salud y Programas Preventivos, Consejería de Sanidad, Valladolid, Castilla y León, Spain
| | - Raquel Zubizarreta
- Galician Breast Cancer Screening Programme, Public Health & Planning Directorate, Health Office, Santiago de Compostela, La Coruña, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Network for Research into Healthcare in Chronic Diseases (REDISECC), Madrid, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
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Interval breast cancers: absolute and proportional incidence and blinded review in a community mammographic screening program. Eur J Radiol 2013; 83:e84-91. [PMID: 24369953 DOI: 10.1016/j.ejrad.2013.11.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 11/15/2013] [Accepted: 11/22/2013] [Indexed: 11/22/2022]
Abstract
PURPOSE To evaluate the performance of the first years since the beginning of a mammographic population-based screening program. MATERIALS AND METHODS Women aged 49-69 were invited biennially for two-view film-screen mammography and double reading without arbitration was performed. Interval cancers (ICs) from 2001 to 2006 were identified using screening archives, local pathology archives, and hospital discharge records. The proportional incidence of IC was determined considering breast cancers expected without screening. Three offsite radiologists experienced in breast cancer screening blindly evaluated mammograms prior to diagnosis, randomly mixed with negative mammograms (1:2 ratio). Cases unrecalled at review were considered as true ICs, those recalled by only one reviewer as minimal signs, and those recalled by two or three reviewers as missed cancers. T and N stage of the reviewed ICs were evaluated and compared. RESULTS A total of 86,276 first level mammograms were performed. Mean recall rate was 6.8% at first and 4.6% at repeat screening. We had 476 screen-detected cancers and 145 ICs (10 of them ductal carcinomas in situ). Absolute incidence was 17 per 10,000 screening examinations. Invasive proportional incidence was 19% (44/234) in the first year, 39% (91/234) in the second year, and 29% (135/468) in the two-year interval. Of 145 ICs, 130 (90%) were reviewed mixed with 287 negative controls: 55% (71/130) resulted to be true ICs, 24% (31/130) minimal signs, and 22% (28/130) missed cancers. The rate of ICs diagnosed in the first year interval was 21% (15/71) for true ICs, 46% (13/28) for missed cancers, and 39% (12/31) for minimal signs, with a significant difference of true ICs rate compared to missed cancers rate (p=0.012). A higher rate of T3 and T4 stages was found for missed cancers (18%, 5/28) compared to minimal signs (6%, 2/31) or true ICs (8%, 6/71), while the rate of N2 and N3 stage for both minimal signs (19%, 6/31) or missed cancers (25%, 7/28) was higher than that for true ICs (10%, 7/71), although all these differences were not significant (p ≥ 0.480). CONCLUSION These results showed the possibility to comply with European Community standards in the first years of a screening program implementation.
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Nederend J, Duijm LEM, Louwman MWJ, Coebergh JW, Roumen RMH, Lohle PN, Roukema JA, Rutten MJCM, van Steenbergen LN, Ernst MF, Jansen FH, Plaisier ML, Hooijen MJHH, Voogd AC. Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment - a population based study from the Netherlands. Eur J Cancer 2013; 50:31-9. [PMID: 24275518 DOI: 10.1016/j.ejca.2013.09.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Revised: 08/17/2013] [Accepted: 09/30/2013] [Indexed: 11/29/2022]
Abstract
INTRODUCTION In most breast screening programmes screen-film mammography (SFM) has been replaced by full-field digital mammography (FFDM). We compared interval cancer characteristics at SFM and FFDM screening mammography. PATIENTS AND METHODS We included all 297 screen-detected and 104 interval cancers in 60,770 SFM examinations and 427 screen-detected and 124 interval cancers in 63,182 FFDM examinations, in women screened in the period 2008-2010. Breast imaging reports, biopsy results and surgical reports of all cancers were collected. Two radiologists reviewed prior and diagnostic mammograms of all interval cancers. They determined breast density, described mammographic abnormalities and classified interval cancers as missed, showing a minimal sign abnormality or true negative. RESULTS The referral rate and cancer detection at SFM were 1.5% and 4.9‰ respectively, compared to 3.0% (p<0.001) and 6.6‰ (p<0.001) at FFDM. Screening sensitivity was 74.1% at SFM (297/401, 95% confidence interval (CI)=69.8-78.4%) and 77.5% at FFDM (427/551, 95% CI=74.0-81.0%). Significantly more interval cancers were true negative at prior FFDM than at prior SFM screening mammography (65.3% (81/124) versus 47.1% (49/104), p=0.02). For interval cancers following SFM or FFDM screening mammography, no significant differences were observed in breast density or mammographic abnormalities at the prior screen, tumour size, lymph node status, receptor status, Nottingham tumour grade or surgical treatment (mastectomy versus breast conserving therapy). CONCLUSION FFDM resulted in a significantly higher cancer detection rate, but sensitivity was similar for SFM and FFDM. Interval cancers are more likely to be true negative at prior FFDM than at prior SFM screening mammography, whereas their tumour characteristics and type of surgical treatment are comparable.
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Affiliation(s)
- Joost Nederend
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands.
| | - Lucien E M Duijm
- Department of Radiology, Canisius Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ Nijmegen, The Netherlands
| | - Marieke W J Louwman
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Jan Willem Coebergh
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Rudi M H Roumen
- Department of Surgery, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Paul N Lohle
- Department of Radiology, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Jan A Roukema
- Department of Surgery, St. Elisabeth Hospital, Hilvarenbeekseweg 60, 5022 GC Tilburg, The Netherlands
| | - Matthieu J C M Rutten
- Department of Radiology, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands
| | - Liza N van Steenbergen
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands
| | - Miranda F Ernst
- Department of Surgery, Jeroen Bosch Hospital, Vlijmenseweg 10, 5223 GW 's-Hertogenbosch, The Netherlands
| | - Frits H Jansen
- Department of Radiology, Catharina Hospital, Michelangelolaan 2, 5623EJ Eindhoven, The Netherlands
| | - Menno L Plaisier
- Department of Radiology, Maxima Medical Centre, De Run 4600, 5504 DB Veldhoven, The Netherlands
| | - Marianne J H H Hooijen
- Department of Radiology, St. Anna Hospital, Bogardeind 2, 5664 EH Geldrop, The Netherlands
| | - Adri C Voogd
- Comprehensive Cancer Centre South (IKZ)/Eindhoven Cancer Registry, Zernikestraat 29, 5612HZ Eindhoven, The Netherlands; Department of Epidemiology, Maastricht University, P Debyelaan 1, 6229 HA Maastricht, The Netherlands
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Setz-Pels W, Duijm LEM, Coebergh JW, Rutten M, Nederend J, Voogd AC. Re-attendance after false-positive screening mammography: a population-based study in the Netherlands. Br J Cancer 2013; 109:2044-50. [PMID: 24052045 PMCID: PMC3798969 DOI: 10.1038/bjc.2013.573] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 08/20/2013] [Accepted: 08/26/2013] [Indexed: 11/09/2022] Open
Abstract
Background: In the current study, mammography adherence of women who had experienced a false-positive referral is evaluated, with emphasis on the probability of receiving surveillance mammography outside the national screening programme. Methods: We included 424 703 consecutive screens and collected imaging, biopsy and surgery reports of 3463 women who experienced a false-positive referral. Adherence to screening, both in and outside the screening programme, was evaluated. Results: Two years after the false-positive referral, overall screening adherence was 94.6%, with 64.7% of women returning to the national screening programme, compared with 94.9% of women re-attending the screening programme after a negative screen (P<0.0001). Four years after the false-positive screen, the overall adherence had decreased to 85.2% (P<0.0001) with a similar proportion of the women re-attending the screening programme (64.4%) and a lower proportion (20.8%) having clinical surveillance mammography. Women who had experienced a false-positive screen at their first screening round were less likely to adhere to mammography than women with an abnormal finding at one of the following screening rounds (92.4% vs 95.5%, P<0.0001). Conclusion: Overall screening adherence after previous false-positive referral was comparable to the re-attendance rate of women with a negative screen at 2-year follow-up. Overall adherence decreased 4 years after previous false-positive referral from 94.6% to 85.2%, with a relatively high estimate of women who continue with clinical surveillance mammography (20.8%). Women with false-positive screens should be made aware of the importance to re-attend future screening rounds, as a way to improve the effectiveness of the screening programme.
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Affiliation(s)
- W Setz-Pels
- Department of Radiology, Catharina Hospital, PO Box 1350, 5602 ZA, Eindhoven, The Netherlands
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Autier P. Mammography screening and women with symptomatic breast cancer. Nat Rev Clin Oncol 2013; 10:nrclinonc.2012.126-c3. [DOI: 10.1038/nrclinonc.2012.126-c3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer 2013; 108:2205-40. [PMID: 23744281 PMCID: PMC3693450 DOI: 10.1038/bjc.2013.177] [Citation(s) in RCA: 602] [Impact Index Per Article: 54.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- M G Marmot
- UCL Department of Epidemiology and Public Health, UCL Institute of Health Equity, 1-19 Torrington Place, London WC1E 7HB,
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Ravi C, Rodrigues G. Accuracy of clinical examination of breast lumps in detecting malignancy: a retrospective study. Indian J Surg Oncol 2013; 3:154-7. [PMID: 23730103 DOI: 10.1007/s13193-012-0151-5] [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] [Received: 02/04/2012] [Accepted: 04/24/2012] [Indexed: 11/24/2022] Open
Abstract
Clinical examination is a simple method to detect breast lumps and their nature as it is inexpensive and non-invasive and if found to be accurate, might be of great value as a diagnostic tool. The aim of this study was to evaluate the accuracy of clinical examination and its contribution towards the diagnosis of a palpable breast lump. The study was record based and conducted at a University Medical College Hospital and a tertiary referral centre of South India. Patient files of those women who presented with a breast lump between January to December 2011 were studied. A total of 120 patients were obtained following necessary exclusions. The accuracy of clinical assessment at an outpatient facility was determined by comparing the physician's diagnosis with the final histopathological diagnosis. The inter-observer agreement (kappa) for diagnosing a breast lump was 81 % (95 % Confidence Interval = 71 % to 92 %) indicating a good agreement between clinical and pathological diagnoses. McNemar test also indicated a high degree of concordance between the two diagnoses (4.17 % discordance). Sensitivity, specificity, positive and negative predictive values of clinical breast examination in comparison to histopathology were 95, 88, 87, and 95 % respectively, with an overall accuracy of 90.8 %. 11 lumps were wrongly diagnosed at the time of clinical examination. Clinical examination of breast lumps was found to have a high sensitivity (94.5 %) and specificity (87.7 %) and can be used as the diagnostic tool to identify the nature of the lump, however, its value in diagnosing breast malignancy remains contributory due to the possibility that malignant lumps could be overlooked and present as advanced cancer at a later stage. Histopathology is recommended in all cases unless clinical examination is supported with strong evidence of benignity based on repeated breast imaging via ultrasound or mammogram (>35 yrs).
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Affiliation(s)
- Chandni Ravi
- Department of General Surgery, Kasturba Medical College, Manipal University, Manipal, 576104 Karnataka India
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Specht MC, Miller CL, Skolny MN, Jammallo LS, O’Toole J, Horick N, Isakoff SJ, Smith BL, Taghian AG. Residual Lymph Node Disease After Neoadjuvant Chemotherapy Predicts an Increased Risk of Lymphedema in Node-Positive Breast Cancer Patients. Ann Surg Oncol 2013; 20:2835-41. [DOI: 10.1245/s10434-012-2828-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Indexed: 11/18/2022]
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Foca F, Mancini S, Bucchi L, Puliti D, Zappa M, Naldoni C, Falcini F, Gambino ML, Piffer S, Sanoja Gonzalez ME, Stracci F, Zorzi M, Paci E. Decreasing incidence of late-stage breast cancer after the introduction of organized mammography screening in Italy. Cancer 2013; 119:2022-8. [PMID: 23504860 DOI: 10.1002/cncr.28014] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2012] [Revised: 01/09/2013] [Accepted: 01/16/2013] [Indexed: 11/11/2022]
Abstract
BACKGROUND After the introduction of a mammography screening program, the incidence of late-stage breast cancer is expected to decrease. The objective of the current study was to evaluate variations in the total incidence of breast cancer and in the incidence of breast cancers with a pathologic tumor (pT) classification of pT2 through pT4 after the introduction of mammography screening in 6 Italian administrative regions. METHODS The study area included 700 municipalities, with a total population of 692,824 women ages 55 to 74 years, that were targeted by organized mammography screening between 1991 and 2005. The year screening started at the municipal level (year 1) was identified. The years of screening were numbered from 1 to 8. The ratio of the observed 2-year, age-standardized (Europe) incidence rate to the expected rate (the incidence rate ratio [IRR]) was calculated. Expected rates were estimated assuming that the incidence of breast cancer was stable and was equivalent to that in the last 3 years before year 1. RESULTS The study was based on a total of 14,447 incident breast cancers, including 4036 pT2 through pT4 breast cancers. The total IRR was 1.35 (95% confidence interval, 1.03-1.41) in years 1 and 2, 1.16 (95% confidence interval, 1.10-1.21) in years 3 and 4, 1.14 (95% confidence interval, 1.08-1.20) in years 5 and 6, and 1.14 (95% confidence interval, 1.08-1.21) in years 7 and 8. The IRR for pT2 through pT4 breast cancers was 0.97 (95% confidence interval, 0.90-1.04) in years 1 and 2, 0.81 (95% confidence interval, 0.75-0.88) in years 3 and 4, 0.79 (95% confidence interval, 0.73-0.87) in years 5 and 6, and 0.71 (95% confidence interval, 0.64-0.79) in years 7 and 8. CONCLUSIONS A significant and stable decrease in the incidence of late-stage breast cancer was observed from the third year of screening onward, when the IRR varied between 0.81 and 0.71.
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Affiliation(s)
- Flavia Foca
- Romagna Cancer Registry, Romagna Cancer Institute, Meldola, Forli, Italy
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Domingo L, Jacobsen KK, von Euler-Chelpin M, Vejborg I, Schwartz W, Sala M, Lynge E. Seventeen-years overview of breast cancer inside and outside screening in Denmark. Acta Oncol 2013; 52:48-56. [PMID: 22943386 DOI: 10.3109/0284186x.2012.698750] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Long-term data on breast cancer detection in mammography screening programs are warranted to better understand the mechanisms by which screening changes the breast cancer pattern in the population. We aimed to analyze 17 years of breast cancer detection rates inside and outside screening in two Danish regions, emphasizing the influence of organizational differences of screening programs on the outcomes. MATERIAL AND METHODS We used data from two long-standing population-based mammography screening programs, Copenhagen and Fyn, in Denmark. Both programs offered biennial screening to women aged 50-69 years. We identified targeted, eligible, invited and participating women. We calculated screening detection and interval cancer rates for participants, and breast cancer incidence in non-screened women (= targeted women excluding participants) by biennial invitation rounds. Tumor characteristics were tabulated for each of the three groups of cancers. RESULTS Start of screening resulted in a prevalence peak in participants, followed by a decrease to a fairly stable detection rate in subsequent invitation rounds. A similar pattern was found for breast cancer incidence in non-screened women. In Fyn, non-screened women even had a higher rate than screening participants during the first three invitation rounds. The interval cancer rate was lower in Copenhagen than in Fyn, with an increase over time in Copenhagen, but not in Fyn. Screen-detected cancers showed tumor features related with a better prognosis than tumors detected otherwise, as more than 80% were smaller than 20 mm and estrogen receptor positive. CONCLUSION Data from two long-standing population-based screening programs in Denmark illustrated that even if background breast cancer incidence and organization were rather similar, performance indicators of screening could be strongly influenced by inclusion criteria and participation rates. Detection rates should be interpreted with caution as they may be biased by selection into the screening population.
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Affiliation(s)
- Laia Domingo
- Department of Public Health, University of Copenhagen, Denmark.
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Autier P, Boniol M. Breast cancer screening: evidence of benefit depends on the method used. BMC Med 2012; 10:163. [PMID: 23234249 PMCID: PMC3554519 DOI: 10.1186/1741-7015-10-163] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2012] [Accepted: 12/12/2012] [Indexed: 11/22/2022] Open
Abstract
In this article, we discuss the most common epidemiological methods used for evaluating the ability of mammography screening to decrease the risk of breast cancer death in general populations (effectiveness). Case-control studies usually find substantial effectiveness. However when breast cancer mortality decreases for reasons unrelated to screening, the case-control design may attribute to screening mortality reductions due to other causes. Studies based on incidence-based mortality have obtained contrasted results compatible with modest to considerable effectiveness, probably because of differences in study design and statistical analysis. In areas where screening has been widespread for a long time, the incidence of advanced breast cancer should be decreasing, which in turn would translate into reduced mortality. However, no or modest declines in the incidence of advanced breast cancer has been observed in these areas. Breast cancer mortality should decrease more rapidly in areas with early introduction of screening than in areas with late introduction of screening. Nonetheless, no difference in breast mortality trends has been observed between areas with early or late screening start. When effectiveness is assessed using incidence-based mortality studies, or the monitoring of advanced cancer incidence, or trends in mortality, the ecological bias is an inherent limitation that is not easy to control. Minimization of this bias requires data over long periods of time, careful selection of populations being compared and availability of data on major confounding factors. If case-control studies seem apparently more adequate for evaluating screening effectiveness, this design has its own limitations and results must be viewed with caution.See related Opinion article: http://www.biomedcentral.com/1741-7015/10/106 and Commentary http://www.biomedcentral.com/1741-7015/10/164.
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Affiliation(s)
- Philippe Autier
- International Prevention Research Institute, 95 Cours Lafayette, F-69006 Lyon, France.
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Abstract
A great deal of misinformation has been promulgated about mammography screening. For example, there is no biological or scientific support for the use of the age of 50 years as a threshold for screening. Mammography screening can reduce deaths from breast cancer even if the rate of advanced cancers is not decreased. The suggestion that screening results in massive amounts of overdiagnosis is based upon faulty methodology. The results reported in the recent study by Nederend and colleagues may be due to the screening interval and thresholds used for intervention. What is clear, however, is that they do not show that screening is ineffective.
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Abstract
Herein I argue that mammographic screening has not delivered on its fundamental premise: to reduce the incidence of advanced breast cancer. Indeed, achieving this goal is required if screening is to reduce breast cancer mortality or mastectomy use. Rather, screening has caused substantial increases in the incidence of in situ and early invasive cancers. Moreover, evidence indicates that these screen-detected cancers are unlikely to be cases that were 'caught early', but instead represent women who would not have been diagnosed in the absence of screening and who, as a result, have received harmful, unnecessary treatment. If true, these observations raise the specter that screening creates breast cancer patients and that this practice carries little or no benefit.
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