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Hendrick RE, Monticciolo DL. USPSTF Recommendations and Overdiagnosis. JOURNAL OF BREAST IMAGING 2024:wbae028. [PMID: 38865364 DOI: 10.1093/jbi/wbae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Indexed: 06/14/2024]
Abstract
Overdiagnosis is the concept that some cancers detected at screening would never have become clinically apparent during a woman's lifetime in the absence of screening. This could occur if a woman dies of a cause other than breast cancer in the interval between mammographic detection and clinical detection (obligate overdiagnosis) or if a mammographically detected breast cancer fails to progress to clinical presentation. Overdiagnosis cannot be measured directly. Indirect methods of estimating overdiagnosis include use of data from randomized controlled trials (RCTs) designed to evaluate breast cancer mortality, population-based screening studies, or modeling. In each case, estimates of overdiagnosis must consider lead time, breast cancer incidence trends in the absence of screening, and accurate and predictable rates of tumor progression. Failure to do so has led to widely varying estimates of overdiagnosis. The U.S. Preventive Services Task Force (USPSTF) considers overdiagnosis a major harm of mammography screening. Their 2024 report estimated overdiagnosis using summary evaluations of 3 RCTs that did not provide screening to their control groups at the end of the screening period, along with Cancer Intervention and Surveillance Network modeling. However, there are major flaws in their evidence sources and modeling estimates, limiting the USPSTF assessment. The most plausible estimates remain those based on observational studies that suggest overdiagnosis in breast cancer screening is 10% or less and can be attributed primarily to obligate overdiagnosis and nonprogressive ductal carcinoma in situ.
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Affiliation(s)
- R Edward Hendrick
- Department of Radiology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
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Park EK, Lee H, Kim M, Kim T, Kim J, Kim KH, Kooi T, Chang Y, Ryu S. Artificial Intelligence-Powered Imaging Biomarker Based on Mammography for Breast Cancer Risk Prediction. Diagnostics (Basel) 2024; 14:1212. [PMID: 38928628 PMCID: PMC11202482 DOI: 10.3390/diagnostics14121212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/28/2024] Open
Abstract
The purposes of this study were to develop an artificial intelligence (AI) model for future breast cancer risk prediction based on mammographic images, investigate the feasibility of the AI model, and compare the AI model, clinical statistical risk models, and Mirai, a state of-the art deep learning algorithm based on screening mammograms for 1-5-year breast cancer risk prediction. We trained and developed a deep learning model using a total of 36,995 serial mammographic examinations from 21,438 women (cancer-enriched mammograms, 17.5%). To determine the feasibility of the AI prediction model, mammograms and detailed clinical information were collected. C-indices and area under the receiver operating characteristic curves (AUCs) for 1-5-year outcomes were obtained. We compared the AUCs of our AI prediction model, Mirai, and clinical statistical risk models, including the Tyrer-Cuzick (TC) model and Gail model, using DeLong's test. A total of 16,894 mammograms were independently collected for external validation, of which 4002 were followed by a cancer diagnosis within 5 years. Our AI prediction model obtained a C-index of 0.76, with AUCs of 0.90, 0.84, 0.81, 0.78, and 0.81, to predict the 1-5-year risks. Our AI prediction model showed significantly higher AUCs than those of the TC model (AUC: 0.57; p < 0.001) and Gail model (AUC: 0.52; p < 0.001), and achieved similar performance to Mirai. The deep learning AI model using mammograms and AI-powered imaging biomarkers has substantial potential to advance accurate breast cancer risk prediction.
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Affiliation(s)
- Eun Kyung Park
- Department of Radiology, We Comfortable Clinic, Seoul 07327, Republic of Korea
| | - Hyeonsoo Lee
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Minjeong Kim
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Taesoo Kim
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Junha Kim
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Ki Hwan Kim
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Thijs Kooi
- Lunit Inc., Seoul 06241, Republic of Korea; (H.L.); (M.K.); (T.K.); (J.K.); (K.H.K.); (T.K.)
| | - Yoosoo Chang
- Center of Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; (Y.C.); (S.R.)
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
| | - Seungho Ryu
- Center of Cohort Studies, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 04514, Republic of Korea; (Y.C.); (S.R.)
- Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea
- Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Science & Technology (SAIHST), Sungkyunkwan University, Seoul 06355, Republic of Korea
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Elías-Cabot E, Romero-Martín S, Raya-Povedano JL, Brehl AK, Álvarez-Benito M. Impact of real-life use of artificial intelligence as support for human reading in a population-based breast cancer screening program with mammography and tomosynthesis. Eur Radiol 2024; 34:3958-3966. [PMID: 37975920 PMCID: PMC11166767 DOI: 10.1007/s00330-023-10426-4] [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: 08/11/2023] [Revised: 08/11/2023] [Accepted: 10/01/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES To evaluate the impact of using an artificial intelligence (AI) system as support for human double reading in a real-life scenario of a breast cancer screening program with digital mammography (DM) or digital breast tomosynthesis (DBT). MATERIAL AND METHODS We analyzed the performance of double reading screening with mammography and tomosynthesis after implementarion of AI as decision support. The study group consisted of a consecutive cohort of 1 year screening between March 2021 and March 2022 where double reading was performed with concurrent AI support that automatically detects and highlights lesions suspicious of breast cancer in mammography and tomosynthesis. Screening performance was measured as cancer detection rate (CDR), recall rate (RR), and positive predictive value (PPV) of recalls. Performance in the study group was compared using a McNemar test to a control group that included a screening cohort of the same size, recorded just prior to the implementation of AI. RESULTS A total of 11,998 women (mean age 57.59 years ± 5.8 [sd]) were included in the study group (5049 DM and 6949 DBT). Comparing global results (including DM and DBT) of double reading with vs. without AI support, we observed an increase in CDR, PPV, and RR by 3.2/‰ (5.8 vs. 9; p < 0.001), 4% (10.6 vs. 14.6; p < 0.001), and 0.7% (5.4 vs. 6.1; p < 0.001) respectively. CONCLUSION AI used as support for human double reading in a real-life breast cancer screening program with DM and DBT increases CDR and PPV of the recalled women. CLINICAL RELEVANCE STATEMENT Artificial intelligence as support for human double reading improves accuracy in a real-life breast cancer screening program both in digital mammography and digital breast tomosynthesis. KEY POINTS • AI systems based on deep learning technology offer potential for improving breast cancer screening programs. • Using artificial intelligence as support for reading improves radiologists' performance in breast cancer screening programs with mammography or tomosynthesis. • Artificial intelligence used concurrently with human reading in clinical screening practice increases breast cancer detection rate and positive predictive value of the recalled women.
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Affiliation(s)
- Esperanza Elías-Cabot
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Menéndez Pidal Avenue s/n, 14004, Córdoba, Spain.
- University of Córdoba, Córdoba, Spain.
| | - Sara Romero-Martín
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Menéndez Pidal Avenue s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - José Luis Raya-Povedano
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Menéndez Pidal Avenue s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - A-K Brehl
- ScreenPoint Medical BV, Toernooiveld 300, 6525 EC, Nijmegen, The Netherlands
| | - Marina Álvarez-Benito
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Menéndez Pidal Avenue s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
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Lauritzen AD, Lillholm M, Lynge E, Nielsen M, Karssemeijer N, Vejborg I. Early Indicators of the Impact of Using AI in Mammography Screening for Breast Cancer. Radiology 2024; 311:e232479. [PMID: 38832880 DOI: 10.1148/radiol.232479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Background Retrospective studies have suggested that using artificial intelligence (AI) may decrease the workload of radiologists while preserving mammography screening performance. Purpose To compare workload and screening performance for two cohorts of women who underwent screening before and after AI system implementation. Materials and Methods This retrospective study included 50-69-year-old women who underwent biennial mammography screening in the Capital Region of Denmark. Before AI system implementation (October 1, 2020, to November 17, 2021), all screenings involved double reading. For screenings conducted after AI system implementation (November 18, 2021, to October 17, 2022), likely normal screenings (AI examination score ≤5 before May 3, 2022, or ≤7 on or after May 3, 2022) were single read by one of 19 senior full-time breast radiologists. The remaining screenings were read by two radiologists with AI-assisted decision support. Biopsy and surgical outcomes were retrieved between October 1, 2020, and April 15, 2023, ensuring at least 180 days of follow-up. Screening metrics were compared using the χ2 test. Reading workload reduction was measured as saved screening reads. Results In total, 60 751 and 58 246 women were screened before and after AI system implementation, respectively (median age, 58 years [IQR, 54-64 years] for both cohorts), with a median screening interval before AI of 845 days (IQR, 820-878 days) and with AI of 993 days (IQR, 968-1013 days; P < .001). After AI system implementation, the recall rate decreased by 20.5% (3.09% before AI [1875 of 60 751] vs 2.46% with AI [1430 of 58 246]; P < .001), the cancer detection rate increased (0.70% [423 of 60 751] vs 0.82% [480 of 58 246]; P = .01), the false-positive rate decreased (2.39% [1452 of 60 751] vs 1.63% [950 of 58 246]; P < .001), the positive predictive value increased (22.6% [423 of 1875] vs 33.6% [480 of 1430]; P < .001), the rate of small cancers (≤1 cm) increased (36.6% [127 of 347] vs 44.9% [164 of 365]; P = .02), the rate of node-negative cancers was unchanged (76.7% [253 of 330] vs 77.8% [273 of 351]; P = .73), and the rate of invasive cancers decreased (84.9% [359 of 423] vs 79.6% [382 of 480]; P = .04). The reading workload was reduced by 33.5% (38 977 of 116 492 reads). Conclusion In a population-based mammography screening program, using AI reduced the overall workload of breast radiologists while improving screening performance. Published under a CC BY 4.0 license. Supplemental material is available for this article. See also the editorial by Lee and Friedewald in this issue.
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Affiliation(s)
- Andreas D Lauritzen
- From the Departments of Computer Science (A.D.L., M.L., M.N.) and Public Health (E.L.), University of Copenhagen, Copenhagen, Denmark; Department of Breast Examinations, Gentofte Hospital, Kildegårdsvej 30A, 2900 Hellerup, Denmark (A.D.L., I.V.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (N.K.); and ScreenPoint Medical, Nijmegen, the Netherlands (N.K.)
| | - Martin Lillholm
- From the Departments of Computer Science (A.D.L., M.L., M.N.) and Public Health (E.L.), University of Copenhagen, Copenhagen, Denmark; Department of Breast Examinations, Gentofte Hospital, Kildegårdsvej 30A, 2900 Hellerup, Denmark (A.D.L., I.V.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (N.K.); and ScreenPoint Medical, Nijmegen, the Netherlands (N.K.)
| | - Elsebeth Lynge
- From the Departments of Computer Science (A.D.L., M.L., M.N.) and Public Health (E.L.), University of Copenhagen, Copenhagen, Denmark; Department of Breast Examinations, Gentofte Hospital, Kildegårdsvej 30A, 2900 Hellerup, Denmark (A.D.L., I.V.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (N.K.); and ScreenPoint Medical, Nijmegen, the Netherlands (N.K.)
| | - Mads Nielsen
- From the Departments of Computer Science (A.D.L., M.L., M.N.) and Public Health (E.L.), University of Copenhagen, Copenhagen, Denmark; Department of Breast Examinations, Gentofte Hospital, Kildegårdsvej 30A, 2900 Hellerup, Denmark (A.D.L., I.V.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (N.K.); and ScreenPoint Medical, Nijmegen, the Netherlands (N.K.)
| | - Nico Karssemeijer
- From the Departments of Computer Science (A.D.L., M.L., M.N.) and Public Health (E.L.), University of Copenhagen, Copenhagen, Denmark; Department of Breast Examinations, Gentofte Hospital, Kildegårdsvej 30A, 2900 Hellerup, Denmark (A.D.L., I.V.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (N.K.); and ScreenPoint Medical, Nijmegen, the Netherlands (N.K.)
| | - Ilse Vejborg
- From the Departments of Computer Science (A.D.L., M.L., M.N.) and Public Health (E.L.), University of Copenhagen, Copenhagen, Denmark; Department of Breast Examinations, Gentofte Hospital, Kildegårdsvej 30A, 2900 Hellerup, Denmark (A.D.L., I.V.); Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, the Netherlands (N.K.); and ScreenPoint Medical, Nijmegen, the Netherlands (N.K.)
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Park EK, Kwak S, Lee W, Choi JS, Kooi T, Kim EK. Impact of AI for Digital Breast Tomosynthesis on Breast Cancer Detection and Interpretation Time. Radiol Artif Intell 2024; 6:e230318. [PMID: 38568095 PMCID: PMC11140510 DOI: 10.1148/ryai.230318] [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: 08/14/2023] [Revised: 02/28/2024] [Accepted: 03/20/2024] [Indexed: 05/16/2024]
Abstract
Purpose To develop an artificial intelligence (AI) model for the diagnosis of breast cancer on digital breast tomosynthesis (DBT) images and to investigate whether it could improve diagnostic accuracy and reduce radiologist reading time. Materials and Methods A deep learning AI algorithm was developed and validated for DBT with retrospectively collected examinations (January 2010 to December 2021) from 14 institutions in the United States and South Korea. A multicenter reader study was performed to compare the performance of 15 radiologists (seven breast specialists, eight general radiologists) in interpreting DBT examinations in 258 women (mean age, 56 years ± 13.41 [SD]), including 65 cancer cases, with and without the use of AI. Area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and reading time were evaluated. Results The AUC for stand-alone AI performance was 0.93 (95% CI: 0.92, 0.94). With AI, radiologists' AUC improved from 0.90 (95% CI: 0.86, 0.93) to 0.92 (95% CI: 0.88, 0.96) (P = .003) in the reader study. AI showed higher specificity (89.64% [95% CI: 85.34%, 93.94%]) than radiologists (77.34% [95% CI: 75.82%, 78.87%]) (P < .001). When reading with AI, radiologists' sensitivity increased from 85.44% (95% CI: 83.22%, 87.65%) to 87.69% (95% CI: 85.63%, 89.75%) (P = .04), with no evidence of a difference in specificity. Reading time decreased from 54.41 seconds (95% CI: 52.56, 56.27) without AI to 48.52 seconds (95% CI: 46.79, 50.25) with AI (P < .001). Interreader agreement measured by Fleiss κ increased from 0.59 to 0.62. Conclusion The AI model showed better diagnostic accuracy than radiologists in breast cancer detection, as well as reduced reading times. The concurrent use of AI in DBT interpretation could improve both accuracy and efficiency. Keywords: Breast, Computer-Aided Diagnosis (CAD), Tomosynthesis, Artificial Intelligence, Digital Breast Tomosynthesis, Breast Cancer, Computer-Aided Detection, Screening Supplemental material is available for this article. © RSNA, 2024 See also the commentary by Bae in this issue.
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Affiliation(s)
- Eun Kyung Park
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - SooYoung Kwak
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Weonsuk Lee
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Joon Suk Choi
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Thijs Kooi
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
| | - Eun-Kyung Kim
- From Lunit, 374 Gangnam-daero, Gangnam-gu, Seoul 06241, Republic of
Korea (E.K.P., S.Y.K., W.L., J.S.C., T.K.); and Department of Radiology, Yongin
Severance Hospital, College of Medicine, Yonsei University, Yongin, Republic of
Korea (E.K.K.)
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Pappas G, Karantanis W, Ayeni FE, Edirimanne S. Does Prior Breast Irradiation Increase Complications of Subsequent Reduction Surgery in Breast Cancer Patients? A systematic Review and Meta-Analysis. Aesthetic Plast Surg 2024:10.1007/s00266-024-04038-6. [PMID: 38658406 DOI: 10.1007/s00266-024-04038-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 03/28/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Reduction mammoplasty and mastopexy are potentially complicated by prior breast irradiation as part of breast conserving therapy. Associated tissue changes with therapeutic irradiation have led to surgeons deciding the risks may outweigh potential benefit for those patients. A systematic review of the existing literature was performed to explore surgical outcomes of patients undergoing delayed bilateral reduction mammoplasty or mastopexy following unilateral breast irradiation as part of breast conserving therapy. METHODS Medline, PubMed and EMBASE were searched from 1990 to 2023 according to PRISMA guidelines. Studies were combined by the generic inverse variance method on the natural logarithms of rate ratios (RR) using a random effect model in Review manager 5.4.1. RESULTS Fifteen studies reported outcomes in 188 patients who underwent breast reduction (BR) following unilateral breast conserving surgery and radiotherapy. The median age at BR was 51.5 years (range 39-60), and median time since radiotherapy was 48 months (range 11.7-86). We compared outcomes for irradiated breast (IB) versus non-irradiated breast (NIB). Pooled results showed higher rate of major complications in the IB (RR 2.52, 95%CI 0.96-6.63, p=0.06), but not statistically significant. However, rate of minor complications was significantly higher in the IB (RR 3.97 95%CI 1.86-8.50, p<0.0004). Incidence of fat necrosis as a discrete complication was 2× higher in IB (RR 2.14 95%CI 0.85-5.35, p-value 0.10) compared to the NIB, but not significant. CONCLUSION We found breast reduction to be safe with acceptable risk of major complications. However, the overall complication rate remains higher in IB compared to NIB. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- George Pappas
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
| | - William Karantanis
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
- Faculty of Medicine, University of New South Wales, Sydney, NSW, 2052, Australia
| | - Femi E Ayeni
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia.
| | - Senarath Edirimanne
- Department of Surgery, Nepean Hospital, Derby Street, Kingswood, NSW, 2747, Australia
- Nepean Institute of Academic Surgery, Nepean Clinical School, The University of Sydney, 62 Derby Street, Kingswood, NSW, 2747, Australia
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Álvarez Benito M. A bimodal nomogram: a non-invasive tool to assist breast radiologists in decision-making. Eur Radiol 2024; 34:2605-2607. [PMID: 37930414 PMCID: PMC10957701 DOI: 10.1007/s00330-023-10357-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/01/2023] [Accepted: 10/07/2023] [Indexed: 11/07/2023]
Affiliation(s)
- Marina Álvarez Benito
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Córdoba, Spain.
- University of Córdoba, Córdoba, Spain.
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Pulido-Carmona C, Romero-Martín S, Raya-Povedano JL, Cara-García M, Font-Ugalde P, Elías-Cabot E, Pedrosa-Garriguet M, Álvarez-Benito M. Interval cancer in the Córdoba Breast Tomosynthesis Screening Trial (CBTST): comparison of digital breast tomosynthesis plus digital mammography to digital mammography alone. Eur Radiol 2024:10.1007/s00330-023-10546-x. [PMID: 38177619 DOI: 10.1007/s00330-023-10546-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Revised: 11/17/2023] [Accepted: 12/02/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE This work aims to compare the interval cancer rate and interval cancer characteristics between women screened with digital breast tomosynthesis (DBT) + digital mammography (DM) and those screened with DM alone. METHODS The interval cancer rate and interval cancer characteristics of the study population included in the Córdoba Breast Tomosynthesis Screening Trial (CBTST) were compared to a contemporary control population screened with DM. The tumour characteristics of screen-detected and interval cancers were also compared. Contingency tables were used to compare interval cancer rates. The chi-square test and Fisher's exact test were used to compare the qualitative characteristics of the cancers whereas Student's t test and the Mann-Whitney U test were used to analyse quantitative features. RESULTS A total of 16,068 screening exams with DBT + DM were conducted within the CBTST (mean age 57.59 ± 5.9 [SD]) between January 2015 and December 2016 (study population). In parallel, 23,787 women (mean age 58.89 ± 5.9 standard deviation [SD]) were screened with DM (control population). The interval cancer rate was lower in the study population than in the control population (15 [0.93‰; 95% confidence interval (CI): 0.73, 1.14] vs 43 [1.8‰; 95% CI: 1.58, 2.04] respectively; p = 0.045). The difference in rate was more marked in women with dense breasts (0.95‰ in the study population vs 3.17‰ in the control population; p = 0.031). Interval cancers were smaller in the study population than in the control population (p = 0.031). CONCLUSIONS The interval cancer rate was lower in women screened with DBT + DM compared to those screened with DM alone. These differences were more pronounced in women with dense breasts. CLINICAL RELEVANCE STATEMENT Women screened using tomosynthesis and digital mammography had a lower rate of interval cancer than women screened with digital mammography, with the greatest difference in the interval cancer rate observed in women with dense breasts. KEY POINTS • The interval cancer rate was lower in the study population (digital breast tomosynthesis [DBT] + digital mammography [DM]) than in the control population (DM). • The difference in interval cancer rates was more pronounced in women with dense breasts. • Interval cancers were smaller in the study population (DBT + DM) than in the control population (DM).
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Affiliation(s)
- Cristina Pulido-Carmona
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain.
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain.
- University of Córdoba, Córdoba, Spain.
| | - Sara Romero-Martín
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - José Luis Raya-Povedano
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - María Cara-García
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - Pilar Font-Ugalde
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- University of Córdoba, Córdoba, Spain
- Rheumatology Department, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
| | - Esperanza Elías-Cabot
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - Margarita Pedrosa-Garriguet
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
| | - Marina Álvarez-Benito
- Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Breast Cancer Unit, Department of Diagnostic Radiology, Reina Sofía University Hospital, Avenida Menéndez Pidal s/n, 14004, Córdoba, Spain
- University of Córdoba, Córdoba, Spain
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9
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Tollens F, Baltzer PA, Froelich MF, Kaiser CG. Economic evaluation of breast MRI in screening - a systematic review and basic approach to cost-effectiveness analyses. Front Oncol 2023; 13:1292268. [PMID: 38130995 PMCID: PMC10733447 DOI: 10.3389/fonc.2023.1292268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
Background Economic evaluations have become an accepted methodology for decision makers to allocate resources in healthcare systems. Particularly in screening, where short-term costs are associated with long-term benefits, and adverse effects of screening intermingle, cost-effectiveness analyses provide a means to estimate the economic value of screening. Purpose To introduce the methodology of economic evaluations and to review the existing evidence on cost-effectiveness of MR-based breast cancer screening. Materials and methods The various concepts and techniques of economic evaluations critical to the interpretation of cost-effectiveness analyses are briefly introduced. In a systematic review of the literature, economic evaluations from the years 2000-2022 are reviewed. Results Despite a considerable heterogeneity in the reported input variables, outcome categories and methodological approaches, cost-effectiveness analyses report favorably on the economic value of breast MRI screening for different risk groups, including both short- and long-term costs and outcomes. Conclusion Economic evaluations indicate a strongly favorable economic value of breast MRI screening for women at high risk and for women with dense breast tissue.
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Affiliation(s)
- Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Pascal A.T. Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - Matthias F. Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Clemens G. Kaiser
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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10
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Eijkelboom AH, Larsen M, Siesling S, Nygård JF, Hofvind S, de Munck L. Prolonged screening interval due to the COVID-19 pandemic and its association with tumor characteristics and treatment; a register-based study from BreastScreen Norway. Prev Med 2023; 175:107723. [PMID: 37820746 DOI: 10.1016/j.ypmed.2023.107723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/05/2023] [Accepted: 10/07/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic Norway had to suspend its national breast cancer screening program. We aimed to investigate the effect of the pandemic-induced suspension on the screening interval, and its subsequent association with the tumor characteristics and treatment of screen-detected (SDC) and interval breast cancer (IC). METHODS Information about women aged 50-69, participating in BreastScreen Norway, and diagnosed with a SDC (N = 3799) or IC (N = 1806) between 2018 and 2021 was extracted from the Cancer Registry of Norway. Logistic regression was used to investigate the association between COVID-19 induced prolonged screening intervals and tumor characteristics and treatment. RESULTS Women with a SDC and their last screening exam before the pandemic had a median screening interval of 24.0 months (interquartile range: 23.8-24.5), compared to 27.0 months (interquartile range: 25.8-28.5) for those with their last screening during the pandemic. The tumor characteristics and treatment of women with a SDC, last screening during the pandemic, and a screening interval of 29-31 months, did not differ from those of women with a SDC, last screening before the pandemic, and a screening interval of 23-25 months. ICs detected 24-31 months after screening, were more likely to be histological grade 3 compared to ICs detected 0-23 months after screening (odds ratio: 1.40, 95% confidence interval: 1.06-1.84). CONCLUSIONS Pandemic-induced prolonged screening intervals were not associated with the tumor characteristics and treatment of SDCs, but did increase the risk of a histopathological grade 3 IC. This study provides insights into the possible effects of extending the screening interval.
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Affiliation(s)
- Anouk H Eijkelboom
- Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
| | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Oslo, Norway.
| | - Sabine Siesling
- Department of Health Technology and Services Research, University of Twente, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands; Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
| | - Jan F Nygård
- Department of Register Informatics, Cancer Registry Norway, P.O. Box 5313, 0304 Oslo, Norway.
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, P.O. Box 5313, 0304, Oslo, Norway; Department of Health and Care Sciences, UiT The Arctic University of Norway, P.O. 6050, 9037, Tromsø, Norway.
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation (IKNL), Godebaldkwartier 419, 3511 DT, Utrecht, the Netherlands.
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11
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Wang S, Sultana F, Kavanagh A, Nickson C, Karahalios A, Gurrin LC, English DR. Benefits and harms of breast cancer screening: Cohort study of breast cancer mortality and overdiagnosis. Cancer Med 2023; 12:18120-18132. [PMID: 37548277 PMCID: PMC10524083 DOI: 10.1002/cam4.6373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 07/15/2023] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Quantifying the benefits and harms of breast cancer screening accurately is important for planning and evaluating screening programs and for enabling women to make informed decisions about participation. However, few cohort studies have attempted to estimate benefit and harm simultaneously. AIMS We aimed to quantify the impact of mammographic screening on breast cancer mortality and overdiagnosis using a cohort of women invited to attend Australia's national screening program, BreastScreen. METHODS In a cohort of 41,330 women without prior breast cancer diagnosis, screening, or diagnostic procedures invited to attend BreastScreen Western Australia in 1994-1995, we estimated the cumulative risk of breast cancer mortality and breast cancer incidence (invasive and ductal carcinoma in situ) from age 50 to 85 years for attenders and non-attenders. Data were obtained by linking population-based state and national health registries. Breast cancer mortality risks were estimated from a survival analysis that accounted for competing risk of death from other causes. Breast cancer risk for unscreened women was estimated by survival analysis, while accounting for competing causes of death. For screened women, breast cancer risk was the sum of risk of being diagnosed at first screen, estimated using logistic regression, and risk of diagnosis following a negative first screen estimated from a survival analysis. RESULTS For every 1,000 women 50 years old at first invitation to attend BreastScreen, there were 20 (95% CI 12-30) fewer breast cancer deaths and 25 (95% CI 15-35) more breast cancers diagnosed for women who attended than for non-attendees by age 85. Of the breast cancers diagnosed in screened women, 21% (95% CI 13%-27%) could be attributed to screening. DISCUSSION The estimated ratio of benefit to harm was consistent with, but slightly less favourable to screening than most other estimates from cohort studies. CONCLUSION Women who participate in organised screening for breast cancer in Australia have substantially lower breast cancer mortality, while some screen-detected cancers may be overdiagnosed.
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Affiliation(s)
- Sabrina Wang
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
| | | | - Anne Kavanagh
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Carolyn Nickson
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
- The Daffodil CentreThe University of SydneySydneyNew South WalesAustralia
| | - Amalia Karahalios
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Lyle C. Gurrin
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
| | - Dallas R. English
- Melbourne School of Population and Global HealthUniversity of MelbourneMelbourneVictoriaAustralia
- Cancer Epidemiology DivisionCancer Council VictoriaMelbourneVictoriaAustralia
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12
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Kregting LM, van Ravesteyn NT, Chootipongchaivat S, Heijnsdijk EAM, Otten JDM, Broeders MJM, de Koning HJ. Cumulative risks of false positive recall and screen-detected breast cancer after multiple screening examinations. Int J Cancer 2023; 153:312-319. [PMID: 37038266 DOI: 10.1002/ijc.34530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 03/10/2023] [Accepted: 03/21/2023] [Indexed: 04/12/2023]
Abstract
Women tend to make a decision about participation in breast cancer screening and adhere to this for future invitations. Therefore, our study aimed to provide high-quality information on cumulative risks of false-positive (FP) recall and screen-detected breast cancer over multiple screening examinations. Individual Dutch screening registry data (2005-2018) were gathered on subsequent screening examinations of 92 902 women age 49 to 51 years in 2005. Survival analyses were used to calculate cumulative risks of a FP and a true-positive (TP) result after seven examinations. Data from 66 472 women age 58 to 59 years were used to extrapolate to 11 examinations. Participation, detection and additional FP rates were calculated for women who previously received FP results compared to women with true negative (TN) results. After 7 examinations, the cumulative risk of a TP result was 3.7% and the cumulative risk of a FP result was 9.1%. After 11 examinations, this increased to 7.1% and 13.5%, respectively. Following a FP result, participation was lower (71%-81%) than following a TN result (>90%). In women with a FP result, more TP results (factor 1.59 [95% CI: 1.44-1.72]), more interval cancers (factor 1.66 [95% CI: 1.41-1.91]) and more FP results (factor 1.96 [95% CI: 1.87-2.05]) were found than in women with TN results. In conclusion, due to a low recall rate in the Netherlands, the cumulative risk of a FP recall is relatively low, while the cumulative risk of a TP result is comparable. Breast cancer diagnoses and FP results were more common in women with FP results than in women with TN results, while participation was lower.
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Affiliation(s)
- Lindy M Kregting
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sarocha Chootipongchaivat
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Mireille J M Broeders
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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13
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Dan Q, Zheng T, Liu L, Sun D, Chen Y. Ultrasound for Breast Cancer Screening in Resource-Limited Settings: Current Practice and Future Directions. Cancers (Basel) 2023; 15:cancers15072112. [PMID: 37046773 PMCID: PMC10093585 DOI: 10.3390/cancers15072112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 03/09/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Breast cancer (BC) is the most prevalent cancer among women globally. Cancer screening can reduce mortality and improve women’s health. In developed countries, mammography (MAM) has been primarily utilized for population-based BC screening for several decades. However, it is usually unavailable in low-resource settings due to the lack of equipment, personnel, and time necessary to conduct and interpret the examinations. Ultrasound (US) with high detection sensitivity for women of younger ages and with dense breasts has become a supplement to MAM for breast examination. Some guidelines suggest using US as the primary screening tool in certain settings where MAM is unavailable and infeasible, but global recommendations have not yet reached a unanimous consensus. With the development of smart devices and artificial intelligence (AI) in medical imaging, clinical applications and preclinical studies have shown the potential of US combined with AI in BC screening. Nevertheless, there are few comprehensive reviews focused on the role of US in screening BC in underserved conditions, especially in technological, economical, and global perspectives. This work presents the benefits, limitations, advances, and future directions of BC screening with technology-assisted and resource-appropriate strategies, which may be helpful to implement screening initiatives in resource-limited countries.
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Affiliation(s)
- Qing Dan
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
| | - Tingting Zheng
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
| | - Li Liu
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
| | - Desheng Sun
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
| | - Yun Chen
- Department of Ultrasound, Peking University Shenzhen Hospital, Shenzhen Peking University-The Hong Kong University of Science and Technology Medical Center, Shenzhen 518036, China
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14
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Rodríguez-Reinado C, Delgado-Parrilla A, Alguacil J. Breast Cancer Treatment in Integrated Care Process in Andalusia: The Challenge of Multidisciplinarity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12728. [PMID: 36232027 PMCID: PMC9566388 DOI: 10.3390/ijerph191912728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 09/30/2022] [Accepted: 10/02/2022] [Indexed: 06/16/2023]
Abstract
Despite the increasing trend in the incidence of breast cancer in recent decades, mortality has decreased in developed countries. The general objective of the study is to analyse the functioning and organisation of the care process for breast cancer treatment in Andalusia (Spain) in order to identify possible barriers and facilitators that may be affecting its effectiveness and, therefore, the survival of the disease. A qualitative method was adopted based on 19 semi-structured interviews with health professionals from different specialities in two Andalusian provinces: Huelva (mortality rate higher than the national average) and Granada (mortality rate similar to the national average). Results show the existence of barriers (seasonal delays, low frequency of multidisciplinary meetings, lack of human and technical resources, difficulties in accessing treatment in certain populations, etc.) and facilitators (creation of multidisciplinary units and committees for breast pathology, standardisation of treatments, assignment of professionals with preferential attention to breast pathology, etc.) in the care process of breast cancer treatment. The combination of these barriers can have an impact on the accessibility, quality, and efficacy of the treatment, and in the long term, on survival from the disease.
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Affiliation(s)
- Carmen Rodríguez-Reinado
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
| | - Ana Delgado-Parrilla
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
| | - Juan Alguacil
- Clinical, Environmental and Social Transformation Epidemiology Research Group, Department of Sociology, Social Work and Public Health, University of Huelva, 21007 Huelva, Spain
- Centro de Investigación en Recursos Naturales, Salud y Medio Ambiente (RENSMA), University of Huelva, 21071 Huelva, Spain
- Consorcio de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
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15
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Kregting LM, Sankatsing VDV, Heijnsdijk EAM, de Koning HJ, van Ravesteyn NT. Reply to: Comments on "Finding the optimal mammography screening strategy: a cost-effectiveness analysis of 920 modelled strategies.". Int J Cancer 2022; 151:651-652. [PMID: 35460077 PMCID: PMC9324213 DOI: 10.1002/ijc.34042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/13/2022] [Indexed: 12/05/2022]
Affiliation(s)
- Lindy M Kregting
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Valérie D V Sankatsing
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nicolien T van Ravesteyn
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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16
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Clift AK, Dodwell D, Lord S, Petrou S, Brady SM, Collins GS, Hippisley-Cox J. The current status of risk-stratified breast screening. Br J Cancer 2022; 126:533-550. [PMID: 34703006 PMCID: PMC8854575 DOI: 10.1038/s41416-021-01550-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 08/25/2021] [Accepted: 09/14/2021] [Indexed: 12/23/2022] Open
Abstract
Apart from high-risk scenarios such as the presence of highly penetrant genetic mutations, breast screening typically comprises mammography or tomosynthesis strategies defined by age. However, age-based screening ignores the range of breast cancer risks that individual women may possess and is antithetical to the ambitions of personalised early detection. Whilst screening mammography reduces breast cancer mortality, this is at the risk of potentially significant harms including overdiagnosis with overtreatment, and psychological morbidity associated with false positives. In risk-stratified screening, individualised risk assessment may inform screening intensity/interval, starting age, imaging modality used, or even decisions not to screen. However, clear evidence for its benefits and harms needs to be established. In this scoping review, the authors summarise the established and emerging evidence regarding several critical dependencies for successful risk-stratified breast screening: risk prediction model performance, epidemiological studies, retrospective clinical evaluations, health economic evaluations and qualitative research on feasibility and acceptability. Family history, breast density or reproductive factors are not on their own suitable for precisely estimating risk and risk prediction models increasingly incorporate combinations of demographic, clinical, genetic and imaging-related parameters. Clinical evaluations of risk-stratified screening are currently limited. Epidemiological evidence is sparse, and randomised trials only began in recent years.
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Affiliation(s)
- Ash Kieran Clift
- Cancer Research UK Oxford Centre, Department of Oncology, University of Oxford, Oxford, UK.
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
| | - David Dodwell
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Simon Lord
- Department of Oncology, University of Oxford, Oxford, UK
| | - Stavros Petrou
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | | | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Julia Hippisley-Cox
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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17
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Romero-Martín S, Elías-Cabot E, Raya-Povedano JL, Gubern-Mérida A, Rodríguez-Ruiz A, Álvarez-Benito M. Stand-Alone Use of Artificial Intelligence for Digital Mammography and Digital Breast Tomosynthesis Screening: A Retrospective Evaluation. Radiology 2021; 302:535-542. [PMID: 34904872 DOI: 10.1148/radiol.211590] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Use of artificial intelligence (AI) as a stand-alone reader for digital mammography (DM) or digital breast tomosynthesis (DBT) breast screening could ease radiologists' workload while maintaining quality. Purpose To retrospectively evaluate the stand-alone performance of an AI system as an independent reader of DM and DBT screening examinations. Materials and Methods Consecutive screening-paired and independently read DM and DBT images acquired between January 2015 and December 2016 were retrospectively collected from the Tomosynthesis Cordoba Screening Trial. An AI system computed a cancer risk score (range, 1-100) for DM and DBT examinations independently. AI stand-alone performance was measured using the area under the receiver operating characteristic curve (AUC) and sensitivity and recall rate at different operating points selected to have noninferior sensitivity compared with the human readings (noninferiority margin, 5%). The recall rate of AI and the human readings were compared using a McNemar test. Results A total of 15 999 DM and DBT examinations (113 breast cancers, including 98 screen-detected and 15 interval cancers) from 15 998 women (mean age, 58 years ± 6 [standard deviation]) were evaluated. AI achieved an AUC of 0.93 (95% CI: 0.89, 0.96) for DM and 0.94 (95% CI: 0.91, 0.97) for DBT. For DM, AI achieved noninferior sensitivity as a single (58.4%; 66 of 113; 95% CI: 49.2, 67.1) or double (67.3%; 76 of 113; 95% CI: 58.2, 75.2) reader, with a reduction in recall rate (P < .001) of up to 2% (95% CI: -2.4, -1.6). For DBT, AI achieved noninferior sensitivity as a single (77%; 87 of 113; 95% CI: 68.4, 83.8) or double (81.4%; 92 of 113; 95% CI: 73.3, 87.5) reader, but with a higher recall rate (P < .001) of up to 12.3% (95% CI: 11.7, 12.9). Conclusion Artificial intelligence could replace radiologists' readings in breast screening, achieving a noninferior sensitivity, with a lower recall rate for digital mammography but a higher recall rate for digital breast tomosynthesis. © RSNA, 2021 See also the editorial by Fuchsjäger and Adelsmayr in this issue.
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Affiliation(s)
- Sara Romero-Martín
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - Esperanza Elías-Cabot
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - José Luis Raya-Povedano
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - Albert Gubern-Mérida
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - Alejandro Rodríguez-Ruiz
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
| | - Marina Álvarez-Benito
- From the Breast Cancer Unit, Department of Radiology, Hospital Universitario Reina Sofía, Av Menéndez Pidal s/n, Córdoba 14004, Spain (S.R., E.E., J.L.R., M.Á.); Maimonides Institute for Biomedical Research of Córdoba, Córdoba, Spain (S.R., E.E., J.L.R., M.Á.); and Department of Clinical Science, ScreenPoint Medical, Nijmegen, the Netherlands (A.G., A.R.)
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Nuche-Berenguer B, Sakellariou D. Socioeconomic Determinants of Participation in Cancer Screening in Argentina: A Cross-Sectional Study. Front Public Health 2021; 9:699108. [PMID: 34504827 PMCID: PMC8423085 DOI: 10.3389/fpubh.2021.699108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/22/2021] [Indexed: 12/24/2022] Open
Abstract
Low socioeconomic status is associated with late cancer diagnosis and mortality in Argentina. It is important that cancer screening services are accessible to the whole population so that cancer can be detected early. Our aim in this study was to investigate socioeconomic determinants for the disparities in the use of breast, cervical, and colorectal cancer screening services in Argentina, and to measure the country progress in reducing differences in cancer screening participation across socioeconomic levels. We performed a secondary analysis of cross-sectional data from the 2018 National Survey of Risk Factors of Argentina. The sample included data from 49,170 households. We also compared the results with data from the 2013 wave of the same survey in order to assess progress on cancer screening participation across income and education categories. Income, education, health insurance, disability, and marital status were associated with cancer screening underuse in Argentina. Comparison between 2013 and 2018 demonstrated that there has been some progress toward increasing cancer screening uptake, but this increase is not equitably distributed across the population. To further reduce disparities in cancer participation across socioeconomic levels, cancer screening programs in Argentina should reinforce strategies to become more accessible. It is important to proactively reach those populations that are underusers of cancer screening and ensure that barriers that stop people from accessing cancer screening are explored and adequately addressed.
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Extending Age Ranges in Breast Cancer Screening in Four European Countries: Model Estimations of Harm-to-Benefit Ratios. Cancers (Basel) 2021; 13:cancers13133360. [PMID: 34283068 PMCID: PMC8268112 DOI: 10.3390/cancers13133360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Revised: 06/22/2021] [Accepted: 06/26/2021] [Indexed: 12/12/2022] Open
Abstract
Simple Summary Breast cancer screening causes harms and benefits. The balance between the two varies by age. By applying microsimulation modelling, we compared several age ranges of screening in four European countries (the Netherlands, Finland, Italy and Slovenia) and evaluated the respective harm-to-benefit ratios. In all countries, adding screening between the ages 45 and 49 or 70 and 74 resulted in more life-years gained and more breast cancer deaths averted, but at the expense of increases in harms. Adapting the age range of breast cancer screening is an option to improve harm-to-benefit ratios in all four countries. The prioritization of considered harms and benefits affects the interpretation of results. Abstract The main benefit of breast cancer (BC) screening is a reduction in mortality from BC. However, screening also causes harms such as overdiagnosis and false-positive results. The balance between benefits and harms varies by age. This study aims to assess how harm-to-benefit ratios of BC screening vary by age in the Netherlands, Finland, Italy and Slovenia. Using microsimulation models, we simulated biennial screening with 100% attendance at varying ages for cohorts of women followed over a lifetime. The number of overdiagnoses, false-positive diagnoses, BC deaths averted and life-years gained (LYG) were calculated per 1000 women. We compared four strategies (50–69, 45–69, 45–74 and 50–74) by calculating four harm-to-benefit ratios, respectively. Compared to the reference strategy 50–69, screening women at 45–74 or 50–74 years would be less beneficial in any of the four countries than screening women at 45–69, which would result in relatively fewer overdiagnoses per death averted or LYG. At the same time, false-positive results per death averted would increase substantially. Adapting the age range of BC screening is an option to improve harm-to-benefit ratios in all four countries. Prioritization of considered harms and benefits affects the interpretation of results.
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Wei G, Zhang K, Gu Y, Guang S, Feng J, Xu H. Novel multifunctional nano-hybrid polyhedral oligomeric silsesquioxane-based molecules with high cell permeability: molecular design and application for diagnosis and treatment of tumors. NANOSCALE 2021; 13:2982-2994. [PMID: 33508044 DOI: 10.1039/d0nr07641d] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Chemotherapy mostly functions as a carrier for direct drug delivery to the tumor, which may induce secondary damage to healthy tissue cells around the tumor. To avoid this side effect, using multifunctional drugs with high cell permeability during chemotherapy is crucial to achieve significant antitumor efficacy. In this study, polyhedral oligomeric silsesquioxane-based multifunctional organic-inorganic hybrid molecules with potential for recognition, imaging, and treatment were designed and successfully synthesized through a facile and efficient one-pot reaction process. The structure and properties of the synthesized multifunctional molecules were characterized by Fourier transform infrared spectroscopy, nuclear magnetic resonance spectroscopy, mass spectrometry, fluorescence spectroscopy, cytotoxicity assay, surface tension testing, cell compatibility testing, hematoxylin and eosin staining, as well as in vivo and in vitro studies. The results demonstrated that these multifunctional molecules can be effectively used for delivering precisely-targeted imaging and therapeutic agents and exhibited considerable cell permeability. The excellent synergy between high permeability and precise targeting results in multifunctional molecules with superior diagnostic performance.
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Affiliation(s)
- Gang Wei
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials, Research Center for Analysis and Measurement & College of Materials Science and Engineering, Donghua University, Shanghai 201620, China.
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Kaiser CG, Dietzel M, Vag T, Rübenthaler J, Froelich MF, Tollens F. Impact of specificity on cost-effectiveness of screening women at high risk of breast cancer with magnetic resonance imaging, mammography and ultrasound. Eur J Radiol 2021; 137:109576. [PMID: 33556759 DOI: 10.1016/j.ejrad.2021.109576] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/24/2021] [Accepted: 01/26/2021] [Indexed: 01/08/2023]
Abstract
PURPOSE Aim of this study was to analyze the comparative cost-effectiveness of MR-mammography vs conventional imaging in a screening setting for women with high risk of breast cancer, with particular focus on the impact of specificity of MRM. METHOD Decision analytic modelling and Markov Modelling were applied to evaluate cumulative costs of each screening modality and their subsequent treatments as well as cumulative outcomes in quality adjusted life years (QALYs). For the selected time horizon of 30 years, false positive and false negative results were included. Model input parameters for women with high risk of breast cancer were estimated based on published data from a US healthcare system perspective. Major influence factors were identified and evaluated in a deterministic sensitivity analysis. Based on current recommendations for economic evaluations, a probabilistic sensitivity analysis was conducted to test the model stability. RESULTS In a base-case analysis, screening with XM vs. MRM and treatment resulted in overall costs of $36,201.57 vs. $39,050.97 and a cumulative effectiveness of 19.53 QALYs vs. 19.59 QALYs. This led to an incremental cost-effectiveness ratio (ICER) of $ 45,373.94 per QALY for MRM. US and XM + US resulted in ICER values higher than the willingness to pay (WTP). In the sensitivity analyses, MRM remained a cost-effective strategy for screening high-risk patients as long as the specificity of MRM did not drop below 86.7 %. CONCLUSION In high-risk breast cancer patients, MRM can be regarded as a cost-effective alternative to XM in a yearly screening setting. Specificity may be an important cost driver in settings with yearly screening intervals.
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Affiliation(s)
- Clemens G Kaiser
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany.
| | - Matthias Dietzel
- Department of Radiology, Friedrich-Alexander-University Hospital Erlangen, Germany
| | - Tibor Vag
- Conradia Radiology & Medical Prevention Munich, Germany
| | | | - Matthias F Froelich
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany
| | - Fabian Tollens
- Department of Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim-University of Heidelberg, Germany
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Abstract
In recommending and offering screening, health services make a health claim ('it's good for you'). This article considers ethical aspects of establishing the case for cancer screening, building a service programme, monitoring its operation, improving its quality and integrating it with medical progress. The value of (first) screening is derived as a function of key parameters: prevalence of the target lesion in the detectable pre-clinical phase, the validity of the test and the respective net utilities or values attributed to four health states-true positives, false positives, false negatives and true negatives. Decision makers as diverse as public regulatory agencies, medical associations, health insurance funds or individual screenees can legitimately come up with different values even when presented with the same evidence base. The main intended benefit of screening is the reduction of cause-specific mortality. All-cause mortality is not measurably affected. Overdiagnosis and false-positive tests with their sequelae are the main harms. Harms and benefits accrue to distinct individuals. Hence the health claim is an invitation to a lottery with benefits for few and harms to many, a violation of the non-maleficence principle. While a public decision maker may still propose a justified screening programme, respect for individual rights and values requires preference-sensitive, autonomy-enhancing educational materials-even at the expense of programme effectiveness. Opt-in recommendations and more 'consumer-oriented' qualitative research are needed.
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Affiliation(s)
- Bernt-Peter Robra
- Institute for Social Medicine and Health Services Research, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, D-39140, Magdeburg, Germany.
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Riganti P, Ruiz Yanzi MV, Escobar Liquitay CM, Kopitowski KS, Franco JVA. Shared decision making for supporting women’s decisions about breast cancer screening. Hippokratia 2020. [DOI: 10.1002/14651858.cd013822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Paula Riganti
- Family and Community Medicine Division; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - M. Victoria Ruiz Yanzi
- Family and Community Medicine; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | | | - Karin S Kopitowski
- Family and Community Medicine Division; Hospital Italiano de Buenos Aires; Buenos Aires Argentina
| | - Juan VA Franco
- Associate Cochrane Centre; Instituto Universitario Hospital Italiano de Buenos Aires; Buenos Aires Argentina
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A method for evaluating breast cancer screening strategies using screen-preventable loss of life. PLoS One 2020; 15:e0243113. [PMID: 33275605 PMCID: PMC7717532 DOI: 10.1371/journal.pone.0243113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
The objective of this study is to describe how screen-preventable loss of life (screen-PLL) can be used to analyze the distribution of life savings with mammographic screening. The determination of screen-PLL with mammography is possible using a natural history model of breast cancer that simulates clinical and pathologic events of this disease. This investigation uses a Monte Carlo Markov model with data from the Surveillance, Epidemiology, and End Results Program; American Cancer Society; and National Vital Statistics System. Populations of one million women per screening strategy are simulated over a lifetime with mammographic screening based on current guidelines of the American Cancer Society (ACS), United States Preventive Services Task Force (USPSTF), triennial screening from age 50–70, and no screening. Screen-PLL curves are generated and show guideline performance over a lifetime. The screen-PLL curve with no screening is determined by tumor discovery through clinical awareness and has the highest values of screen-PLL. The ACS and USPSTF strategies demonstrate screen-PLL curves favoring the elderly. The curve for triennial screening is more uniform than the ACS or USPSTF curves but could be improved by adding screen(s) at either end of the 50–70 age range. This study introduces the use of screen-PLL as a tool to improve the understanding of screening guidelines and allowing a more balanced allocation of life savings across an aging population. The method presented shows how screen-PLL can be used to analyze and potentially improve breast cancer screening guidelines.
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Nakamura M, Ishizuka Y, Horimoto Y, Shiraishi A, Arakawa A, Yanagisawa N, Iijima K, Saito M. Clinicopathological features of breast cancer without mammographic findings suggesting malignancy. Breast 2020; 54:335-342. [PMID: 33285381 PMCID: PMC7721633 DOI: 10.1016/j.breast.2020.11.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 11/17/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background Mammography (MG) is widely used for screening examinations. Dense breast reduces MG screening sensitivity, possibly delaying diagnosis. However, little is known about the characteristics of breast cancers without MG findings indicative of malignancy. Hence, we investigated breast cancer patients with tumors not detected by MG. Patients and methods In total, 1758 Japanese patients with breast cancer, undergoing curative surgery between 2012 and 2018 without neo-adjuvant chemotherapy, were retrospectively investigated. Clinicopathological features were compared between patients without (MG-negative) and with (MG-positive) cancer-specific findings on MG. The current study included cases who came to our hospital after experiencing subjective symptoms, or whose tumors were detected by MG and/or US-screening. We reviewed results of both MG and US conducted at our institution. Results There were 201 MG-negative cases (11.4%). In patients with invasive disease, multivariate analysis revealed MG-negative patients to have higher breast density on MG (p < 0.001). Tumors of MG-negative patients were smaller (p < 0.001), showed less lymph node involvement (p = 0.011), and were of lower grade (p = 0.027). The majority of MG-negative tumors were found by ultrasound screening, being smaller than tumors in patients with subjective symptoms. In the MG-negative group, tumor characteristics such as tumor grade did not differ between those detected by screening versus subjective symptoms. Conclusion Most tumors in MG-negative group patients were identified by US screening and the diseases were found at early stages with low malignancy. The usefulness of additional ultrasound with MG-screening might merit further investigations. Breast cancers without cancer-specific findings on mammograms were pathologically at early stages and low-grade . The majority of mammogram-negative tumors were found by ultrasound screening. Mammogram-negative tumors were low-grade regardless of motives for visiting the hospital.
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Affiliation(s)
- Mei Nakamura
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Kotobashi, Sumida-ku, Tokyo, 130-8575, Japan
| | - Yumiko Ishizuka
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan; Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| | - Akihiko Shiraishi
- Department of Radiology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Kotaro Iijima
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Mitsue Saito
- Department of Breast Oncology, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
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Agustsson AS, Birgisson H, Agnarsson BA, Jonsson T, Stefansdottir H, Wärnberg F, Lambe M, Tryggvadottir L, Sverrisdottir A. In situ breast cancer incidence patterns in Iceland and differences in ductal carcinoma in situ treatment compared to Sweden. Sci Rep 2020; 10:17623. [PMID: 33077767 PMCID: PMC7572374 DOI: 10.1038/s41598-020-74134-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 09/22/2020] [Indexed: 01/12/2023] Open
Abstract
The purpose was to review the incidence of in situ carcinoma in Iceland after initiating population-based mammography screening in 1987 and to compare management of ductal carcinoma in situ (DCIS) between Iceland and the Uppsala-Örebro region (UÖR) in Central Sweden. The Icelandic Cancer Registry provided data on in situ breast carcinomas for women between 1957 and 2017. Clinical data for women with DCIS between 2008 and 2014 was extracted from hospital records and compared to women diagnosed in UÖR. In Iceland, in situ carcinoma incidence increased from 7 to 30 per 100 000 women per year, following the introduction of organised mammography screening. The proportion of in situ carcinoma of all breast carcinomas increased from 4 to 12%. More than one third (35%) of women diagnosed with DCIS in Iceland were older than 70 years versus 18% in UÖR. In Iceland, 49% of all DCIS women underwent mastectomy compared to 40% in UÖR. The incidence of in situ carcinoma in Iceland increased four-fold after the uptake of population-based mammography screening causing considerable risk of overtreatment. Differences in treatment of DCIS were seen between Iceland and UÖR, revealing the importance of quality registration for monitoring patterns of management.
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Affiliation(s)
| | - Helgi Birgisson
- Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavík, Iceland
| | - Bjarni A Agnarsson
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Landspitali, The National University Hospital of Iceland, Reykjavík, Iceland
| | - Thorvaldur Jonsson
- Landspitali, The National University Hospital of Iceland, Reykjavík, Iceland
| | | | | | - Mats Lambe
- Regional Cancer Centre Uppsala-Örebro, Uppsala, Sweden.,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Laufey Tryggvadottir
- Faculty of Medicine, University of Iceland, Reykjavík, Iceland.,Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavík, Iceland
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Vanni G, Pellicciaro M, Materazzo M, Bruno V, Oldani C, Pistolese CA, Buonomo C, Caspi J, Gualtieri P, Chiaravalloti A, Palombi L, Piccione E, Buonomo OC. Lockdown of Breast Cancer Screening for COVID-19: Possible Scenario. In Vivo 2020; 34:3047-3053. [PMID: 32871851 DOI: 10.21873/invivo.12139] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM Coronavirus disease is spreading worldwide. Due to fast transmission and high fatality rate drastic emergency restrictions were issued. During the lockdown, only urgent medical services are guaranteed. All non-urgent services, as breast cancer (BC) screening, are temporarily suspended. The potential of breast cancer screening programs in increasing the survival rate and decreasing the mortality rate has been widely confirmed. Suspension could lead to worse outcomes for breast cancer patients. Our study aimed to analyse the data and provide estimates regarding the temporary BC screening suspension. PATIENTS AND METHODS Data regarding breast cancer and respective screening programs were achieved through literature research and analysis. RESULTS Considering three different scenarios with respect to the lockdown's impact on breast cancer screening, we estimate that approximately 10,000 patients could have a missed diagnosis during these 3 months. Considering a 6-month period, as suggested by the Imperial college model, the number of patients who will not receive a diagnosis will rise to 16,000. CONCLUSION Breast cancer screening should be resumed as soon as possible in order to avoid further breast cancer missed diagnosis and reduce the impact of delayed diagnosis.
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Affiliation(s)
- Gianluca Vanni
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Pellicciaro
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Marco Materazzo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Valentina Bruno
- Section of Gynecology, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Oldani
- Department of Economics and Engineering, University of Viterbo 'La Tuscia', Viterbo, Italy
| | - Chiara Adriana Pistolese
- Department of Diagnostic Imaging and Interventional Radiology, Molecular Imaging and Radiotherapy Policlinico Tor Vergata University, Rome, Italy
| | - Chiara Buonomo
- Department of Emergency and Admission, Critical Care Medicine, Pain Medicine and Anesthetic Science, Policlinico Tor Vergata University, Rome, Italy
| | - Jonathan Caspi
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Paola Gualtieri
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy
| | - Agostino Chiaravalloti
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy.,IRCCS Neuromed, UOC Medicina Nucleare, Pozzilli, Italy
| | - Leonardo Palombi
- Department of Biomedicine and Prevention, Policlinico Tor Vergata University, Rome, Italy
| | - Emilio Piccione
- Section of Gynecology, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
| | - Oreste Claudio Buonomo
- Breast Unit, Department of Surgical Science, Policlinico Tor Vergata University, Rome, Italy
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Ritchie D, Van Hal G, Van den Broucke S. How is informed decision-making about breast cancer screening addressed in Europe? An international survey of 28 countries. Health Policy 2020; 124:1017-1031. [DOI: 10.1016/j.healthpol.2020.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 12/15/2022]
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Breast cancer mortality and overdiagnosis after implementation of population-based screening in Denmark. Breast Cancer Res Treat 2020; 184:891-899. [PMID: 32862304 PMCID: PMC7655583 DOI: 10.1007/s10549-020-05896-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 08/18/2020] [Indexed: 11/04/2022]
Abstract
Introduction Service breast cancer screening is difficult to evaluate because there is no unscreened control group. Due to a natural experiment, where 20% of women were offered screening in two regions up to 17 years before other women, Denmark is in a unique position. We utilized this opportunity to assess outcome of service screening. Materials and methods Screening was offered in Copenhagen from 1991 and Funen from 1993 to women aged 50–69 years. We used difference-in-differences methodology with a study group offered screening; a historical control group; a regional control group; and a regional–historical control group, comparing breast cancer mortality and incidence, including ductal carcinoma in situ, between study and historical control group adjusted for changes in other regions, and calculating ratios of rate ratios (RRR) with 95% confidence intervals (CI). Data came from Central Population Register; mammography screening databases; Cause of Death Register; and Danish Cancer Register. Results For breast cancer mortality, the study group accumulated 1,551,465 person-years and 911 deaths. Long-term breast cancer mortality in Copenhagen was 20% below expected in absence of screening; RRR 0.80 (95% CI 0.71–0.90), and in Funen 22% below; RRR 0.78 (95% CI 0.68–0.89). Combined, cumulative breast cancer incidence in women followed 8+ years post-screening was 2.3% above expected in absence of screening; RRR 1.023 (95% CI 0.97–1.08). Discussion Benefit-to-harm ratio of the two Danish screening programs was 2.6 saved breast cancer deaths per overdiagnosed case. Screening can affect only breast cancers diagnosed in screening age. Due to high breast cancer incidence after age 70, only one-third of breast cancer deaths after age 50 could potentially be affected by screening. Increasing upper age limit could be considered, but might affect benefit-to-harm ratio negatively.
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Froelich MF, Kaiser CG. Cost-effectiveness of MR-mammography as a solitary imaging technique in women with dense breasts: an economic evaluation of the prospective TK-Study. Eur Radiol 2020; 31:967-974. [PMID: 32856166 PMCID: PMC7813739 DOI: 10.1007/s00330-020-07129-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/09/2020] [Accepted: 07/31/2020] [Indexed: 12/03/2022]
Abstract
Objectives To evaluate the economic implications of our previous study on the use of MR-mammography (MRM) as a solitary imaging tool in women at intermediate risk due to dense breasts. Background In our previous study, we found MRM to be a specific diagnostic tool with high accuracy in patients with dense breasts representing a patient collective at intermediate risk of breast cancer. For this study, we examined whether MRM is an economical alternative. Methods For the determination of outcomes and costs, a decision model based on potential diagnostic results of MRM was developed. Quality of life was estimated in a Markov chain model distinguishing between the absence of malignancy, the presence of malignancy, and death. Input parameters were utilized from the prospective TK-Study. To investigate the economic impact of MRM, overall costs in € and outcomes of MRM in quality-adjusted life years (QALYs) were estimated. A deterministic sensitivity analysis was performed. Results MRM was associated with expected costs of 1650.48 € in the 5-year period and an expected cumulative outcome of 4.69 QALYs. A true positive diagnosis resulted in significantly lower costs and a higher quality of life when compared to the consequences of a false negative result. In the deterministic sensitivity analysis, treatment costs had more impact on overall costs than the costs of MRM. The total costs per patient remained below 2500 € in the 5-year period. Conclusion MRM, as a solitary imaging tool in patients at intermediate risk due to dense breasts, is economically feasible. Key Points • In patients with dense breasts (i.e., patients at intermediate risk of breast cancer), the relative cost of MR-mammography examinations only had moderate impact on overall costs. • This is due to cost-savings through the application of a sensitive imaging technique resulting in an optimized staging and therapy planning. • MR-mammography, unaccompanied by mammography or ultrasound in patients with dense breasts, was economically feasible in our analysis.
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Affiliation(s)
- Matthias F Froelich
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim - University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Clemens G Kaiser
- Institute of Clinical Radiology and Nuclear Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim - University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
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31
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Hermann N, Klil-Drori A, Angarita FA, Westergard S, Freitas V, Scaranelo A, McCready DR, Cil TD. Screening women at high risk for breast cancer: one program fits all? Breast Cancer Res Treat 2020; 184:763-770. [DOI: 10.1007/s10549-020-05895-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 08/18/2020] [Indexed: 12/19/2022]
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A dynamic web-based decision aid to improve informed choice in organised breast cancer screening. A pragmatic randomised trial in Italy. Br J Cancer 2020; 123:714-721. [PMID: 32546834 PMCID: PMC7462858 DOI: 10.1038/s41416-020-0935-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 12/29/2022] Open
Abstract
Background Improving the quality of information and communication is a priority in organised breast cancer screening and an ethical duty. Programmes must offer the information each woman is looking for, promoting informed decision-making. This study aimed to develop and evaluate a web-based dynamic decision aid (DA). Methods A pragmatic randomised trial carried out in six regional organised screening programmes recruited women at the first invitation receiving DA or a web-based standard brochure (SB). The primary outcome was informed choice measured on knowledge, attitudes, and intentions. Follow-up period: 7–10 days. Secondary outcomes included participation rate, satisfaction, decisional conflict, and acceptability of DA. Results Two thousand one hundred and nineteen women were randomised and 1001 completed the study. Respectively, 43.9% and 36.9% in the DA and SB reached the informed choice. The DA gave a 13-point higher proportion of women aware about overdiagnosis compared to SB (38.3% versus 25.2%, p < 0.0001). The percentage of women attending screening was the same: 84% versus 83%. Decisional conflict was significantly lower in the DA group (14.4%) than in the SB group (19.3%). Conclusion DA increases informed choice. Complete information including the pros, cons, controversies, and overdiagnosis–overtreatment issues boost a woman’s knowledge without reducing the rate of actual screening participation. Clinical trial registration ClinicalTrials.gov number NCT 03097653.
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Abstract
Cancer is the second leading cause of mortality in women. Although treatments have improved, prevention and early detection can have the greatest effect on reducing the burden of cancer in women, with an estimated 40% of cancers being potentially avoidable. Cancers related to smoking, obesity, physical inactivity, alcohol consumption, and poor nutrition account for the largest share of this estimate. This review examines strategies for reducing the burden of cancer in average-risk women. Specifically, we examine primary prevention strategies-those aimed at reducing the risk of developing cancer-as well as secondary prevention strategies-measures aimed at the early detection of disease. Annual well-women examinations are endorsed by the American College of Obstetricians and Gynecologists as opportunities to counsel patients on preventive care or to refer to other specialists for recommended services.
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34
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Haug U, Senore C, Corley DA. Promises and Potential Pitfalls of Shared Decision Making in Cancer Screening. Gastroenterology 2020; 158:802-805. [PMID: 31812511 DOI: 10.1053/j.gastro.2019.11.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/04/2019] [Accepted: 11/16/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS and, Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Carlo Senore
- SSD Epidemiologia e screening - CPO, University Hospital 'Città della Salute e della Scienza', Turin, Italy
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Miret C, Domingo L, Louro J, Barata T, Baré M, Ferrer J, Carmona-García MC, Castells X, Sala M. Factors associated with readmissions in women participating in screening programs and treated for breast cancer: a retrospective cohort study. BMC Health Serv Res 2019; 19:940. [PMID: 31805926 PMCID: PMC6896282 DOI: 10.1186/s12913-019-4789-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 11/28/2019] [Indexed: 01/15/2023] Open
Abstract
Background We aimed to identify the risk factors associated with early, late and long-term readmissions in women diagnosed with breast cancer participating in screening programs. Methods We performed a multicenter cohort study of 1055 women aged 50–69 years participating in Spanish screening programs, diagnosed with breast cancer between 2000 and 2009, and followed up to 2014. Readmission was defined as a hospital admission related to the disease and/or treatment complications, and was classified as early (< 30 days), late (30 days-1 year), or long-term readmission (> 1 year). We used logistic regression to estimate the adjusted odds ratios (aOR), and 95% confidence intervals (95% CI) to explore the factors associated with early, late and long-term readmissions, adjusting by women’s and tumor characteristics, detection mode, treatments received, and surgical and medical complications. Results Among the women included, early readmission occurred in 76 (7.2%), late readmission in 87 (8.2%), long-term readmission in 71 (6.7%), and no readmission in 821 (77.8%). Surgical complications were associated with an increased risk of early readmissions (aOR = 3.62; 95%CI: 1.27–10.29), and medical complications with late readmissions (aOR = 8.72; 95%CI: 2.83–26.86) and long-term readmissions (aOR = 4.79; 95%CI: 1.41–16.31). Conclusion Our results suggest that the presence of surgical or medical complications increases readmission risk, taking into account the detection mode and treatments received. Identifying early complications related to an increased risk of readmission could be useful to adapt the management of patients and reduce further readmissions. Trial Registration ClinicalTrials.govIdentifier: NCT03165006. Registration date: May 22, 2017 (Retrospectively registered).
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Affiliation(s)
- Carme Miret
- Preventive Medicine and Public Health Training Unit PSMar-UPF-ASPB, Parc de Salut Mar, Agència de Salut Pública de Barcelona, Pompeu Fabra University, Barcelona, Spain.,Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Barcelona, Spain
| | - Laia Domingo
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain. .,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain.
| | - Javier Louro
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Teresa Barata
- General Directorate of Health Care Programs, Canary Islands Health Service, C/ Juan XXIII,13, 35005, Las Palmas de Gran Canaria, Spain
| | - Marisa Baré
- Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain.,Cancer Screening and Clinical Epidemiology, Corporació Sanitària Parc Taulí, 08208, Sabadell, Spain
| | - Joana Ferrer
- Department of Radiology, Hospital de Santa Caterina, C/ Dr. Castany, s/n, 17190 Salt, Girona, Spain
| | - Maria Carmen Carmona-García
- Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Department of Health, Catalan Institute of Oncology, C/ Sol, 15, 17004, Girona, Spain.,Girona Biomedical Research Institute (IDIBGI), C/ Dr Castany s/n, 17190 Salt, Girona, Spain.,Department of Medical Oncology, Catalan Institute of Oncology, University Hospital Dr Josep Trueta, Av. França, S/N, 17007, Girona, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autònoma de Barcelona (UAB), 08193 Bellaterra, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Maria Sala
- Department of Epidemiology and Evaluation, IMIM (Hospital del Mar Medical Research Institute), Passeig Marítim, 25-29, 08003, Barcelona, Spain.,Research Network on Health Services in Chronic Diseases (REDISSEC), Av. de Monforte de Lemos, 5, 28029, Madrid, Spain
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Nuche-Berenguer B, Sakellariou D. Socioeconomic determinants of cancer screening utilisation in Latin America: A systematic review. PLoS One 2019; 14:e0225667. [PMID: 31765426 PMCID: PMC6876872 DOI: 10.1371/journal.pone.0225667] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/08/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Cancer incidence and mortality in Latin America are rising. While effective cancer screening services, accessible to the whole population and enabling early cancer detection are needed, existing research shows the existence of disparities in screening uptake in the region. OBJECTIVE We conducted a systematic review to investigate the socioeconomic determinants for the disparities in the use of breast, cervical and colorectal cancer screening services in Latin America. METHODS We searched for studies reporting on socioeconomic determinants impacting on access to breast, cervical and colorectal cancer screening, published from 2009 through 2018. The studies that qualified for inclusion contained original analyses on utilisation of breast, cervical and colorectal cancer screening across socioeconomic levels in Latin America. For each study, paired reviewers performed a quality analysis followed by detailed review and data extraction. RESULTS Twenty-four articles that met the eligibility criteria and were of sufficient quality were included in this review. Thirteen of the included articles were written in English, eight in Portuguese and three in Spanish, and they reported on the use of breast or cervical cancer screening. No studies were found on the socioeconomic determinants regarding the utilisation of colorectal cancer screening in Latin America. Low income, low education level, lack of health insurance and single marital status were all found to be determinants of underuse of breast and cervical cancer screening services. CONCLUSIONS Cancer screening programs in the region must prioritize reaching those populations that underuse cancer screening services to ensure equitable access to preventive services. It is important to develop national screening programmes that are accessible to all (including uninsured people) through, for example, the use of mobile units for mammography and self-screening methods.
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Affiliation(s)
| | - Dikaios Sakellariou
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
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Czwikla J, Urbschat I, Kieschke J, Schüssler F, Langner I, Hoffmann F. Assessing and Explaining Geographic Variations in Mammography Screening Participation and Breast Cancer Incidence. Front Oncol 2019; 9:909. [PMID: 31620366 PMCID: PMC6759661 DOI: 10.3389/fonc.2019.00909] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 09/02/2019] [Indexed: 12/29/2022] Open
Abstract
Investigating geographic variations in mammography screening participation and breast cancer incidence help improve prevention strategies to reduce the burden of breast cancer. This study examined the suitability of health insurance claims data for assessing and explaining geographic variations in mammography screening participation and breast cancer incidence at the district level. Based on screening unit data (1,181,212 mammography screening events), cancer registry data (13,241 incident breast cancer cases) and claims data (147,325 mammography screening events; 1,778 incident breast cancer cases), screening unit and claims-based standardized participation ratios (SPR) of mammography screening as well as cancer registry and claims-based standardized incidence ratios (SIR) of breast cancer between 2011 and 2014 were estimated for the 46 districts of the German federal state of Lower Saxony. Bland-Altman analyses were performed to benchmark claims-based SPR and SIR against screening unit and cancer registry data. Determinants of district-level variations were investigated at the individual and contextual level using claims-based multilevel logistic regression analysis. In claims and benchmark data, SPR showed considerable variations and SIR hardly any. Claims-based estimates were between 0.13 below and 0.14 above (SPR), and between 0.36 below and 0.36 above (SIR) the benchmark. Given the limited suitability of health insurance claims data for assessing geographic variations in breast cancer incidence, only mammography screening participation was investigated in the multilevel analysis. At the individual level, 10 of 31 Elixhauser comorbidities were negatively and 11 positively associated with mammography screening participation. Age and comorbidities did not contribute to the explanation of geographic variations. At the contextual level, unemployment rate was negatively and the proportion of employees with an academic degree positively associated with mammography screening participation. Unemployment, income, education, foreign population and type of district explained 58.5% of geographic variations. Future studies should combine health insurance claims data with individual data on socioeconomic characteristics, lifestyle factors, psychological factors, quality of life and health literacy as well as contextual data on socioeconomic characteristics and accessibility of mammography screening. This would allow a comprehensive investigation of geographic variations in mammography screening participation and help to further improve prevention strategies for reducing the burden of breast cancer.
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Affiliation(s)
- Jonas Czwikla
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany.,Department of Health, Long-Term Care and Pensions, SOCIUM Research Center on Inequality and Social Policy, University of Bremen, Bremen, Germany.,High-Profile Area of Health Sciences, University of Bremen, Bremen, Germany
| | - Iris Urbschat
- Epidemiological Cancer Registry of Lower Saxony, Registry Unit Oldenburg, Oldenburg, Germany
| | - Joachim Kieschke
- Epidemiological Cancer Registry of Lower Saxony, Registry Unit Oldenburg, Oldenburg, Germany
| | - Frank Schüssler
- Institute for Applied Photogrammetry and Geoinformatics, Jade University of Applied Sciences Wilhelmshaven/Oldenburg/Elsfleth, Oldenburg, Germany
| | - Ingo Langner
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen, Germany
| | - Falk Hoffmann
- Department of Health Services Research, Carl von Ossietzky University of Oldenburg, Oldenburg, Germany
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Bonafede MM, Miller JD, Pohlman SK, Troeger KA, Sprague BL, Herschorn SD, Winer IH. Breast, Cervical, and Colorectal Cancer Screening: Patterns Among Women With Medicaid and Commercial Insurance. Am J Prev Med 2019; 57:394-402. [PMID: 31377088 PMCID: PMC7433028 DOI: 10.1016/j.amepre.2019.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite healthcare reforms mandating expanded insurance coverage and reduced out-of-pocket costs for preventive care, cancer screening rates remain relatively static. No study has measured cancer screening rates for multiple tests among non-Medicare patients. METHODS This retrospective, population-based claims analysis, conducted in 2016-2017, of commercially insured and Medicaid-insured women aged 30-59 years enrolled in IBM MarketScan Commercial and Medicaid Databases (containing approximately 90 and 17 million enrollees, respectively) during 2010-2015 describes screening rates for breast, cervical, and colorectal cancer. Key outcomes were (1) proportion screened for breast, cervical, and colorectal cancer among the age-eligible population compared with accepted age-based recommendations and (2) proportion with longer-than-recommended intervals between tests. RESULTS One half (54.7%) of commercially insured women aged 40-59 years (n=1,538,444) were screened three or more times during the 6-year study period for breast cancer; for Medicaid-insured women (n=78,897), the rates were lower (23.7%). One third (43.4%) of commercially insured and two thirds (68.9%) of Medicaid-insured women had a >2.5-year gap between mammograms. Among women aged 30-59 years, 59.3% of commercially insured women and 31.4% of Medicaid-insured women received two or more Pap tests. The proportion of patients with a >3.5-year gap between Pap tests was 33.9% (commercially insured) and 57.1% (Medicaid-insured). Among women aged 50-59 years, 63.3% of commercially insured women and 47.2% of Medicaid-insured women were screened at least one time for colorectal cancer. Almost all women aged 30-59 years (commercially insured, 99.1%; Medicaid-insured, 98.9%) had at least one healthcare encounter. CONCLUSIONS Breast and cervical cancer screenings remain underutilized among both commercially insured and Medicaid-insured populations, with lower rates among the Medicaid-insured population. However, almost all women had at least one healthcare encounter, suggesting opportunities for better coordinated care.
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Affiliation(s)
| | | | - Scott K Pohlman
- Outcomes Research, Hologic, Inc., Marlborough, Massachusetts
| | | | - Brian L Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont; Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
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Malmartel A, Tron A, Caulliez S. Accuracy of clinical breast examination's abnormalities for breast cancer screening: cross-sectional study. Eur J Obstet Gynecol Reprod Biol 2019; 237:1-6. [PMID: 30974372 DOI: 10.1016/j.ejogrb.2019.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 03/06/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The guidelines for breast cancer screening with clinical breast examination (CBE) are diverging CBE is recommended in France, whereas it is not recommended in the United States and Canada, given the lack of clear benefit and the risk of overmedication. To assess the accuracy of abnormalities found during CBE for in breast cancer screening. STUDY DESIGN A cross-sectional study included women over 18 years with no history of breast cancer coming for a mammography at 3 ambulatory radiology practices in Paris. A questionnaire collected the risk of breast cancer on mammography according to the Breast Imaging-Reporting And Data System (Bi-RADS) (high risk: Bi-RADS 4 or 5 versus lower risk: other Bi-RADS categories), the risk factors for breast cancer and the breast clinical abnormalities (none, mass, skin abnormality, oedema, pain, nipple discharge, lymph nodes…) For each abnormality, sensitivity, specificity, positive (PPV) and negative (NPV) predictive values were calculated. RESULT Among the 3218 included patients (mean age 55.1 +/-10 years), 713 (22.2%) had an abnormal CBE and 133 (4.1%) had high-risk mammography. The sensitivity of CBE was 36%[28%;45%] and the specificity was 78%[77%;80%]. The PPV and NPV for each clinical abnormality were low, except for nipple discharge, retraction and lymph nodes, for which the PPV were 10.5[3.7;29.9], 6.6[1.4;31.6], and 5.0[1.5;17.1], respectively, but these abnormalities were rare (0.5%, 0.2% and 0.5% respectively). These values were similar across all age groups. CONCLUSION The accuracy of CBE for breast cancer screening appeared to be low which did not support recommending regular CBE in France.
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Affiliation(s)
- Alexandre Malmartel
- Department of General Practice, Faculté de medicine, Université Paris Descartes, Paris, France.
| | - Arthur Tron
- Department of General Practice, Faculté de medicine, Université Paris Descartes, Paris, France
| | - Ségolène Caulliez
- Department of General Practice, Faculté de medicine, Université Paris Descartes, Paris, France
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Impact of Overdiagnosis on Long-Term Breast Cancer Survival. Cancers (Basel) 2019; 11:cancers11030325. [PMID: 30866499 PMCID: PMC6468420 DOI: 10.3390/cancers11030325] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 02/24/2019] [Accepted: 03/04/2019] [Indexed: 12/31/2022] Open
Abstract
Elucidating whether and how long-term survival of breast cancer is mainly due to cure after early detection and effective treatment and therapy or overdiagnosis resulting from the widespread use of mammography provides a new insight into the role mammography plays in screening, surveillance, and treatment of breast cancer. Given information on detection modes, the impact of overdiagnosis due to mammography screening on long-term breast cancer survival was quantitatively assessed by applying a zero (cured or overdiagnosis)-inflated model design and analysis to a 15-year follow-up breast cancer cohort in Dalarna, Sweden. The probability for non-progressive breast cancer (the zero part) was 56.14% including the 44.34% complete cure after early detection and initial treatment and a small 11.80% overdiagnosis resulting from mammography screening program (8.94%) and high awareness (2.86%). The 15-year adjusted cumulative survival of breast cancer was dropped from 88.25% to 74.80% after correcting for the zero-inflated part of overdiagnosis. The present findings reveal that the majority of survivors among women diagnosed with breast cancer could be attributed to the cure resulting from mammography screening and accompanying effective treatment and therapy and only a small fraction of those were due to overdiagnosis.
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Rogers WA. Analysing the ethics of breast cancer overdiagnosis: a pathogenic vulnerability. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:129-140. [PMID: 30030748 DOI: 10.1007/s11019-018-9852-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Breast cancer screening aims to help women by early identification and treatment of cancers that might otherwise be life-threatening. However, breast cancer screening also leads to the detection of some cancers that, if left undetected and untreated, would not have damaged the health of the women concerned. At the time of diagnosis, harmless cancers cannot be identified as non-threatening, therefore women are offered invasive breast cancer treatment. This phenomenon of identifying (and treating) non-harmful cancers is called overdiagnosis. Overdiagnosis is morally problematic as it leads to overall patient harm rather than benefit. Further, breast cancer screening is offered in a context that exaggerates cancer risk and screening benefit, minimises risk of harm and impedes informed choice. These factors combine to create pathogenic vulnerability. That is, breast cancer screening exacerbates rather than reduces women's vulnerability and undermines women's agency. This paper provides an original way of conceptualising agency-supporting responses to the harms of breast cancer overdiagnosis through application of the concept of pathogenic vulnerability.
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Affiliation(s)
- Wendy A Rogers
- Department of Philosophy and Department of Clinical Medicine, Macquarie University, North Ryde, NSW, 2107, Australia.
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Csanádi M, de Kok IM, Heijnsdijk EA, Anttila A, Heinävaara S, Pitter JG, Széles G, Ivanuš U, Priaulx J, Veerus P, Senore C, Koning HJD, Vokó Z. Key indicators of organized cancer screening programs: Results from a Delphi study. J Med Screen 2019; 26:120-126. [PMID: 30621498 DOI: 10.1177/0969141318820362] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To maximize benefits and reduce potential harms of organized cancer screening programs in Europe, monitoring, quality assurance, and evaluation of long-term impact are required. We aimed to identify the most important indicators to be collected and reported. The study was designed to establish a consensus within a European-level working group and suggest a manageable list of key indicators. Methods We conducted a Delphi study among policymakers, researchers, and program coordinators who were experts in breast, cervical, or colorectal cancer screening. Study participants evaluated the importance of screening indicators on a 5-point Likert scale. Results The top 10 indicators by study participants were interval cancer rate, detection rate, screening attendance, screening coverage, cancer incidence, cause-specific mortality, proportion of persons attending further assessment after a positive screen test result, proportion of persons attending a treatment after diagnosis, invitation coverage, and distribution of cancers by mode of detection. Performance indicators were generally considered more important than outcome indicators. Subgroup analyses by cancer types showed similar results, and only cervical cancer screening experts had slightly different preferences. Subgroup analyses by experts’ roles indicated that policymakers found different indicators important compared with researchers or program coordinators, probably because of their different point of view on screening. Conclusion The implication of our priority ranking is twofold: it serves as an initial guidance for countries that have not yet established a system to collect data, and as a checklist for those where data collection is already established, to assess the comprehensiveness of their system.
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Affiliation(s)
| | - Inge McM de Kok
- 2 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Eveline Am Heijnsdijk
- 2 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | | | | | | | | | - Urška Ivanuš
- 4 Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Piret Veerus
- 6 National Institute for Health Development, Tallinn, Estonia
| | - Carlo Senore
- 7 CPO Piemonte and University Hospital "Città della Salute e della Scienza", Turin, Italy
| | - Harry J de Koning
- 2 Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Zoltán Vokó
- 1 Syreon Research Institute, Budapest, Hungary
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Sicsic J, Pelletier-Fleury N, Carretier J, Moumjid N. [Eliciting women’s preferences for breast cancer screening]. SANTE PUBLIQUE 2019; 2:7-17. [PMID: 32372583 DOI: 10.3917/spub.197.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Over the past decade, the balance between the benefits and harms of breast cancer screening (BCS) has been widely debated. To date, no French study has interrogated women's points of view and preferences (in the economic sense) for this controversial screening. This study aims to bridge this gap. We aimed to elicit women's trade-offs between the benefits and harms of BCS. METHODS A discrete choice experiment questionnaire was developed and administered by a survey institute to French women in order to elicit their preferences and trade-offs between the benefits and risks of BCS (i.e., overdiagnosis and false-positive mammography). RESULTS Eight hundred and twelve women, representative of the French general population (age, socioeconomic level, and geographical location), completed the survey. The women would be willing to accept on average 14.1 overdiagnosis cases (median = 9.6) and 47.8 women with a false-positive result (median = 27.2) to avoid one BC-related death. Results from our simulations predict that less than 50% of women would be willing to accept 10 overdiagnosis cases (respectively, 30 women with a false-positive mammography) for one BC-related death avoided. CONCLUSION Women are sensitive to both the benefits and harms of BC screening and their preferences are highly heterogeneous. Providing balanced information on both benefits and harms to women through an informed decision-making process would be more respectful of women's preferences.
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How long should we continue gastric cancer screening? From an epidemiological point of view. Gastric Cancer 2019; 22:456-462. [PMID: 30242605 PMCID: PMC6476823 DOI: 10.1007/s10120-018-0877-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/17/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND In Japan, incidence of gastric cancer is expected to follow the current downward trend as the younger generation has lower incidence of Helicobacter pylori infection. In this study we aimed to estimate how long gastric cancer screening is deemed necessary in the future from epidemiologic perspectives. METHODS Following the Japanese guidelines for gastric cancer screening 2014, recommendation of providing population-based gastric cancer screening is judged by balancing benefits and harms. Benefits and harms are estimated by number needed to screen (NNS) < 1000 and Number Needed to Recall (NNR) < 100. NNS is the number of people required to participate in a screening to prevent one death and NNR is the number of people required to undergo diagnostic examination to prevent one death. These index are estimated for 2020-2035 using future projections of gastric cancer mortality for the scenarios of relative risk (RR) of 0.5-0.9 for mortality reduction by the screening. RESULTS The criteria of both NNS < 1000 and NNR < 100 are fulfilled for the following age groups: when RR is set as 0.6, men ≥ 55 and women ≥ 65; when RR is set as 0.7 and 0.8, men ≥ 65 and women ≥ 75; when RR is set as 0.9, men ≥ 75 only. CONCLUSIONS In case of RR of 0.5 and 0.6, the gastric cancer screening are recommended for men ≥ 55 and women ≥ 65 until 2035, while it is not recommended for men and women in the 45-54 even in 2010 and 2015.
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Wu WYY, Törnberg S, Elfström KM, Liu X, Nyström L, Jonsson H. Overdiagnosis in the population-based organized breast cancer screening program estimated by a non-homogeneous multi-state model: a cohort study using individual data with long-term follow-up. Breast Cancer Res 2018; 20:153. [PMID: 30558679 PMCID: PMC6296133 DOI: 10.1186/s13058-018-1082-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Accepted: 11/19/2018] [Indexed: 12/31/2022] Open
Abstract
Background Overdiagnosis, defined as the detection of a cancer that would not become clinically apparent in a woman’s lifetime without screening, has become a growing concern. Similar underlying risk of breast cancer in the screened and control groups is a prerequisite for unbiased estimates of overdiagnosis, but a contemporary control group is usually not available in organized screening programs. Methods We estimated the frequency of overdiagnosis of breast cancer due to screening in women 50–69 years old by using individual screening data from the population-based organized screening program in Stockholm County 1989–2014. A hidden Markov model with four latent states and three observed states was constructed to estimate the natural progression of breast cancer and the test sensitivity. Piecewise transition rates were used to consider the time-varying transition rates. The expected number of detected non-progressive breast cancer cases was calculated. Results During the study period, 2,333,153 invitations were sent out; on average, the participation rate in the screening program was 72.7% and the average recall rate was 2.48%. In total, 14,648 invasive breast cancer cases were diagnosed; among the 8305 screen-detected cases, the expected number of non-progressive breast cancer cases was 35.9, which is equivalent to 0.43% (95% confidence interval (CI) 0.10%–2.2%) overdiagnosis. The corresponding estimates for the prevalent and subsequent rounds were 15.6 (0.87%, 95% CI 0.20%–4.3%) and 20.3 (0.31%, 95% CI 0.07%–1.6%), respectively. The likelihood ratio test showed that the non-homogeneous model fitted the data better than an age-homogeneous model (P <0.001). Conclusions Our findings suggest that overdiagnosis in the organized biennial mammographic screening for women 50–69 in Stockholm County is a minor phenomenon. The frequency of overdiagnosis in the prevalent screening round was higher than that in subsequent rounds. The non-homogeneous model performed better than the simpler, traditional homogeneous model. Electronic supplementary material The online version of this article (10.1186/s13058-018-1082-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, 90187, Umeå, Sweden.
| | - Sven Törnberg
- Department of Oncology-Pathology, Karolinska Institute, 17177 Solna, Stockholm, Sweden
| | | | - Xijia Liu
- Department of Mathematics and Mathematical Statistics, Umeå University, 90187, Umeå, Sweden
| | - Lennarth Nyström
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, 90187, Umeå, Sweden
| | - Håkan Jonsson
- Department of Radiation Sciences, Oncology, Umeå University, 90187, Umeå, Sweden
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An evaluation of online information available for women with breast implants aged 47-73 who have been invited to attend the NHS Breast Screening Programme. Radiography (Lond) 2018; 24:315-327. [PMID: 30292500 DOI: 10.1016/j.radi.2018.03.008] [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: 07/03/2017] [Revised: 03/20/2018] [Accepted: 03/26/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION The Internet has become an innovative instrument older adults utilise to obtain health-related information. Poor quality health information may cause harm to individuals. If not accessible, or at a level comprehended by target audiences, this does not support the development of their knowledge and subsequently hinders patient's ability to make informed-decisions. AIM evaluate quality, readability, accessibility and usability of online information for women with breast implants invited to attend the NHSBSP. METHODS Eight websites were evaluated for quality and accessibility/usability using uniquely developed evaluation tools. The 'three-click' rule was used to assess usability and SMOG tool to measure readability. Quality and accessibility/usability scores were combined to give an overall score, which were then converted into percentages. A percentage categorisation system ranked the percentage scores from poor to excellent. Readability scores were represented in number of years of education required to read/understand text. RESULTS Average quality score = 14 (66.6%). Average accessibility/usability score = 9 (56.6%). 7 websites achieved an overall score in the poor percentage category (below 75%). Over 50% of websites had readability levels higher than the recommended level for online health information. 100% were above the UK average reading age. CONCLUSION Websites providing information on breast screening with implants are not easily accessible, are of poor quality and too difficult to be read by most people. The quality, readability and accessibility of each website's content should be improved to help support women make informed decisions relating-to breast-screening attendance, increase their understanding and lessen their anxiety.
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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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Lazzaretti MG, Ponti A, Mano MP, Barca A, Casella D, Frigerio A, Giordano L, Mantellini P, Paduos A, Pitarella S, Ravaioli A, Taffurelli M, Tomatis M, Segnan N. Reducing harms from treatment. Sixteen years of surgery of the axilla for screen-detected breast cancers in Italy. Breast 2018; 42:15-22. [PMID: 30138762 DOI: 10.1016/j.breast.2018.08.001] [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: 05/06/2018] [Revised: 07/16/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Available evidence on axillary surgery has accumulated dramatically in the last two decades in favor of less invasive care. The aim of this paper is to study 16-years trends in the surgical management of the axilla in a large population-based data set of screen-detected breast cancers in Italy and to document at what extent recommendations have been adopted in actual clinical care. MATERIAL AND METHODS This is a retrospective cohort study documenting the surgical management of the axilla in primary breast cancer patients over time. We retrieved from the Italian database of screen-detected cancers 41213 cases diagnosed in women aged 50-69 between years 2000 and 2015 in twelve Italian Regions. RESULTS In pN0 cases, an increasing trend (p < 0.001) in the number of patients who received sentinel lymph node biopsy (SLNB) as the only axillary staging procedure was observed. In pN + cases SLNB was the only staging procedure in an increasing number of patients (p < 0.001) especially since the publication of the ACOSOG-Z0011 paper. In ductal carcinoma in situ (DCIS) SLNB was more frequent in mastectomies and in high grade and large lesions. However, 45% of low grade, small DCIS over the whole time period had some form of axillary surgery. CONCLUSION This large series of screen-detected cases documents a strong time trend in the direction of reducing axillary surgery and hence potential harms from treatment. The continuing practice of SLNB in low risk DCIS is of concern in an era of increasing awareness towards overdiagnosis and overtreatment.
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Affiliation(s)
| | - Antonio Ponti
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Maria Piera Mano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alessandra Barca
- Area Prevenzione e Promozione della Salute, Ufficio Screening, Regione Lazio, Italy
| | - Denise Casella
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Alfonso Frigerio
- SSD Screening, AOU Città della Salute e della Scienza, Torino, Italy
| | - Livia Giordano
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Paola Mantellini
- SC Prevenzione Secondaria Screening, Istituto per lo Studio e la Prevenzione Oncologica, Firenze, Italy
| | - Adriana Paduos
- Department of Surgery, ASL Biella, Italy, and Fondazione Edo Tempia, Italy
| | - Sabina Pitarella
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | | | - Mario Taffurelli
- Chief of Breast Surgery, S.Orsola-Malpighi Hospital, Bologna, Italy
| | - Mariano Tomatis
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza, Torino, Italy; Director of WHO Collaborating Centre for Cancer Early Detection and Screening, Torino, Italy
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Paixão L, Chevalier M, Hurtado-Romero AE, Garayoa J. Mean glandular dose to patients from stereotactic breast biopsy procedures. ACTA ACUST UNITED AC 2018; 63:145008. [DOI: 10.1088/1361-6560/aacb06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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Weigel S, Gerss J, Hense HW, Krischke M, Sommer A, Czwoydzinski J, Lenzen H, Kerschke L, Spieker K, Dickmaenken S, Baier S, Urban M, Hecht G, Heidinger O, Kieschke J, Heindel W. Digital breast tomosynthesis plus synthesised images versus standard full-field digital mammography in population-based screening (TOSYMA): protocol of a randomised controlled trial. BMJ Open 2018; 8:e020475. [PMID: 29764880 PMCID: PMC5961594 DOI: 10.1136/bmjopen-2017-020475] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/14/2018] [Accepted: 03/27/2018] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Development of digital breast tomosynthesis (DBT) provides a technology that generates three-dimensional data sets, thus reducing the pitfalls of overlapping breast tissue. Observational studies suggest that the combination of two-dimensional (2D) digital mammography and DBT increases diagnostic accuracy. However, because of duplicate exposure, this comes at the cost of an augmented radiation dose. This undesired adverse impact can be avoided by using synthesised 2D images reconstructed from the DBT data (s2D).We designed a diagnostic superiority trial on a high level of evidence with the aim of providing a comparison of screening efficacy parameters resulting from DBT+s2D versus the current screening standard 2D full-field digital mammography (FFDM) in a multicentre and multivendor setting on the basis of the quality-controlled, population-based, biennial mammography screening programme in Germany. METHODS AND ANALYSIS 80 000 women in the eligible age 50-69 years attending the routine mammography screening programme and willing to participate in the TOSYMA trial will be assigned by 1:1 randomisation to either the intervention arm (DBT+s2D) or the control arm (FFDM) during a 12-month recruitment period in screening units of North Rhine-Westphalia and Lower Saxony. State cancer registries will provide the follow-up of interval cancers.Primary endpoints are the detection rate of invasive breast cancers at screening examination and the cumulative incidence of interval cancers in the 2 years after a negative examination. Secondary endpoints are the detection rate of ductal carcinoma in situ and of tumour size T1, the recall rate for assessment, the positive predictive value of recall and the cumulative 12-month incidence of interval cancers. An adaptive statistical design with one interim analysis provides the option to modify the design. ETHICS AND DISSEMINATION This protocol has been approved by the local medical ethical committee (2016-132-f-S). Results will be submitted to international peer-reviewed journals. TRIAL REGISTRATION NCT03377036; Pre-results.
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Affiliation(s)
- Stefanie Weigel
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Joachim Gerss
- Institute of Biostatistics and Clinical Research, IBKF, University of Münster, Münster, Germany
| | - Hans-Werner Hense
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Miriam Krischke
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Alexander Sommer
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Jörg Czwoydzinski
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Horst Lenzen
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
| | - Laura Kerschke
- Institute of Biostatistics and Clinical Research, IBKF, University of Münster, Münster, Germany
| | - Karin Spieker
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Stefanie Dickmaenken
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Sonja Baier
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Marc Urban
- Center for Clinical Trials Münster, University Hospital Münster, Münster, Germany
| | - Gerold Hecht
- Reference Center for Mammography North, Oldenburg, Germany
| | | | | | - Walter Heindel
- Institute of Clinical Radiology and Reference Center for Mammography Münster, University of Münster and University Hospital Münster, Münster, Germany
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