1
|
Macis D, Bellerba F, Aristarco V, Johansson H, Guerrieri-Gonzaga A, Lazzeroni M, Sestak I, Cuzick J, DeCensi A, Bonanni B, Gandini S. A Mediation Analysis of Obesity and Adiponectin Association with Postmenopausal Breast Cancer Risk: A Nested Cohort Study in the International Breast Cancer Intervention Study II (IBIS-II) Prevention Trial. Nutrients 2024; 16:2098. [PMID: 38999846 PMCID: PMC11242930 DOI: 10.3390/nu16132098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/14/2024] Open
Abstract
Obesity is a risk factor for postmenopausal breast cancer (BC), and evidence suggests a role for adiponectin in the relationship between obesity and BC. We investigated whether adiponectin or other biomarkers mediate the effect of body mass index (BMI) on postmenopausal BC risk in a cohort study nested in the IBIS-II Prevention Trial. We measured adiponectin, leptin, IGF-I, IGFBP-1, high-sensitivity C-reactive protein, glycemia, insulin, HOMA-IR index, and SHBG in baseline and 12-month serum samples from 123 cases and 302 matched controls in the placebo arm of the IBIS-II Prevention trial. We conducted the main mediation analysis considering baseline BMI as an exposure and the 12-month adiponectin increase as a mediator after adjustment for the Tyrer-Cuzick score and the lipid-lowering medications/supplements use. In the multivariable Cox model, both the 12-month adiponectin increase (HR, 0.60; 95%CI, 0.36-1.00) and BMI were associated with BC risk (HR, 1.05; 95%CI, 1.00-1.09), with a 40% reduction in women with a 12-month increase in adiponectin. A significantly higher cumulative hazard of BC events was observed in obese women (BMI > 30) with decreased adiponectin (p = 0.0087). No mediating effect of the adiponectin increase on the total effect of BMI on BC risk was observed (natural indirect effect: HR, 1.00; 95%CI, 0.98-1.02). Raising adiponectin levels might be an attractive target for postmenopausal BC prevention.
Collapse
Affiliation(s)
- Debora Macis
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20141 Milan, Italy; (V.A.); (H.J.); (A.G.-G.); (M.L.); (B.B.)
| | - Federica Bellerba
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology (IEO), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20139 Milan, Italy; (F.B.); (S.G.)
| | - Valentina Aristarco
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20141 Milan, Italy; (V.A.); (H.J.); (A.G.-G.); (M.L.); (B.B.)
| | - Harriet Johansson
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20141 Milan, Italy; (V.A.); (H.J.); (A.G.-G.); (M.L.); (B.B.)
| | - Aliana Guerrieri-Gonzaga
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20141 Milan, Italy; (V.A.); (H.J.); (A.G.-G.); (M.L.); (B.B.)
| | - Matteo Lazzeroni
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20141 Milan, Italy; (V.A.); (H.J.); (A.G.-G.); (M.L.); (B.B.)
| | - Ivana Sestak
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (I.S.); (J.C.); (A.D.)
| | - Jack Cuzick
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (I.S.); (J.C.); (A.D.)
| | - Andrea DeCensi
- Wolfson Institute of Population Health, Queen Mary University of London, London EC1M 6BQ, UK; (I.S.); (J.C.); (A.D.)
- Division of Medical Oncology, Ente Ospedaliero Galliera, 16128 Genoa, Italy
| | - Bernardo Bonanni
- Division of Cancer Prevention and Genetics, European Institute of Oncology (IEO), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20141 Milan, Italy; (V.A.); (H.J.); (A.G.-G.); (M.L.); (B.B.)
| | - Sara Gandini
- Molecular and Pharmaco-Epidemiology Unit, Department of Experimental Oncology, European Institute of Oncology (IEO), Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20139 Milan, Italy; (F.B.); (S.G.)
| |
Collapse
|
2
|
Katsika L, Boureka E, Kalogiannidis I, Tsakiridis I, Tirodimos I, Lallas K, Tsimtsiou Z, Dagklis T. Screening for Breast Cancer: A Comparative Review of Guidelines. Life (Basel) 2024; 14:777. [PMID: 38929759 PMCID: PMC11204612 DOI: 10.3390/life14060777] [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: 05/26/2024] [Revised: 06/14/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024] Open
Abstract
Breast cancer is the most common malignancy diagnosed in the female population worldwide and the leading cause of death among perimenopausal women. Screening is essential, since earlier detection in combination with improvements in breast cancer treatment can reduce the associated mortality. The aim of this study was to review and compare the recommendations from published guidelines on breast cancer screening. A total of 14 guidelines on breast cancer screening issued between 2014 and 2022 were identified. A descriptive review of relevant guidelines by the World Health Organization (WHO), the U.S. Preventive Services Task Force (USPSTF), the American Cancer Society (ACS), the National Comprehensive Cancer Network (NCCN), the American College of Obstetricians and Gynecologists (ACOG), the American Society of Breast Surgeons (ASBrS), the American College of Radiology (ACR), the Task Force on Preventive Health Care (CTFPHC), the European Commission Initiative on Breast Cancer (ECIBC), the European Society for Medical Oncology (ESMO), the Royal Australian College of General Practitioners (RACGP) and the Japanese Journal of Clinical Oncology (JJCO) for women both at average and high-risk was carried out. There is a consensus among all the reviewed guidelines that mammography is the gold standard screening modality for average-risk women. For this risk group, most of the guidelines suggest annual or biennial mammographic screening at 40-74 years, while screening should particularly focus at 50-69 years. Most of the guidelines suggest that the age limit to stop screening should be determined based on the women's health status and life expectancy. For women at high-risk, most guidelines recommend the use of annual mammography or magnetic resonance imaging, while the starting age should be earlier than the average-risk group, depending on the risk factor. There is discrepancy among the recommendations regarding the age at onset of screening in the various high-risk categories. The development of consistent international practice protocols for the most appropriate breast cancer screening programs seems of major importance to reduce mortality rates and safely guide everyday clinical practice.
Collapse
Affiliation(s)
- Laskarina Katsika
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Eirini Boureka
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ioannis Tsakiridis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| | - Ilias Tirodimos
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Konstantinos Lallas
- Department of Medical Oncology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece;
| | - Zoi Tsimtsiou
- Laboratory of Hygiene, Social & Preventive Medicine and Medical Statistics, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (L.K.); (I.T.); (Z.T.)
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece; (E.B.); (I.K.); (T.D.)
| |
Collapse
|
3
|
Bhatt R, van den Hout A, Antoniou AC, Shah M, Ficorella L, Steggall E, Easton DF, Pharoah PDP, Pashayan N. Estimation of age of onset and progression of breast cancer by absolute risk dependent on polygenic risk score and other risk factors. Cancer 2024; 130:1590-1599. [PMID: 38174903 PMCID: PMC7615824 DOI: 10.1002/cncr.35183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/08/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Genetic, lifestyle, reproductive, and anthropometric factors are associated with the risk of developing breast cancer. However, it is not yet known whether polygenic risk score (PRS) and absolute risk based on a combination of risk factors are associated with the risk of progression of breast cancer. This study aims to estimate the distribution of sojourn time (pre-clinical screen-detectable period) and mammographic sensitivity by absolute breast cancer risk derived from polygenic profile and the other risk factors. METHODS The authors used data from a population-based case-control study. Six categories of 10-year absolute risk based on different combinations of risk factors were derived using the Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm. Women were classified into low, medium, and high-risk groups. The authors constructed a continuous-time multistate model. To calculate the sojourn time, they simulated the trajectories of subjects through the disease states. RESULTS There was little difference in sojourn time with a large overlap in the 95% confidence interval (CI) between the risk groups across the six risk categories and PRS studied. However, the age of entry into the screen-detectable state varied by risk category, with the mean age of entry of 53.4 years (95% CI, 52.2-54.1) and 57.0 years (95% CI, 55.1-57.7) in the high-risk and low-risk women, respectively. CONCLUSION In risk-stratified breast screening, the age at the start of screening, but not necessarily the frequency of screening, should be tailored to a woman's risk level. The optimal risk-stratified screening strategy that would improve the benefit-to-harm balance and the cost-effectiveness of the screening programs needs to be studied.
Collapse
Affiliation(s)
- Rikesh Bhatt
- Department of Applied Health Research, University College London, London, UK
| | - Ardo van den Hout
- Department of Statistical Science, University College London, London, UK
| | - Antonis C. Antoniou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Mitul Shah
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Lorenzo Ficorella
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Douglas F. Easton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Paul D. P. Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Computational Biomedicine, Cedars Sinai Medical Center, Los Angeles, California, USA
| | - Nora Pashayan
- Department of Applied Health Research, University College London, London, UK
| |
Collapse
|
4
|
Loft LH, Pedersen LH, Bigaard J, Bojesen SE. Attitudes towards risk-stratified breast cancer screening: a population-based survey among 5,001 Danish women. BMC Cancer 2024; 24:347. [PMID: 38504201 PMCID: PMC10949660 DOI: 10.1186/s12885-024-12083-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 03/04/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND The individual woman's risk of being diagnosed with breast cancer can now be estimated more precisely, and screening can be stratified accordingly. The risk assessment requires that women are willing to provide a blood test, additional personal information, to know their risk, and alter screening intervals. This study aimed to investigate Danish women's attitudes towards risk-stratified breast cancer screening. METHODS An online, cross-sectional survey was conducted among Danish women aged 52-67 years. We used logistic regression analyses to assess how personal characteristics were associated with the women's attitudes. RESULTS 5,001 women completed the survey (response rate 44%) of which 74% approved of risk estimation to potentially alter their screening intervals. However, only 42% would accept an extended screening interval if found to have low breast cancer risk, while 89% would accept a reduced interval if at high risk. The main determinants of these attitudes were age, education, screening participation, history of breast cancer, perceived breast cancer risk and to some extent breast cancer worry. CONCLUSION This study indicates that women are positive towards risk-stratified breast cancer screening. However, reservations and knowledge among subgroups of women must be carefully considered and addressed before wider implementation of risk-stratified breast cancer screening in a national program.
Collapse
Affiliation(s)
- Louise Hougaard Loft
- Prevention and Information Dept, Danish Cancer Society, Strandboulevarden 49, DK-2100, Copenhagen, Denmark
| | - Line Hjøllund Pedersen
- Prevention and Information Dept, Danish Cancer Society, Strandboulevarden 49, DK-2100, Copenhagen, Denmark
- Science to Society Dept, Danish Cancer Institute, Danish Cancer Society, Copenhagen, Denmark
| | - Janne Bigaard
- Prevention and Information Dept, Danish Cancer Society, Strandboulevarden 49, DK-2100, Copenhagen, Denmark.
| | - Stig Egil Bojesen
- Department of Clinical Biochemistry, Herlev and Gentofte Hospitals, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
van Strien-Knippenberg IS, Arjangi-Babetti H, Timmermans DRM, Schrauwen L, Fransen MP, Melles M, Damman OC. Communicating the results of risk-based breast cancer screening through visualizations of risk: a participatory design approach. BMC Med Inform Decis Mak 2024; 24:78. [PMID: 38500098 PMCID: PMC10949766 DOI: 10.1186/s12911-024-02483-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 03/11/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Risk-based breast cancer (BC) screening raises new questions regarding information provision and risk communication. This study aimed to: 1) investigate women's beliefs and knowledge (i.e., mental models) regarding BC risk and (risk-based) BC screening in view of implications for information development; 2) develop novel informational materials to communicate the screening result in risk-based BC screening, including risk visualizations of both quantitative and qualitative information, from a Human-Centered Design perspective. METHODS Phase 1: Interviews were conducted (n = 15, 40-50 years, 5 lower health literate) on women's beliefs about BC risk and (risk-based) BC screening. Phase 2: In three participatory design sessions, women (n = 4-6 across sessions, 40-50 years, 2-3 lower health literate) made assignments and created and evaluated visualizations of risk information central to the screening result. Prototypes were evaluated in two additional sessions (n = 2, 54-62 years, 0-1 lower health literate). Phase 3: Experts (n = 5) and women (n = 9, 40-74 years) evaluated the resulting materials. Two other experts were consulted throughout the development process to ensure that the content of the information materials was accurate. Interviews were transcribed literally and analysed using qualitative thematic analysis, focusing on implications for information development. Notes, assignments and materials from the participatory design sessions were summarized and main themes were identified. RESULTS Women in both interviews and design sessions were positive about risk-based BC screening, especially because personal risk factors would be taken into account. However, they emphasized that the rationale of risk-based screening and classification into a risk category should be clearly stated and visualized, especially for higher- and lower-risk categories (which may cause anxiety or feelings of unfairness due to a lower screening frequency). Women wanted to know their personal risk, preferably visualized in an icon array, and wanted advice on risk reduction and breast self-examination. However, most risk factors were considered modifiable by women, and the risk factor breast density was not known, implying that information should emphasize that BC risk depends on multiple factors, including breast density. CONCLUSIONS The information materials, including risk visualizations of both quantitative and qualitative information, developed from a Human-Centered Design perspective and a mental model approach, were positively evaluated by the target group.
Collapse
Affiliation(s)
- Inge S van Strien-Knippenberg
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands.
| | - Hannah Arjangi-Babetti
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Danielle R M Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Laura Schrauwen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| | - Marijke Melles
- Industrial Design Engineering, Delft University of Technology, Delft, The Netherlands
| | - Olga C Damman
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, The Netherlands
| |
Collapse
|
6
|
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.
Collapse
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.
| |
Collapse
|
7
|
Mittmann N, Blackmore KM, Seung SJ, Diong C, Done SJ, Chiarelli AM. Healthcare and Cancer Treatment Costs of Breast Screening Outcomes among Higher than Average Risk Women. Curr Oncol 2023; 30:8550-8562. [PMID: 37754535 PMCID: PMC10529052 DOI: 10.3390/curroncol30090620] [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: 07/31/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 09/28/2023] Open
Abstract
Concurrent cohorts of 644,932 women aged 50-74 screened annually due to family history, dense breasts or biennially in the Ontario Breast Screening Program (OBSP) from 2011-2014 were linked to provincial administrative datasets to determine health system resource utilization and costs. Age-adjusted mean and median total healthcare costs (2018 CAD) and incremental cost differences were calculated by screening outcome and compared by recommendation using regression models. Healthcare costs were compared overall and 1 year after a false positive (n = 46,081) screening mammogram and 2 years after a breast cancer diagnosis (n = 6011). Mean overall healthcare costs by age were highest for those 60-74, particularly with annual screening for family/personal history (CAD 5425; 95% CI: 5308 to 5557) compared to biennial. Although the mean incremental cost difference was higher (23.4%) by CAD 10,235 (95% CI: 6141 to 14,329) per breast cancer for women screened annually for density ≥ 75% compared to biennially, the cost difference was 12.0% lower (-CAD 461; 95% CI: -777 to -114) per false positive result. In contrast, for women screened annually for family/personal history, the mean cost difference per false positive was 19.7% higher than for biennially (CAD 758; 95% CI: 404 to 1118); however, the cost difference per breast cancer was only slightly higher (2.5%) by CAD 1093 (95% CI: -1337 to CAD 3760). Understanding that associated costs of annual compared to biennial screening may balance out by age and outcome can assist decision-making regarding the use of limited healthcare resources.
Collapse
Affiliation(s)
- Nicole Mittmann
- Department of Pharmacology & Toxicology, University of Toronto, 1 King’s College Circle, Toronto, ON M5S 1A8, Canada
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON M4G 3M5, Canada
| | | | - Soo Jin Seung
- HOPE Research Centre, Sunnybrook Research Institute, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Christina Diong
- ICES Central, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - Susan J. Done
- Laboratory Medicine Program, University Health Network, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
| | - Anna M. Chiarelli
- Ontario Health, 525 University Avenue, 5th Floor, Toronto, ON M5G 2L3, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, ON M5T 3M7, Canada
| |
Collapse
|
8
|
Louro J, Román M, Moshina N, Olstad CF, Larsen M, Sagstad S, Castells X, Hofvind S. Personalized Breast Cancer Screening: A Risk Prediction Model Based on Women Attending BreastScreen Norway. Cancers (Basel) 2023; 15:4517. [PMID: 37760486 PMCID: PMC10526465 DOI: 10.3390/cancers15184517] [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: 06/09/2023] [Revised: 09/06/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND We aimed to develop and validate a model predicting breast cancer risk for women targeted by breast cancer screening. METHOD This retrospective cohort study included 57,411 women screened at least once in BreastScreen Norway during the period from 2007 to 2019. The prediction model included information about age, mammographic density, family history of breast cancer, body mass index, age at menarche, alcohol consumption, exercise, pregnancy, hormone replacement therapy, and benign breast disease. We calculated a 4-year absolute breast cancer risk estimates for women and in risk groups by quartiles. The Bootstrap resampling method was used for internal validation of the model (E/O ratio). The area under the curve (AUC) was estimated with a 95% confidence interval (CI). RESULTS The 4-year predicted risk of breast cancer ranged from 0.22-7.33%, while 95% of the population had a risk of 0.55-2.31%. The thresholds for the quartiles of the risk groups, with 25% of the population in each group, were 0.82%, 1.10%, and 1.47%. Overall, the model slightly overestimated the risk with an E/O ratio of 1.10 (95% CI: 1.09-1.11) and the AUC was 62.6% (95% CI: 60.5-65.0%). CONCLUSIONS This 4-year risk prediction model showed differences in the risk of breast cancer, supporting personalized screening for breast cancer in women aged 50-69 years.
Collapse
Affiliation(s)
- Javier Louro
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (J.L.); (M.R.); (X.C.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 48902 Barakaldo, Spain
| | - Marta Román
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (J.L.); (M.R.); (X.C.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 48902 Barakaldo, Spain
| | - Nataliia Moshina
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
| | - Camilla F. Olstad
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
| | - Marthe Larsen
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
| | - Silje Sagstad
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
| | - Xavier Castells
- Department of Epidemiology and Evaluation, Hospital del Mar Medical Research Institute, 08003 Barcelona, Spain; (J.L.); (M.R.); (X.C.)
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), 48902 Barakaldo, Spain
| | - Solveig Hofvind
- Section for Breast Cancer Screening, Cancer Registry of Norway, 0304 Oslo, Norway; (N.M.); (C.F.O.); (M.L.); (S.S.)
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT, The Arctic University of Norway, 9037 Tromsø, Norway
| |
Collapse
|
9
|
Ghorbani S, Rezapour A, Eisavi M, Barahman M, Bagheri Faradonbeh S. Cost-benefit Analysis of Breast Cancer Screening with Digital Mammography: A Systematic Review. Med J Islam Repub Iran 2023; 37:89. [PMID: 37750094 PMCID: PMC10518066 DOI: 10.47176/mjiri.37.89] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Indexed: 09/27/2023] Open
Abstract
Background Breast cancer is a non-communicable and common disease that accounts for a high percentage of deaths. Early diagnosis of this disease reduces the death rate. Screening methods such as digital mammography can help prevent or identify the disease earlier. Therefore, this study aims to analyze the cost-benefit of breast cancer using digital mammography. Methods This systematic review was conducted based on PRISMA 2020 checklist. PubMed, Scopus, Web of Science, ProQuest, Cochrane Library, and Google Scholar were searched without any time limitation on June 2022. The quality of the studies was evaluated with the CHEERS checklist. After data extraction, the results were synthesized by thematic content analysis. Results During the search, 3468 records were identified, of which 1061 were duplicates. 2407 titles and abstracts screened in terms of inclusion criteria. Finally, after studying 20 fulltexts, three of them were included in the study. The quality of these articles was scored between 10 and 16. These studies were from Spain, Denmark, and the United States from 2000 to 2019. Two studies showed that digital mammography is not as effective as other screening methods. Conclusion The results of this study showed that digital mammography is not very cost-benefit for the health care system. An increase in its repetition frequency imposes more costs on the health system and doesn't have more benefits for it.
Collapse
Affiliation(s)
- Salar Ghorbani
- Department of Health Economics, School of Health Management and Information
Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Aziz Rezapour
- Health Management and Economics Research Center, Health Management Research
Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Eisavi
- Department of Economics, Faculty of Economics, Allameh Tabatabai University,
Tehran, Iran
| | - Maedeh Barahman
- Department of Radiotherapy, School of Medicine, Firoozgar General Hospital, Iran
University of Medical Sciences, Tehran, Iran
| | - Saeed Bagheri Faradonbeh
- Department of Healthcare Services Management, School of Health, Ahvaz
Jundishapur University of Medical Sciences, Ahvaz, Iran
| |
Collapse
|
10
|
Lapointe J, Côté JM, Mbuya-Bienge C, Dorval M, Pashayan N, Chiquette J, Eloy L, Turgeon A, Lambert-Côté L, Brooks JD, Walker MJ, Blackmore KM, Joly Y, Knoppers BM, Chiarelli AM, Simard J, Nabi H. Canadian Healthcare Professionals' Views and Attitudes toward Risk-Stratified Breast Cancer Screening. J Pers Med 2023; 13:1027. [PMID: 37511640 PMCID: PMC10381377 DOI: 10.3390/jpm13071027] [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: 04/14/2023] [Revised: 06/02/2023] [Accepted: 06/19/2023] [Indexed: 07/30/2023] Open
Abstract
Given the controversy over the effectiveness of age-based breast cancer (BC) screening, offering risk-stratified screening to women may be a way to improve patient outcomes with detection of earlier-stage disease. While this approach seems promising, its integration requires the buy-in of many stakeholders. In this cross-sectional study, we surveyed Canadian healthcare professionals about their views and attitudes toward a risk-stratified BC screening approach. An anonymous online questionnaire was disseminated through Canadian healthcare professional associations between November 2020 and May 2021. Information collected included attitudes toward BC screening recommendations based on individual risk, comfort and perceived readiness related to the possible implementation of this approach. Close to 90% of the 593 respondents agreed with increased frequency and earlier initiation of BC screening for women at high risk. However, only 9% agreed with the idea of not offering BC screening to women at very low risk. Respondents indicated that primary care physicians and nurse practitioners should play a leading role in the risk-stratified BC screening approach. This survey identifies health services and policy enhancements that would be needed to support future implementation of a risk-stratified BC screening approach in healthcare systems in Canada and other countries.
Collapse
Affiliation(s)
- Julie Lapointe
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Jean-Martin Côté
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Cynthia Mbuya-Bienge
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, Av de la Médecine, Québec City, QC G1V 0A6, Canada
| | - Michel Dorval
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- Faculty of Pharmacy, Université Laval, 1050, Av de la Médecine, Québec City, QC G1V 0A6, Canada
- CISSS de Chaudière-Appalaches Research Center, 143 Rue Wolfe, Lévis, QC G6V 3Z1, Canada
| | - Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, Gower Street, London WC1E 6BT, UK
| | - Jocelyne Chiquette
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- CHU de Québec-Université Laval, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Laurence Eloy
- Programme Québécois de Cancérologie, Ministère de la Santé et des Services Sociaux, 1075, Chemin Sainte-Foy, Québec City, QC G1S 2M1, Canada
| | - Annie Turgeon
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Laurence Lambert-Côté
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
| | - Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, 155, College Street, Toronto, ON M5T 3M7, Canada
| | - Meghan J Walker
- Dalla Lana School of Public Health, University of Toronto, 155, College Street, Toronto, ON M5T 3M7, Canada
- Cancer Care Ontario, Ontario Health, 525, University Avenue, Toronto, ON M5G 2L3, Canada
| | | | - Yann Joly
- Centre of Genomics and Policy, McGill University, 740, Ave Penfield, Montreal, QC H3A 0G1, Canada
- Human Genetics Department and Bioethics Unit, Faculty of Medicine, McGill University, 3647, Peel Street, Montreal, QC G1V 0A6, Canada
| | - Bartha Maria Knoppers
- Centre of Genomics and Policy, McGill University, 740, Ave Penfield, Montreal, QC H3A 0G1, Canada
| | - Anna Maria Chiarelli
- Dalla Lana School of Public Health, University of Toronto, 155, College Street, Toronto, ON M5T 3M7, Canada
- Cancer Care Ontario, Ontario Health, 525, University Avenue, Toronto, ON M5G 2L3, Canada
| | - Jacques Simard
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- Department of Molecular Medicine, Faculty of Medicine, Université Laval, 1050, Avenue de la Médecine, Québec City, QC G1V 0A6, Canada
| | - Hermann Nabi
- Oncology Division, CHU de Québec-Université Laval Research Center, 1050, Chemin Sainte-Foy, Québec City, QC G1S 4L8, Canada
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, 1050, Av de la Médecine, Québec City, QC G1V 0A6, Canada
| |
Collapse
|
11
|
Fanizzi A, Graps E, Bavaro DA, Farella M, Bove S, Campobasso F, Comes MC, Cristofaro C, Forgia DL, Milella M, Iacovelli S, Villani R, Signorile R, De Bartolo A, Lorusso V, Massafra R. Assessing the cost-effectiveness of waiting list reduction strategies for a breast radiology department: a real-life case study. BMC Health Serv Res 2023; 23:526. [PMID: 37221516 PMCID: PMC10207781 DOI: 10.1186/s12913-023-09447-y] [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: 08/03/2022] [Accepted: 04/25/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND A timely diagnosis is essential for improving breast cancer patients' survival and designing targeted therapeutic plans. For this purpose, the screening timing, as well as the related waiting lists, are decisive. Nonetheless, even in economically advanced countries, breast cancer radiology centres fail in providing effective screening programs. Actually, a careful hospital governance should encourage waiting lists reduction programs, not only for improving patients care, but also for minimizing costs associated with the treatment of advanced cancers. Thus, in this work, we proposed a model to evaluate several scenarios for an optimal distribution of the resources invested in a Department of Breast Radiodiagnosis. MATERIALS AND METHODS Particularly, we performed a cost-benefit analysis as a technology assessment method to estimate both costs and health effects of the screening program, to maximise both benefits related to the quality of care and resources employed by the Department of Breast Radiodiagnosis of Istituto Tumori "Giovanni Paolo II" of Bari in 2019. Specifically, we determined the Quality-Adjusted Life Year (QALY) for estimating health outcomes, in terms of usefulness of two hypothetical screening strategies with respect to the current one. While the first hypothetical strategy adds one team made up of a doctor, a technician and a nurse, along with an ultrasound and a mammograph, the second one adds two afternoon teams. RESULTS This study showed that the most cost-effective incremental ratio could be achieved by reducing current waiting lists from 32 to 16 months. Finally, our analysis revealed that this strategy would also allow to include more people in the screening programs (60,000 patients in 3 years).
Collapse
Affiliation(s)
- Annarita Fanizzi
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Elisabetta Graps
- Direttore medico Area Valutazione e Ricerca, coordinatore del Centro regionale di Health Technology Assessment AReSS Puglia, Bari, Italy
| | | | - Marco Farella
- Dipartimento di Economia, Management e Diritto dell'Impresa, Università degli Studi di Bari "Aldo Moro", Largo Abbazia Santa Scolastica, 53, Bari, 70124, Italy
| | - Samantha Bove
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Francesco Campobasso
- Dipartimento di Economia, Management e Diritto dell'Impresa, Università degli Studi di Bari "Aldo Moro", Largo Abbazia Santa Scolastica, 53, Bari, 70124, Italy
| | - Maria Colomba Comes
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Cristian Cristofaro
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Daniele La Forgia
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy.
| | - Martina Milella
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Serena Iacovelli
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Rossella Villani
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Rahel Signorile
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Alessio De Bartolo
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Vito Lorusso
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| | - Raffaella Massafra
- I.R.C.C.S. Istituto Tumori "Giovanni Paolo II", Viale Orazio Flacco 65, Bari, 70124, Italy
| |
Collapse
|
12
|
Shi J, Guan Y, Liang D, Li D, He Y, Liu Y. Cost-effectiveness evaluation of risk-based breast cancer screening in Urban Hebei Province. Sci Rep 2023; 13:3370. [PMID: 36849794 PMCID: PMC9971026 DOI: 10.1038/s41598-023-29985-z] [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: 08/12/2022] [Accepted: 02/14/2023] [Indexed: 03/01/2023] Open
Abstract
To evaluate the implementations of Cancer Screening Program in Urban Hebei and to model the cost-effectiveness of a risk-based breast Cancer Screening Program. Women aged 40-74 years were invited to participate the Cancer Screening Program in Urban Hebei form 2016 to 2020 by completing questionnaires to collect information about breast cancer exposure. Clinical screening including ultrasound and mammography examination were performed. We developed a Markov model to estimate the lifetime costs and benefits, in terms of quality-adjusted life years (QALY), of a high-risk breast Cancer Screening Program. Nine screening strategies and no screening were included in the study. The age-specific incidence, transition probability data and lifetime treatment costs were derived and adopted from other researches. Average cost-effectiveness ratios (ACERs) were estimated as the ratios of the additional costs of the screening strategies to the QLYG compared to no screening. Incremental cost-effectiveness ratios (ICERs) were calculated based on the comparison of a lower cost strategies to the next more expensive and effective strategies after excluding dominated strategies and extendedly dominated strategies. ICERs were used to compare with a willingness-to-pay (WTP) threshold. Sensitivity analysis was explored the influence factors. A total of 84,029 women completed a risk assessment questionnaire, from which 20,655 high-risk breast cancer females were evaluated, with a high-risk rate of 24.58%. There were 13,392 high-risk females completed the screening program, with participation rate was 64.84%. Undergoing ultrasound, mammography and combined screening, the suspicious positive detection rates were 15.00%, 9.20% and 19.30%, and the positive detection rates were 2.11%, 2.76% and 3.83%, respectively. According to the results by Markov model, at the end of 45 cycle, the early diagnosis rates were 55.53%, 60.68% and 62.47% underwent the annual screening by ultrasound, mammography and combined, the proportion of advanced cancer were 17.20%, 15.85% and 15.36%, respectively. Different screening method and interval yield varied. In the exploration of various scenarios, annual ultrasound screening is the most cost-effective strategy with the ICER of ¥116,176.15/QALY. Sensitivity analyses demonstrated that the results are robust. Although it was not cost effective, combined ultrasound and mammography screening was an effective strategy for higher positive detection rate of breast cancer. High-risk population-based breast cancer screening by ultrasound annually was the most cost-effective strategy in Urban Hebei Province.
Collapse
Affiliation(s)
- Jin Shi
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yazhe Guan
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Di Liang
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Daojuan Li
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China
| | - Yutong He
- Cancer Institute, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China.
| | - Yunjiang Liu
- Department of Breast Cancer Center, The Tumor Hospital of Hebei Province, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050011, Hebei, People's Republic of China.
| |
Collapse
|
13
|
Usher-Smith JA, Hindmarch S, French DP, Tischkowitz M, Moorthie S, Walter FM, Dennison RA, Stutzin Donoso F, Archer S, Taylor L, Emery J, Morris S, Easton DF, Antoniou AC. Proactive breast cancer risk assessment in primary care: a review based on the principles of screening. Br J Cancer 2023; 128:1636-1646. [PMID: 36737659 PMCID: PMC9897164 DOI: 10.1038/s41416-023-02145-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/05/2023] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
In the UK, the National Institute for Health and Care Excellence (NICE) recommends that women at moderate or high risk of breast cancer be offered risk-reducing medication and enhanced breast screening/surveillance. In June 2022, NICE withdrew a statement recommending assessment of risk in primary care only when women present with concerns. This shift to the proactive assessment of risk substantially changes the role of primary care, in effect paving the way for a primary care-based screening programme to identify those at moderate or high risk of breast cancer. In this article, we review the literature surrounding proactive breast cancer risk assessment within primary care against the consolidated framework for screening. We find that risk assessment for women under 50 years currently satisfies many of the standard principles for screening. Most notably, there are large numbers of women at moderate or high risk currently unidentified, risk models exist that can identify those women with reasonable accuracy, and management options offer the opportunity to reduce breast cancer incidence and mortality in that group. However, there remain a number of uncertainties and research gaps, particularly around the programme/system requirements, that need to be addressed before these benefits can be realised.
Collapse
Affiliation(s)
- Juliet A. Usher-Smith
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Sarah Hindmarch
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - David P. French
- grid.5379.80000000121662407Manchester Centre for Health Psychology, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Marc Tischkowitz
- grid.5335.00000000121885934Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Sowmiya Moorthie
- grid.5335.00000000121885934PHG Foundation, University of Cambridge, Cambridge, UK
| | - Fiona M. Walter
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.4868.20000 0001 2171 1133Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca A. Dennison
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Francisca Stutzin Donoso
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Stephanie Archer
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK ,grid.5335.00000000121885934Department of Psychology, University of Cambridge, Cambridge, UK
| | - Lily Taylor
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Jon Emery
- grid.1008.90000 0001 2179 088XCentre for Cancer Research and Department of General Practice, University of Melbourne, Melbourne, VIC Australia
| | - Stephen Morris
- grid.5335.00000000121885934The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Douglas F. Easton
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Antonis C. Antoniou
- grid.5335.00000000121885934Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
14
|
Zhang J, McGuinness JE, He X, Jones T, Silverman T, Guzman A, May BL, Kukafka R, Crew KD. Breast Cancer Risk and Screening Mammography Frequency Among Multiethnic Women. Am J Prev Med 2023; 64:51-60. [PMID: 36137818 DOI: 10.1016/j.amepre.2022.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 07/19/2022] [Accepted: 08/02/2022] [Indexed: 02/05/2023]
Abstract
INTRODUCTION In 2009, the U.S. Preventive Services Task Force updated recommended mammography screening frequency from annual to biennial for average-risk women aged 50-74 years. The association between estimated breast cancer risk and mammography screening frequency was evaluated. METHODS A single-center retrospective cohort study was conducted among racially/ethnically diverse women, aged 50-74 years, who underwent screening mammography from 2014 to 2018. Data on age, race/ethnicity, first-degree family history of breast cancer, previous benign breast biopsies, and mammographic density were extracted from the electronic health record to calculate Breast Cancer Surveillance Consortium 5-year risk of invasive breast cancer, with a 5-year risk ≥1.67% defined as high risk. Multivariable analyses were conducted to determine the association between breast cancer risk factors and mammography screening frequency (annual versus biennial). Data were analyzed from 2020 to 2022. RESULTS Among 12,929 women with a mean age of 61±6.9 years, 82.7% underwent annual screening mammography, and 30.7% met high-risk criteria for breast cancer. Hispanic women were more likely to screen annually than non-Hispanic Whites (85.0% vs 79.8%, respectively), despite fewer meeting high-risk criteria. In multivariable analyses adjusting for breast cancer risk factors, high- versus low/average-risk women (OR=1.17; 95% CI=1.04, 1.32) and Hispanic versus non-Hispanic White women (OR=1.46; 95% CI=1.29, 1.65) were more likely to undergo annual mammography. CONCLUSIONS A majority of women continue to undergo annual screening mammography despite only a minority meeting high-risk criteria, and Hispanic women were more likely to screen annually despite lower overall breast cancer risk. Future studies should focus on the implementation of risk-stratified breast cancer screening strategies.
Collapse
Affiliation(s)
- Jingwen Zhang
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Julia E McGuinness
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York.
| | - Xin He
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Tarsha Jones
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida
| | - Thomas Silverman
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Ashlee Guzman
- Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Benjamin L May
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | - Rita Kukafka
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York; Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Katherine D Crew
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| |
Collapse
|
15
|
"It Will Lead You to Make Better Decisions about Your Health"-A Focus Group and Survey Study on Women's Attitudes towards Risk-Based Breast Cancer Screening and Personalised Risk Assessments. Curr Oncol 2022; 29:9181-9198. [PMID: 36547133 PMCID: PMC9776908 DOI: 10.3390/curroncol29120719] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022] Open
Abstract
Singapore launched a population-based organised mammography screening (MAM) programme in 2002. However, uptake is low. A better understanding of breast cancer (BC) risk factors has generated interest in shifting from a one-size-fits-all to a risk-based screening approach. However, public acceptability of the change is lacking. Focus group discussions (FGD) were conducted with 54 women (median age 37.5 years) with no BC history. Eight online sessions were transcribed, coded, and thematically analysed. Additionally, we surveyed 993 participants in a risk-based MAM study on how they felt in anticipation of receiving their risk profiles. Attitudes towards MAM (e.g., fear, low perceived risk) have remained unchanged for ~25 years. However, FGD participants reported that they would be more likely to attend routine mammography after having their BC risks assessed, despite uncertainty and concerns about risk-based screening. This insight was reinforced by the survey participants reporting more positive than negative feelings before receiving their risk reports. There is enthusiasm in knowing personal disease risk but concerns about the level of support for individuals learning they are at higher risk for breast cancer. Our results support the empowering of Singaporean women with personal health information to improve MAM uptake.
Collapse
|
16
|
Voelkel V, Draeger T, van Mossel S, Siesling S, Koffijberg H. The value of time-dependent risk predictions in a screening context - a comprehensive simulation analysis validated on German cancer registry data. BMC Med Res Methodol 2022; 22:239. [PMID: 36088300 PMCID: PMC9464381 DOI: 10.1186/s12874-022-01718-2] [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: 02/17/2022] [Accepted: 08/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background Risk-prediction tools allow classifying individuals into risk groups based on risk thresholds. Such risk categorization is often used to inform screening schemes by offering screening only to individuals at increased risk of harmful events. Adding information concerning an individual’s risk development over time would allow assessing not just who to screen but also when to screen. This paper illustrates the value of personalised, time-dependent risk predictions to optimize risk-based screening schemes. Methods In a simulation analysis, two different time-dependent risk-based screening approaches are compared to another risk-based, but time-independent approach regarding their impact on screening efficiency. For this purpose, 81 scenarios featuring 5000 patients with five consecutive annual risk estimations for a hypothetical disease D are simulated, using different parameters to model disease progression and risk distribution. This simulation analysis is validated using a real-world clinical case study based on German breast cancer patients and the INFLUENCE-nomogram for locoregional breast cancer recurrence. Results If individual risk estimations were used to personalise screening for a disease D aiming at detecting a 90% of curable cases, more than 20% of screening examinations could be avoided relative to a conventional uninformed approach, depending on the simulated scenario. Whereas an individual but time-independent approach is associated with acceptable saving potentials in case of a relatively homogenous risk distribution, the time-dependent approaches are superior when the complexity of a scenario increases. With slowly progressing diseases, risk-accumulation over time needs to be considered to achieve the highest screening efficiency on population level, for rapidly progressing diseases, an interval-specific approach is superior. The possible benefits of time-dependent risk-based screening were confirmed in the real-world clinical case study. Conclusions Appropriate approaches to use time-dependent risk predictions may considerably enhance screening efficiency on individual and population level. Therefore, predicting risk development over time should be supported by future prediction tools and be incorporated in decision algorithms. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-022-01718-2.
Collapse
|
17
|
Laza-Vásquez C, Martínez-Alonso M, Forné-Izquierdo C, Vilaplana-Mayoral J, Cruz-Esteve I, Sánchez-López I, Reñé-Reñé M, Cazorla-Sánchez C, Hernández-Andreu M, Galindo-Ortego G, Llorens-Gabandé M, Pons-Rodríguez A, Rué M. Feasibility and Acceptability of Personalized Breast Cancer Screening (DECIDO Study): A Single-Arm Proof-of-Concept Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10426. [PMID: 36012059 PMCID: PMC9407798 DOI: 10.3390/ijerph191610426] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 08/11/2022] [Accepted: 08/18/2022] [Indexed: 06/15/2023]
Abstract
The aim of this study was to assess the acceptability and feasibility of offering risk-based breast cancer screening and its integration into regular clinical practice. A single-arm proof-of-concept trial was conducted with a sample of 387 women aged 40-50 years residing in the city of Lleida (Spain). The study intervention consisted of breast cancer risk estimation, risk communication and screening recommendations, and a follow-up. A polygenic risk score with 83 single nucleotide polymorphisms was used to update the Breast Cancer Surveillance Consortium risk model and estimate the 5-year absolute risk of breast cancer. The women expressed a positive attitude towards varying the frequency of breast screening according to individual risk and, especially, more frequently inviting women at higher-than-average risk. A lower intensity screening for women at lower risk was not as welcome, although half of the participants would accept it. Knowledge of the benefits and harms of breast screening was low, especially with regard to false positives and overdiagnosis. The women expressed a high understanding of individual risk and screening recommendations. The participants' intention to participate in risk-based screening and satisfaction at 1-year were very high.
Collapse
Affiliation(s)
- Celmira Laza-Vásquez
- Department of Nursing and Physiotherapy and Health Care Research Group (GRECS), IRBLleida—Institut de Recerca Biomèdica de Lleida, University of Lleida, 25198 Lleida, Spain
| | - Montserrat Martínez-Alonso
- IRBLleida—Institut de Recerca Biomèdica de Lleida, Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
| | - Carles Forné-Izquierdo
- Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
- Heorfy Consulting, 25007 Lleida, Spain
| | - Jordi Vilaplana-Mayoral
- Department of Computing and Industrial Engineering, University of Lleida, 25001 Lleida, Spain
| | - Inés Cruz-Esteve
- Primer de Maig Basic Health Area, Catalan Institute of Health, 25003 Lleida, Spain
| | | | - Mercè Reñé-Reñé
- Department of Radiology, Arnau de Vilanova University Hospital, 25198 Lleida, Spain
| | | | | | | | | | - Anna Pons-Rodríguez
- Example Basic Health Area, Catalan Institute of Health, 25006 Lleida, Spain
- Health PhD Program, University of Lleida, 25198 Lleida, Spain
| | - Montserrat Rué
- IRBLleida—Institut de Recerca Biomèdica de Lleida, Department of Basic Medical Sciences, University of Lleida, 25198 Lleida, Spain
| |
Collapse
|
18
|
Mohamed A, Fakhry S, Basha T. Bilateral Analysis Boosts the Performance of Mammography-based Deep Learning Models in Breast Cancer Risk Prediction. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:1440-1443. [PMID: 36086431 DOI: 10.1109/embc48229.2022.9872011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Breast cancer is one of the leading causes of death among women. Early prediction of breast cancer can significantly improve the survival rates. Breast density was proven as a reliable risk factor. Deep learning models can learn subtle cues in the mammogram images. CNN models were recently shown to improve the risk discrimination in full-field mammograms. This study aims to improve risk prediction models using bilateral analysis. Bilateral analysis is the process of comparing two breasts to verify presence of anomalies. We developed a Siamese neural network to leverage the bilateral information and asymmetries between the two mammograms of the same patient. We tested our model on 271 patients and compared the results of our Siamese model against the traditional unilateral CNN model. Our results showed AUCs of 0.75 and 0.70 respectively (p = 0.0056). The Siamese model also exhibits higher sensitivity, specificity, precision, and false positive rate with values of 0.68, 0.69, 0.71, 0.31 respectively. While the CNN values were 0.61, 0.66, 0.67, 0.34 respectively. We merged both models by two techniques using pre-trained weights and weighted voting ensemble. The merging technique boosted the AUC to 0.78. The results suggest that bilateral analysis can significantly improve the risk discrimination.
Collapse
|
19
|
Kim S, Tran TXM, Song H, Ryu S, Chang Y, Park B. Mammographic Breast Density, Benign Breast Disease, and Subsequent Breast Cancer Risk in 3.9 Million Korean Women. Radiology 2022; 304:534-541. [PMID: 35579518 DOI: 10.1148/radiol.212727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background Mammographic breast density and benign breast disease are strong risk factors for breast cancer. Accordingly, women with both risk factors may have a markedly high risk for developing breast cancer. Purpose To investigate the risk of breast cancer associated with the combination of mammographic density and benign breast disease in Korean women, where population-based mammographic breast cancer screening is provided for all women aged at least 40 years. Materials and Methods This is a retrospective analysis of data from a nationwide breast cancer screening program linked with the national cancer registry. The study included Korean women between 40-74 years of age screened for breast cancer between January 2009 and December 2010 and observed up to December 2020 (median follow-up of 10.6 years). Benign breast disease and breast density were extracted from mammography screening results. Cox proportional hazard regression analysis was used to calculate adjusted hazard ratios (HRs) for breast cancer risk. Results In this study, 3 911 348 women (mean age, 53 years ± 9 [SD]) were analyzed. During follow-up (median, 10.6 years), 58 321 women developed breast cancer. At screening, 10 729 (18.4%) cases of benign breast disease were detected among women who developed breast cancer. Women with extremely dense breasts (Breast Imaging Reporting and Data System [BI-RADS] density category D) and benign breast disease had a greater risk of breast cancer when compared with women presenting with fatty breast (BI-RADS density category A) and those without benign breast disease (HR, 2.75; 95% CI: 2.63, 2.88; P < .001). Women with benign breast disease and fatty breasts (HR, 1.49; 95% CI: 1.40, 1.58; P < .001) and women with extremely dense breasts and without benign breast disease (HR, 2.28; 95% CI: 2.20, 2.35; P < .001) also had an elevated breast cancer risk compared with women with fatty breast tissue. Conclusion Women with dense breasts and benign breast disease at screening mammography had an elevated risk of future breast cancer. © RSNA, 2022 Online supplemental material is available for this article.
Collapse
Affiliation(s)
- Soyeoun Kim
- From the Departments of Health Sciences (S.K.) and Preventive Medicine (T.X.M.T., B.P.), Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; Department of Epidemiology and Biostatistics, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea (H.S.); Center for Cohort Studies and Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (S.R., Y.C.); and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (S.R., Y.C.)
| | - Thi Xuan Mai Tran
- From the Departments of Health Sciences (S.K.) and Preventive Medicine (T.X.M.T., B.P.), Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; Department of Epidemiology and Biostatistics, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea (H.S.); Center for Cohort Studies and Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (S.R., Y.C.); and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (S.R., Y.C.)
| | - Huiyeon Song
- From the Departments of Health Sciences (S.K.) and Preventive Medicine (T.X.M.T., B.P.), Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; Department of Epidemiology and Biostatistics, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea (H.S.); Center for Cohort Studies and Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (S.R., Y.C.); and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (S.R., Y.C.)
| | - Seungho Ryu
- From the Departments of Health Sciences (S.K.) and Preventive Medicine (T.X.M.T., B.P.), Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; Department of Epidemiology and Biostatistics, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea (H.S.); Center for Cohort Studies and Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (S.R., Y.C.); and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (S.R., Y.C.)
| | - Yoosoo Chang
- From the Departments of Health Sciences (S.K.) and Preventive Medicine (T.X.M.T., B.P.), Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; Department of Epidemiology and Biostatistics, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea (H.S.); Center for Cohort Studies and Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (S.R., Y.C.); and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (S.R., Y.C.)
| | - Boyoung Park
- From the Departments of Health Sciences (S.K.) and Preventive Medicine (T.X.M.T., B.P.), Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Republic of Korea; Department of Epidemiology and Biostatistics, Graduate School of Public Health, Hanyang University, Seoul, Republic of Korea (H.S.); Center for Cohort Studies and Department of Occupational and Environmental Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (S.R., Y.C.); and Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, Republic of Korea (S.R., Y.C.)
| |
Collapse
|
20
|
Kerlikowske K, Chen S, Golmakani MK, Sprague BL, Tice JA, Tosteson ANA, Rauscher GH, Henderson LM, Buist DSM, Lee JM, Gard CC, Miglioretti DL. Cumulative Advanced Breast Cancer Risk Prediction Model Developed in a Screening Mammography Population. J Natl Cancer Inst 2022; 114:676-685. [PMID: 35026019 PMCID: PMC9086807 DOI: 10.1093/jnci/djac008] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Estimating advanced breast cancer risk in women undergoing annual or biennial mammography could identify women who may benefit from less or more intensive screening. We developed an actionable model to predict cumulative 6-year advanced cancer (prognostic pathologic stage II or higher) risk according to screening interval. METHODS We included 931 186 women aged 40-74 years in the Breast Cancer Surveillance Consortium undergoing 2 542 382 annual (prior mammogram within 11-18 months) or 752 049 biennial (prior within 19-30 months) screening mammograms. The prediction model includes age, race and ethnicity, body mass index, breast density, family history of breast cancer, and prior breast biopsy subdivided by menopausal status and screening interval. We used fivefold cross-validation to internally validate model performance. We defined higher than 95th percentile as high risk (>0.658%), higher than 75th percentile to 95th or less percentile as intermediate risk (0.380%-0.658%), and 75th or less percentile as low to average risk (<0.380%). RESULTS Obesity, high breast density, and proliferative disease with atypia were strongly associated with advanced cancer. The model is well calibrated and has an area under the receiver operating characteristics curve of 0.682 (95% confidence interval = 0.670 to 0.694). Based on women's predicted advanced cancer risk under annual and biennial screening, 69.1% had low or average risk regardless of screening interval, 12.4% intermediate risk with biennial screening and average risk with annual screening, and 17.4% intermediate or high risk regardless of screening interval. CONCLUSION Most women have low or average advanced cancer risk and can undergo biennial screening. Intermediate-risk women may consider annual screening, and high-risk women may consider supplemental imaging in addition to annual screening.
Collapse
Affiliation(s)
- Karla Kerlikowske
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Shuai Chen
- Department of Public Health Sciences, University of California, Davis, CA, USA
| | | | - Brian L Sprague
- Department of Surgery and Radiology, University of Vermont, Burlington, VT, USA
| | - Jeffrey A Tice
- Department of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Garth H Rauscher
- School of Public Health, Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, IL, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| | - Janie M Lee
- Department of Radiology, University of Washington, and Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Charlotte C Gard
- Department of Economics, Applied Statistics, and International Business, New Mexico State University, Las Cruces, NM, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, CA, USA
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, WA, USA
| |
Collapse
|
21
|
BREAst screening Tailored for HEr (BREATHE)-A study protocol on personalised risk-based breast cancer screening programme. PLoS One 2022; 17:e0265965. [PMID: 35358246 PMCID: PMC8970365 DOI: 10.1371/journal.pone.0265965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/22/2022] [Indexed: 12/29/2022] Open
Abstract
Routine mammography screening is currently the standard tool for finding cancers at an early stage, when treatment is most successful. Current breast screening programmes are one-size-fits-all which all women above a certain age threshold are encouraged to participate. However, breast cancer risk varies by individual. The BREAst screening Tailored for HEr (BREATHE) study aims to assess acceptability of a comprehensive risk-based personalised breast screening in Singapore. Advancing beyond the current age-based screening paradigm, BREATHE integrates both genetic and non-genetic breast cancer risk prediction tools to personalise screening recommendations. BREATHE is a cohort study targeting to recruit ~3,500 women. The first recruitment visit will include questionnaires and a buccal cheek swab. After receiving a tailored breast cancer risk report, participants will attend an in-person risk review, followed by a final session assessing the acceptability of our risk stratification programme. Risk prediction is based on: a) Gail model (non-genetic), b) mammographic density and recall, c) BOADICEA predictions (breast cancer predisposition genes), and d) breast cancer polygenic risk score. For national implementation of personalised risk-based breast screening, exploration of the acceptability within the target populace is critical, in addition to validated predication tools. To our knowledge, this is the first study to implement a comprehensive risk-based mammography screening programme in Asia. The BREATHE study will provide essential data for policy implementation which will transform the health system to deliver a better health and healthcare outcomes.
Collapse
|
22
|
Kregting LM, Sankatsing VD, Heijnsdijk EA, de Koning HJ, van Ravesteyn NT. Finding the optimal mammography screening strategy: a cost‐effectiveness analysis of 920 modelled strategies. Int J Cancer 2022; 151:287-296. [PMID: 35285018 PMCID: PMC9310858 DOI: 10.1002/ijc.34000] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 12/24/2022]
Abstract
Breast cancer screening policies have been designed decades ago, but current screening strategies may not be optimal anymore. Next to that, screening capacity issues may restrict feasibility. This cost‐effectiveness study evaluates an extensive set of breast cancer screening strategies in the Netherlands. Using the Microsimulation Screening Analysis‐Breast (MISCAN‐Breast) model, the cost‐effectiveness of 920 breast cancer screening strategies with varying starting ages (40‐60), stopping ages (64‐84) and intervals (1‐4 years) were simulated. The number of quality adjusted life years (QALYs) gained and additional net costs (in €) per 1000 women were predicted (3.5% discounted) and incremental cost‐effectiveness ratios (ICERs) were calculated to compare screening scenarios. Sensitivity analyses were performed using different assumptions. In total, 26 strategies covering all four intervals were on the efficiency frontier. Using a willingness‐to‐pay threshold of €20 000/QALY gained, the biennial 40 to 76 screening strategy was optimal. However, this strategy resulted in more overdiagnoses and false positives, and required a high screening capacity. The current strategy in the Netherlands, biennial 50 to 74 years, was dominated. Triennial screening in the age range 44 to 71 (ICER 9364) or 44 to 74 (ICER 11144) resulted in slightly more QALYs gained and lower costs than the current Dutch strategy. Furthermore, these strategies were estimated to require a lower screening capacity. Findings were robust when varying attendance and effectiveness of treatment. In conclusion, switching from biennial to triennial screening while simultaneously lowering the starting age to 44 can increase benefits at lower costs and with a minor increase in harms compared to the current strategy.
Collapse
Affiliation(s)
- Lindy M. Kregting
- Department of Public Health, Erasmus MC University Medical Center Rotterdam The Netherlands
| | | | | | - Harry J. de Koning
- Department of Public Health, Erasmus MC University Medical Center Rotterdam The Netherlands
| | | |
Collapse
|
23
|
Benefits and harms of annual, biennial, or triennial breast cancer mammography screening for women at average risk of breast cancer: a systematic review for the European Commission Initiative on Breast Cancer (ECIBC). Br J Cancer 2022; 126:673-688. [PMID: 34837076 PMCID: PMC8854566 DOI: 10.1038/s41416-021-01521-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 06/20/2021] [Accepted: 07/30/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Although mammography screening is recommended in most European countries, the balance between the benefits and harms of different screening intervals is still a matter of debate. This review informed the European Commission Initiative on Breast Cancer (BC) recommendations. METHODS We searched PubMed, EMBASE, and the Cochrane Library to identify RCTs, observational or modelling studies, comparing desirable (BC deaths averted, QALYs, BC stage, interval cancer) and undesirable (overdiagnosis, false positive related, radiation related) effects from annual, biennial, or triennial mammography screening in women of average risk for BC. We assessed the certainty of the evidence using the GRADE approach. RESULTS We included one RCT, 13 observational, and 11 modelling studies. In women 50-69, annual compared to biennial screening may have small additional benefits but an important increase in false positive results; triennial compared to biennial screening may have smaller benefits while avoiding some harms. In younger women (aged 45-49), annual compared to biennial screening had a smaller gain in benefits and larger harms, showing a less favourable balance in this age group than in women 50-69. In women 70-74, there were fewer additional harms and similar benefits with shorter screening intervals. The overall certainty of the evidence for each of these comparisons was very low. CONCLUSIONS In women of average BC risk, screening intervals have different trade-offs for each age group. The balance probably favours biennial screening in women 50-69. In younger women, annual screening may have a less favourable balance, while in women aged 70-74 years longer screening intervals may be more favourable.
Collapse
|
24
|
Román M, Louro J, Posso M, Vidal C, Bargalló X, Vázquez I, Quintana MJ, Alcántara R, Saladié F, del Riego J, Peñalva L, Sala M, Castells X. Long-Term Risk of Breast Cancer after Diagnosis of Benign Breast Disease by Screening Mammography. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052625. [PMID: 35270331 PMCID: PMC8909630 DOI: 10.3390/ijerph19052625] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 02/11/2022] [Accepted: 02/18/2022] [Indexed: 12/04/2022]
Abstract
Assessing the long-term risk of breast cancer after diagnosis of benign breast disease by mammography is of utmost importance to design personalised screening strategies. We analysed individual-level data from 778,306 women aged 50–69 years with at least one mammographic screening participation in any of ten breast cancer screening centers in Spain from 1996 to 2015, and followed-up until 2017. We used Poisson regression to compare the rates of incident breast cancer among women with and without benign breast disease. During a median follow-up of 7.6 years, 11,708 (1.5%) women had an incident of breast cancer and 17,827 (2.3%) had a benign breast disease. The risk of breast cancer was 1.77 times higher among women with benign breast disease than among those without (95% CI: 1.61 to 1.95). The relative risk increased to 1.99 among women followed for less than four years, and remained elevated for two decades, with relative risk 1.96 (95% CI: 1.32 to 2.92) for those followed from 12 to 20 years. Benign breast disease is a long-term risk factor for breast cancer. Women with benign breast disease could benefit from closer surveillance and personalized screening strategies.
Collapse
Affiliation(s)
- Marta Román
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
| | - Javier Louro
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Margarita Posso
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Carmen Vidal
- Cancer Prevention and Monitoring Program, Catalan Institute of Oncology (ICO), 08908 Barcelona, Spain;
| | - Xavier Bargalló
- Department of Radiology, Hospital Clinic, 08036 Barcelona, Spain;
| | - Ivonne Vázquez
- Pathology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - María Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain;
| | - Rodrigo Alcántara
- Radiology Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain;
| | - Francina Saladié
- Epidemiology and Cancer Prevention Service, Hospital Universitari Sant Joan de Reus, IISPV, 43204 Reus, Spain;
| | - Javier del Riego
- Department of Radiology, Parc Taulí University Hospital-UAB, 08208 Sabadell, Spain;
| | - Lupe Peñalva
- Breast Cancer Screening Technical Office, Private Foundation Asil Hospital, 08402 Granollers, Spain;
| | - Maria Sala
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
| | - Xavier Castells
- Epidemiology and Evaluation Department, IMIM (Hospital del Mar Medical Research Institute), 08003 Barcelona, Spain; (J.L.); (M.P.); (M.S.)
- Research Network on Health Services in Chronic Diseases (REDISSEC), 08003 Barcelona, Spain
- Correspondence: (M.R.); (X.C.)
| | | |
Collapse
|
25
|
Laza-Vásquez C, Codern-Bové N, Cardona-Cardona À, Hernández-Leal MJ, Pérez-Lacasta MJ, Carles-Lavila M, Rué M. Views of health professionals on risk-based breast cancer screening and its implementation in the Spanish National Health System: A qualitative discussion group study. PLoS One 2022; 17:e0263788. [PMID: 35120169 PMCID: PMC8815913 DOI: 10.1371/journal.pone.0263788] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 01/26/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND With the aim of increasing benefits and decreasing harms, risk-based breast cancer screening has been proposed as an alternative to age-based screening. This study explores barriers and facilitators to implementing a risk-based breast cancer screening program from the perspective of health professionals, in the context of a National Health Service. METHODS Socio-constructivist qualitative research carried out in Catalonia (Spain), in the year 2019. Four discussion groups were conducted, with a total of 29 health professionals from primary care, breast cancer screening programs, hospital breast units, epidemiology units, and clinical specialties. A descriptive-interpretive thematic analysis was performed. RESULTS Identified barriers included resistance to reducing the number of screening exams for low-risk women; resistance to change for health professionals; difficulties in risk communication; lack of conclusive evidence of the benefits of risk-based screening; limited economic resources; and organizational transformation. Facilitators include benefits of risk-based strategies for high and low-risk women; women's active role in their health care; proximity of women and primary care professionals; experience of health professionals in other screening programs; and greater efficiency of a risk-based screening program. Organizational and administrative changes in the health system, commitment by policy makers, training of health professionals, and educational interventions addressed to the general population will be required. CONCLUSIONS Despite the expressed difficulties, participants supported the implementation of risk-based screening. They highlighted its benefits, especially for women at high risk of breast cancer and those under 50 years of age, and assumed a greater efficiency of the risk-based program compared to the aged-based one. Future studies should assess the efficiency and feasibility of risk-based breast cancer screening for its transfer to clinical practice.
Collapse
Affiliation(s)
- Celmira Laza-Vásquez
- Department of Nursing and Physiotherapy, University of Lleida-IRBLleida, Lleida, Spain
- Health Care Research Group (GRECS), Lleida, Spain
| | - Núria Codern-Bové
- Escola Universitària d’Infermeria i Teràpia Ocupacional de Terrassa, Universitat Autònoma de Barcelona, Terrassa, Spain
- Health, Participation, Occupation and Care Research Group (GrEUIT), Terrassa, Spain
- ÀreaQ, Evaluation and Qualitative Research, Barcelona, Spain
| | | | - Maria José Hernández-Leal
- Department of Economics and Research Centre on Economics and Sustainability (ECO-SOS), Rovira i Virgili University (URV), Tarragona, Spain
- Research Group in Statistical and Economic Analysis in Health (GRAEES), Reus, Spain
| | - Maria José Pérez-Lacasta
- Department of Economics and Research Centre on Economics and Sustainability (ECO-SOS), Rovira i Virgili University (URV), Tarragona, Spain
- Research Group in Statistical and Economic Analysis in Health (GRAEES), Reus, Spain
| | - Misericòrdia Carles-Lavila
- Department of Economics and Research Centre on Economics and Sustainability (ECO-SOS), Rovira i Virgili University (URV), Tarragona, Spain
- Research Group in Statistical and Economic Analysis in Health (GRAEES), Reus, Spain
| | - Montserrat Rué
- Department of Basic Medical Sciences, University of Lleida-IRBLleida, Lleida, Spain
- Research Group in Statistical and Economic Analysis in Health (GRAEES), Lleida, Spain
| | | |
Collapse
|
26
|
Laza-Vásquez C, Hernández-Leal MJ, Carles-Lavila M, Pérez-Lacasta MJ, Cruz-Esteve I, Rué M. Barriers and Facilitators to the Implementation of a Personalized Breast Cancer Screening Program: Views of Spanish Health Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031406. [PMID: 35162427 PMCID: PMC8835407 DOI: 10.3390/ijerph19031406] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 02/01/2023]
Abstract
This study explored the barriers and facilitators to the implementation of a risk-based breast cancer screening program from the point of view of Spanish health professionals. A cross-sectional study with 220 Spanish health professionals was designed. Data were collected in 2020 via a web-based survey and included the advantages and disadvantages of risk-based screening and barriers and facilitators for the implementation of the program. Descriptive statistics and Likert scale responses analyzed as category-ordered data were obtained. The risk-based screening was considered important or very important to reduce breast cancer mortality and promote a more proactive role for women in breast cancer prevention, to increase coverage for women under 50 years, to promote a breast cancer prevention strategy for women at high risk, and to increase efficiency and effectiveness. Switching to a risk-based program from an age-based program was rated as important or very important by 85% of participants. As barriers for implementation, risk communication, the workload of health professionals, and limited human and financial resources were mentioned. Despite the barriers, there is good acceptance, and it seems feasible, from the perspective of health professionals, to implement a risk-based breast cancer screening program in Spain. However, this poses a number of organizational and resource challenges.
Collapse
Affiliation(s)
- Celmira Laza-Vásquez
- Health Care Research Group (GRECS), Department of Nursing and Physiotherapy, University of Lleida-IRBLleida, 25198 Lleida, Spain;
| | - María José Hernández-Leal
- Research Centre on Economics and Sustainability (ECO-SOS), Department of Economics, Rovira i Virgili University (URV), 43003 Tarragona, Spain; (M.J.H.-L.); (M.C.-L.); (M.J.P.-L.)
- Research Group in Statistical and Economic Analysis in Health (GRAEES), 43204 Reus, Spain
| | - Misericòrdia Carles-Lavila
- Research Centre on Economics and Sustainability (ECO-SOS), Department of Economics, Rovira i Virgili University (URV), 43003 Tarragona, Spain; (M.J.H.-L.); (M.C.-L.); (M.J.P.-L.)
- Research Group in Statistical and Economic Analysis in Health (GRAEES), 43204 Reus, Spain
| | - Maria José Pérez-Lacasta
- Research Centre on Economics and Sustainability (ECO-SOS), Department of Economics, Rovira i Virgili University (URV), 43003 Tarragona, Spain; (M.J.H.-L.); (M.C.-L.); (M.J.P.-L.)
- Research Group in Statistical and Economic Analysis in Health (GRAEES), 43204 Reus, Spain
| | - Inés Cruz-Esteve
- Primer de Maig Basic Health Area, Catalan Health Institute (ICS), 25003 Lleida, Spain;
| | - Montserrat Rué
- Research Group in Statistical and Economic Analysis in Health (GRAEES), 43204 Reus, Spain
- Department of Basic Medical Sciences, University of Lleida-IRBLleida, 25198 Lleida, Spain
- Correspondence:
| | | |
Collapse
|
27
|
Rainey L, van der Waal D, Donnelly LS, Southworth J, French DP, Evans DG, Broeders MJM. Women's health behaviour change after receiving breast cancer risk estimates with tailored screening and prevention recommendations. BMC Cancer 2022; 22:69. [PMID: 35033023 PMCID: PMC8761310 DOI: 10.1186/s12885-022-09174-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 01/04/2022] [Indexed: 11/29/2022] Open
Abstract
Background The Predicting Risk of Cancer at Screening (PROCAS) study provided women who were eligible for breast cancer screening in Greater Manchester (United Kingdom) with their 10-year risk of breast cancer, i.e., low (≤1.5%), average (1.5–4.99%), moderate (5.-7.99%) or high (≥8%). The aim of this study is to explore which factors were associated with women’s uptake of screening and prevention recommendations. Additionally, we evaluated women’s organisational preferences regarding tailored screening. Methods A total of 325 women with a self-reported low (n = 60), average (n = 125), moderate (n = 80), or high (n = 60) risk completed a two-part web-based survey. The first part contained questions about personal characteristics. For the second part women were asked about uptake of early detection and preventive behaviours after breast cancer risk communication. Additional questions were posed to explore preferences regarding the organisation of risk-stratified screening and prevention. We performed exploratory univariable and multivariable regression analyses to assess which factors were associated with uptake of primary and secondary breast cancer preventive behaviours, stratified by breast cancer risk. Organisational preferences are presented using descriptive statistics. Results Self-reported breast cancer risk predicted uptake of (a) supplemental screening and breast self-examination, (b) risk-reducing medication and (c) preventive lifestyle behaviours. Further predictors were (a) having a first degree relative with breast cancer, (b) higher age, and (c) higher body mass index (BMI). Women’s organisational preferences for tailored screening emphasised a desire for more intensive screening for women at increased risk by further shortening the screening interval and moving the starting age forward. Conclusions Breast cancer risk communication predicts the uptake of key tailored primary and secondary preventive behaviours. Effective communication of breast cancer risk information is essential to optimise the population-wide impact of tailored screening. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09174-3.
Collapse
Affiliation(s)
- Linda Rainey
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | | | - Louise S Donnelly
- Centre for Mental Health and Safety, University of Manchester, Manchester, M13 9PL, England
| | - Jake Southworth
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Coupland Street, Manchester, M13 9PL, UK
| | - D Gareth Evans
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Manchester University NHS Foundation Trust, Southmoor Road, Manchester, M23 9LT, UK.,Genomic Medicine, Division of Evolution and Genomic Sciences, Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, M13 9WL, UK.,The Christie NHS Foundation Trust, Withington, Manchester, M20 4BX, UK
| | - Mireille 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, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
| |
Collapse
|
28
|
UK Women's Views of the Concepts of Personalised Breast Cancer Risk Assessment and Risk-Stratified Breast Screening: A Qualitative Interview Study. Cancers (Basel) 2021; 13:cancers13225813. [PMID: 34830965 PMCID: PMC8616436 DOI: 10.3390/cancers13225813] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 11/12/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
Simple Summary Risk-based breast screening will involve tailoring the amount of screening to women’s level of risk. Therefore, women at high-risk may be offered more frequent screening and over a longer period of time than those at low risk for whom less screening may be recommended. As this will involve considerable changes to the NHS Breast Screening Programme, it is important to explore what women in the UK think and feel about this approach. Analysis of in-depth interviews revealed that some women would find both high and low-risk screening options acceptable whereas others were resistant to the prospect of reduced screening if they were assessed as low-risk. We also found that the idea of risk-based screening had little influence on the attitudes of women who were already sceptical about breast screening. These findings highlight the communication challenges that will be faced by those introducing risk-based screening and suggest a need for tailored support and advice. Abstract Any introduction of risk-stratification within the NHS Breast Screening Programme needs to be considered acceptable by women. We conducted interviews to explore women’s attitudes to personalised risk assessment and risk-stratified breast screening. Twenty-five UK women were purposively sampled by screening experience and socioeconomic background. Interview transcripts were qualitatively analysed using Framework Analysis. Women expressed positive intentions for personal risk assessment and willingness to receive risk feedback to provide reassurance and certainty. Women responded to risk-stratified screening scenarios in three ways: ‘Overall acceptors’ considered both high- and low-risk options acceptable as a reasonable allocation of resources to clinical need, yet acceptability was subject to specified conditions including accuracy of risk estimates and availability of support throughout the screening pathway. Others who thought ‘more is better’ only supported high-risk scenarios where increased screening was proposed. ‘Screening sceptics’ found low-risk scenarios more aligned to their screening values than high-risk screening options. Consideration of screening recommendations for other risk groups had more influence on women’s responses than screening-related harms. These findings demonstrate high, but not universal, acceptability. Support and guidance, tailored to screening values and preferences, may be required by women at all levels of risk.
Collapse
|
29
|
Mühlberger N, Sroczynski G, Gogollari A, Jahn B, Pashayan N, Steyerberg E, Widschwendter M, Siebert U. Cost effectiveness of breast cancer screening and prevention: a systematic review with a focus on risk-adapted strategies. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2021; 22:1311-1344. [PMID: 34342797 DOI: 10.1007/s10198-021-01338-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 06/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES Benefit and cost effectiveness of breast cancer screening are still matters of controversy. Risk-adapted strategies are proposed to improve its benefit-harm and cost-benefit relations. Our objective was to perform a systematic review on economic breast cancer models evaluating primary and secondary prevention strategies in the European health care setting, with specific focus on model results, model characteristics, and risk-adapted strategies. METHODS Literature databases were systematically searched for economic breast cancer models evaluating the cost effectiveness of breast cancer screening and prevention strategies in the European health care context. Characteristics, methodological details and results of the identified studies are reported in evidence tables. Economic model outputs are standardized to achieve comparable cost-effectiveness ratios. RESULTS Thirty-two economic evaluations of breast cancer screening and seven evaluations of primary breast cancer prevention were included. Five screening studies and none of the prevention studies considered risk-adapted strategies. Studies differed in methodologic features. Only about half of the screening studies modeled overdiagnosis-related harms, most often indirectly and without reporting their magnitude. All models predict gains in life expectancy and/or quality-adjusted life expectancy at acceptable costs. However, risk-adapted screening was shown to be more effective and efficient than conventional screening. CONCLUSIONS Economic models suggest that breast cancer screening and prevention are cost effective in the European setting. All screening models predict gains in life expectancy, which has not yet been confirmed by trials. European models evaluating risk-adapted screening strategies are rare, but suggest that risk-adapted screening is more effective and efficient than conventional screening.
Collapse
Affiliation(s)
- Nikolai Mühlberger
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Gaby Sroczynski
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Artemisa Gogollari
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Beate Jahn
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria
| | - Nora Pashayan
- Institute of Epidemiology and Healthcare, Department of Applied Health Research, UCL-University College London, 1-19 Torrington Place, London, WC1E 7HB, UK
| | - Ewout Steyerberg
- Department of Public Health, Erasmus MC, PO Box 9600, 3000 CA, Rotterdam, The Netherlands
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Widschwendter
- Department of Women's Cancer, EGA Institute for Women's Health, UCL - University College London, 74 Huntley St, Rm 340, London, WC1E 6AU, UK
| | - Uwe Siebert
- Institute of Public Health, Medical Decision Making and Health Technology Assessment, Department of Public Health, Health Services Research and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Eduard-Wallnoefer-Zentrum I, 6060, Hall i.T, Austria.
- Division of Health Technology Assessment and Bioinformatics, ONCOTYROL - Center for Personalized Cancer Medicine, Innsbruck, Austria.
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Center for Health Decision Science, Boston, MA, USA.
- Harvard Medical School, Institute for Technology Assessment and Department of Radiology, Massachusetts General Hospital, Boston, MA, USA.
| |
Collapse
|
30
|
O'Mahony JF. Risk Stratification in Cost-Effectiveness Analyses of Cancer Screening: Intervention Eligibility, Strategy Choice, and Optimality. Med Decis Making 2021; 42:513-523. [PMID: 34634972 PMCID: PMC9005837 DOI: 10.1177/0272989x211050918] [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] [Indexed: 11/16/2022]
Abstract
Introduction There is increasing interest in risk-stratified approaches to cancer
screening in cost-effectiveness analysis (CEA). Current CEA practice
regarding risk stratification is heterogeneous and guidance on the best
approach is lacking. This article suggests how stratification in CEA can be
improved. Methods I use a simple example of a hypothetical screening intervention with 3
potential recipient risk strata. The screening intervention has 6
alternative intensities, each with different costs and effects, all of which
vary between strata. I consider a series of alternative stratification
approaches, demonstrating the consequences for estimated costs, effects, and
the choice of optimal strategy. I supplement this analysis with applied
examples from the literature. Results Adopting the same screening policy for all strata yields the least efficient
strategies, where efficiency is understood as the volume of net health
benefit generated across a range of cost-effectiveness threshold values.
Basic stratification that withholds screening from lower-risk strata while
adopting a common strategy for those screened increases efficiency. Greatest
efficiency is achieved when different strata receive separate strategies.
While complete optimization can be achieved within a single analysis by
considering all possible policy combinations, the resulting number of
strategy combinations may be inconveniently large. Optimization with
separate strata-specific analyses is simpler and more transparent. Despite
this, there can be good reasons to simulate all strata together in a single
analysis. Conclusions If the benefits of risk stratification are to be fully realized, policy
makers need to consider the extent to which stratification is feasible, and
modelers need to simulate those choices adequately. It is hoped this
analysis will clarify those policy and modeling choices and therefore lead
to improved population health outcomes.
Collapse
Affiliation(s)
- James F O'Mahony
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, Dublin, Ireland (JFO)
| |
Collapse
|
31
|
Li H, Sun D, Cao M, He S, Zheng Y, Yu X, Wu Z, Lei L, Peng J, Li J, Li N, Chen W. Risk prediction models for esophageal cancer: A systematic review and critical appraisal. Cancer Med 2021; 10:7265-7276. [PMID: 34414682 PMCID: PMC8525074 DOI: 10.1002/cam4.4226] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 08/05/2021] [Accepted: 08/12/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND AND AIMS Esophageal cancer risk prediction models allow for risk-stratified endoscopic screening. We aimed to assess the quality of these models developed in the general population. METHODS A systematic search of the PubMed and Embase databases from January 2000 through May 2021 was performed. Studies that developed or validated a model of esophageal cancer in the general population were included. Screening, data extraction, and risk of bias (ROB) assessment by the Prediction model Risk Of Bias Assessment Tool (PROBAST) were performed independently by two reviewers. RESULTS Of the 13 models included in the qualitative analysis, 8 were developed for esophageal squamous cell carcinoma (ESCC) and the other 5 were developed for esophageal adenocarcinoma (EAC). Only two models conducted external validation. In the ESCC models, cigarette smoking was included in each model, followed by age, sex, and alcohol consumption. For EAC models, cigarette smoking and body mass index were included in each model, and gastroesophageal reflux disease, uses of acid-suppressant medicine, and nonsteroidal anti-inflammatory drug were exclusively included. The discriminative performance was reported in all studies, with C statistics ranging from 0.71 to 0.88, whereas only six models reported calibration. For ROB, all the models had a low risk in participant and outcome, but all models showed high risk in analysis, and 60% of models showed a high risk in predictors, which resulted in all models being classified as having overall high ROB. For model applicability, about 60% of these models had an overall low risk, with 30% of models of high risk and 10% of models of unclear risk, concerning the assessment of participants, predictors, and outcomes. CONCLUSIONS Most current risk prediction models of esophageal cancer have a high ROB. Prediction models need further improvement in their quality and applicability to benefit esophageal cancer screening.
Collapse
Affiliation(s)
- He Li
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Dianqin Sun
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Maomao Cao
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Siyi He
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Yadi Zheng
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Xinyang Yu
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Zheng Wu
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Lin Lei
- Department of Cancer Prevention and ControlShenzhen Center for Chronic Disease ControlShenzhenChina
| | - Ji Peng
- Department of Cancer Prevention and ControlShenzhen Center for Chronic Disease ControlShenzhenChina
| | - Jiang Li
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Ni Li
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| | - Wanqing Chen
- Office of Cancer ScreeningNational Cancer Center/ National Clinical Research Center for Cancer/ Cancer HospitalChinese Academy of Medical Sciences and Peking Union Medical CollegeBeijingChina
| |
Collapse
|
32
|
Trentham-Dietz A, Alagoz O, Chapman C, Huang X, Jayasekera J, van Ravesteyn NT, Lee SJ, Schechter CB, Yeh JM, Plevritis SK, Mandelblatt JS. Reflecting on 20 years of breast cancer modeling in CISNET: Recommendations for future cancer systems modeling efforts. PLoS Comput Biol 2021; 17:e1009020. [PMID: 34138842 PMCID: PMC8211268 DOI: 10.1371/journal.pcbi.1009020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Since 2000, the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET) modeling teams have developed and applied microsimulation and statistical models of breast cancer. Here, we illustrate the use of collaborative breast cancer multilevel systems modeling in CISNET to demonstrate the flexibility of systems modeling to address important clinical and policy-relevant questions. Challenges and opportunities of future systems modeling are also summarized. The 6 CISNET breast cancer models embody the key features of systems modeling by incorporating numerous data sources and reflecting tumor, person, and health system factors that change over time and interact to affect the burden of breast cancer. Multidisciplinary modeling teams have explored alternative representations of breast cancer to reveal insights into breast cancer natural history, including the role of overdiagnosis and race differences in tumor characteristics. The models have been used to compare strategies for improving the balance of benefits and harms of breast cancer screening based on personal risk factors, including age, breast density, polygenic risk, and history of Down syndrome or a history of childhood cancer. The models have also provided evidence to support the delivery of care by simulating outcomes following clinical decisions about breast cancer treatment and estimating the relative impact of screening and treatment on the United States population. The insights provided by the CISNET breast cancer multilevel modeling efforts have informed policy and clinical guidelines. The 20 years of CISNET modeling experience has highlighted opportunities and challenges to expanding the impact of systems modeling. Moving forward, CISNET research will continue to use systems modeling to address cancer control issues, including modeling structural inequities affecting racial disparities in the burden of breast cancer. Future work will also leverage the lessons from team science, expand resource sharing, and foster the careers of early stage modeling scientists to ensure the sustainability of these efforts. Since 2000, our research teams have used computer models of breast cancer to address important clinical and policy-relevant questions as part of the National Cancer Institute’s Cancer Intervention and Surveillance Modeling Network (CISNET). Our 6 CISNET breast cancer models embody the key features of systems modeling by incorporating numerous data sources and reflecting tumor, person, and health system factors that change over time and interact to represent the burden of breast cancer. We have used our models to investigate questions related to breast cancer biology, compare strategies to improve the balance of benefits and harms of screening mammography, and support insights into the delivery of care by modeling outcomes following clinical decisions about breast cancer treatment. Moving forward, our research will continue to use systems modeling to address issues related to reducing the burden of breast cancer including modeling structural inequities affecting racial disparities. Our future work will also leverage lessons from engaging multidisciplinary scientific teams, expand efforts to share modeling resources with other researchers, and foster the careers of early stage modeling scientists to ensure the sustainability of these efforts.
Collapse
Affiliation(s)
- Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- * E-mail:
| | - Oguzhan Alagoz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, Wisconsin, United States of America
| | - Christina Chapman
- Department of Radiation Oncology, University of Michigan Medical School, Ann Arbor, Michigan, United States of America
| | - Xuelin Huang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Jinani Jayasekera
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States of America
| | | | - Sandra J. Lee
- Department of Data Science, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Clyde B. Schechter
- Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, New York, United States of America
| | - Jennifer M. Yeh
- Department of Pediatrics, Boston Children’s Hospital and Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sylvia K. Plevritis
- Department of Biomedical Data Science, Stanford University School of Medicine, Stanford, California, United States of America
| | - Jeanne S. Mandelblatt
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, DC, United States of America
| | | |
Collapse
|
33
|
Shih YCT, Dong W, Xu Y, Etzioni R, Shen Y. Incorporating Baseline Breast Density When Screening Women at Average Risk for Breast Cancer : A Cost-Effectiveness Analysis. Ann Intern Med 2021; 174:602-612. [PMID: 33556275 PMCID: PMC8171124 DOI: 10.7326/m20-2912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Breast density classification is largely determined by mammography, making the timing of the first screening mammogram clinically important. OBJECTIVE To evaluate the cost-effectiveness of breast cancer screening strategies that are stratified by breast density. DESIGN Microsimulation model to generate the natural history of breast cancer for women with and those without dense breasts and assessment of the cost-effectiveness of strategies tailored to breast density and nontailored strategies. DATA SOURCES Model parameters from the literature; statistical modeling; and analysis of Surveillance, Epidemiology, and End Results-Medicare data. TARGET POPULATION Women aged 40 years or older. TIME HORIZON Lifetime. PERSPECTIVE Societal. INTERVENTION No screening; biennial or triennial mammography from age 50 to 75 years; annual mammography from age 50 to 75 years for women with dense breasts at age 50 years and biennial or triennial mammography from age 50 to 75 years for those without dense breasts at age 50 years; and annual mammography at age 40 to 75 years for women with dense breasts at age 40 years and biennial or triennial mammography at age 50 to 75 years for those without dense breasts at age 40 years. OUTCOME MEASURES Lifetime costs and quality-adjusted life-years (QALYs), discounted at 3% annually. RESULTS OF BASE-CASE ANALYSIS Baseline screening at age 40 years followed by annual screening at age 40 to 75 years for women with dense breasts and biennial screening at age 50 to 75 years for women without dense breasts was effective and cost-effective, yielding an incremental cost-effectiveness ratio of $36 200 per QALY versus the biennial strategy at age 50 to 75 years. RESULTS OF SENSITIVITY ANALYSIS At a societal willingness-to-pay threshold of $100 000 per QALY, the probability that the density-stratified strategy at age 40 years was optimal was 56% compared with 6 other strategies. LIMITATION Findings may not be generalizable outside the United States. CONCLUSION The study findings advocate for breast density-stratified screening with baseline mammography at age 40 years. PRIMARY FUNDING SOURCE National Cancer Institute.
Collapse
Affiliation(s)
- Ya-Chen Tina Shih
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Y.T.S., W.D., Y.X., Y.S.)
| | - Wenli Dong
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Y.T.S., W.D., Y.X., Y.S.)
| | - Ying Xu
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Y.T.S., W.D., Y.X., Y.S.)
| | - Ruth Etzioni
- Fred Hutchinson Cancer Center, Seattle, Washington (R.E.)
| | - Yu Shen
- The University of Texas MD Anderson Cancer Center, Houston, Texas (Y.T.S., W.D., Y.X., Y.S.)
| |
Collapse
|
34
|
|
35
|
Wong JZY, Chai JH, Yeoh YS, Mohamed Riza NK, Liu J, Teo YY, Wee HL, Hartman M. Cost effectiveness analysis of a polygenic risk tailored breast cancer screening programme in Singapore. BMC Health Serv Res 2021; 21:379. [PMID: 33892705 PMCID: PMC8066868 DOI: 10.1186/s12913-021-06396-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 04/14/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the cost-effectiveness of a breast cancer screening programme that incorporates genetic testing using breast cancer associated single nucleotide polymorphisms (SNPs), against the current biennial mammogram-only screening programme to aid in its implementation into the current programme in Singapore. METHODS A Markov model was used to compare the costs and health outcomes of the current screening programme, against a polygenic risk-tailored screening programme, which can advise a long-term screening strategy depending on the individual's polygenic risk. The model took the perspective of the healthcare system, with a time horizon of 40 years, following women from the age of 35 to 74. Epidemiological and cost data were taken from Asian studies, and an annual discount rate of 3% was used. The model outcome was the incremental cost-effectiveness ratio (ICER), calculated from the difference in costs per quality-adjusted life year (QALY). Scenarios with varying risk thresholds for each polygenic risk group were examined. One-way and probabilistic sensitivity analyses were performed to assess parameter uncertainty. RESULTS The ICER for a polygenic risk-tailored breast cancer screening programme, compared with the current biennial mammogram-only screening programme, was - 3713.80 SGD/QALY, with incremental costs < 0 and incremental effects > 0. The scenario analysis of different polygenic risk cutoffs showed that the ICERs remain negative, with all ICERs falling within the south-east quadrant of the cost-effectiveness plane, indicating that tailored screening is more cost effective than mammogram-only screening, with lower costs and higher QALYs to be gained. This suggests that a polygenic risk-tailored breast cancer screening programme is cost effective, entailing lower cost than the current mammogram-only programme, while causing no additional harm to women. CONCLUSION Results from this cost-effectiveness analysis show that polygenic risk-tailored screening is cost effective with an ICER of - 3713.80 SGD/QALY. Tailored screening remains cost effective even across varying percentile cutoffs for each risk group. While the results look promising for incorporating polygenic risk into the current breast cancer screening programme, further studies should be conducted to address various limitations.
Collapse
Affiliation(s)
| | - Jia Hui Chai
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems Singapore, Singapore, Singapore
| | - Yen Shing Yeoh
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems Singapore, Singapore, Singapore
| | - Nur Khaliesah Mohamed Riza
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems Singapore, Singapore, Singapore
| | - Jenny Liu
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems Singapore, Singapore, Singapore
| | - Yik-Ying Teo
- Life Sciences Institute, National University of Singapore, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems Singapore, Singapore, Singapore
| | - Hwee Lin Wee
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems Singapore, Singapore, Singapore.
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Singapore.
| | - Mikael Hartman
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health Systems Singapore, Singapore, Singapore
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore and National University Health Systems, Singapore, Singapore
| |
Collapse
|
36
|
Khan SA, Hernandez-Villafuerte KV, Muchadeyi MT, Schlander M. Cost-effectiveness of risk-based breast cancer screening: A systematic review. Int J Cancer 2021; 149:790-810. [PMID: 33844853 DOI: 10.1002/ijc.33593] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/09/2021] [Accepted: 03/23/2021] [Indexed: 01/01/2023]
Abstract
To analyse published evidence on the economic evaluation of risk-based screening (RBS), a full systematic literature review was conducted. After a quality appraisal, we compared the cost-effectiveness of risk-based strategies (low-risk, medium-risk and high-risk) with no screening and age-based screening. Studies were also analysed for modelling, risk stratification methods, input parameters, data sources and harms and benefits. The 10 modelling papers analysed were based on screening performance of film-based mammography (FBM) (three); digital mammography (DM) and FBM (two); DM alone (three); DM, ultrasound (US) and magnetic resonance imaging (one) and DM and US (one). Seven studies did not include the cost of risk-stratification, and one did not consider the cost of diagnosis. Disutility was incorporated in only six studies (one for screening and five for diagnosis). None of the studies reported disutility of risk-stratification (being considered as high-risk). Risk-stratification methods varied from only breast density (BD) to the combination of familial risk, genetic susceptibility, lifestyle, previous biopsies, Jewish ancestry and reproductive history. Less or no screening in low-risk women and more frequent mammography screening in high-risk women was more cost-effective compared to no screening and age-based screening. High-risk women screened annually yielded a higher mortality rate reduction and more quality-adjusted life years at the expense of higher cost and false positives. RBS can be cost effective compared to the alternatives. However, heterogeneity among risk-stratification methods, input parameters, and weaknesses in the methodologies hinder the derivation of robust conclusions. Therefore, further studies are warranted to assess newer technologies and innovative risk-stratification methods.
Collapse
Affiliation(s)
- Shah Alam Khan
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | | | - Muchandifunga Trust Muchadeyi
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Michael Schlander
- Division of Health Economics, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| |
Collapse
|
37
|
van den Broek JJ, Schechter CB, van Ravesteyn NT, Janssens ACJW, Wolfson MC, Trentham-Dietz A, Simard J, Easton DF, Mandelblatt JS, Kraft P, de Koning HJ. Personalizing Breast Cancer Screening Based on Polygenic Risk and Family History. J Natl Cancer Inst 2021; 113:434-442. [PMID: 32853342 PMCID: PMC8599807 DOI: 10.1093/jnci/djaa127] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 08/10/2020] [Accepted: 08/18/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND We assessed the clinical utility of a first-degree breast cancer family history and polygenic risk score (PRS) to inform screening decisions among women aged 30-50 years. METHODS Two established breast cancer models evaluated digital mammography screening strategies in the 1985 US birth cohort by risk groups defined by family history and PRS based on 313 single nucleotide polymorphisms. Strategies varied in initiation age (30, 35, 40, 45, and 50 years) and interval (annual, hybrid, biennial, triennial). The benefits (breast cancer deaths averted, life-years gained) and harms (false-positive mammograms, overdiagnoses) were compared with those seen with 3 established screening guidelines. RESULTS Women with a breast cancer family history who initiated biennial screening at age 40 years (vs 50 years) had a 36% (model range = 29%-40%) increase in life-years gained and 20% (model range = 16%-24%) more breast cancer deaths averted, but 21% (model range = 17%-23%) more overdiagnoses and 63% (model range = 62%-64%) more false positives. Screening tailored to PRS vs biennial screening from 50 to 74 years had smaller positive effects on life-years gained (20%) and breast cancer deaths averted (11%) but also smaller increases in overdiagnoses (10%) and false positives (26%). Combined use of family history and PRS vs biennial screening from 50 to 74 years had the greatest increase in life-years gained (29%) and breast cancer deaths averted (18%). CONCLUSIONS Our results suggest that breast cancer family history and PRS could guide screening decisions before age 50 years among women at increased risk for breast cancer but expected increases in overdiagnoses and false positives should be expected.
Collapse
Affiliation(s)
- Jeroen J van den Broek
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Clyde B Schechter
- Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | | | - Michael C Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Amy Trentham-Dietz
- Carbone Cancer Center and Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Jacques Simard
- Department of Medicine, Centre de recherche du CHU de Québec-Université Laval, Québec, QC, Canada
| | - Douglas F Easton
- Centre for Cancer Genetic Epidemiology, Department Public Health, and Primary Care, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown-Lombardi Comprehensive Cancer Center, Georgetown University School of Medicine, Washington, DC, USA
| | - Peter Kraft
- Department of Biostatistics and Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Harry J de Koning
- Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
| |
Collapse
|
38
|
Louro J, Román M, Posso M, Vázquez I, Saladié F, Rodriguez-Arana A, Quintana MJ, Domingo L, Baré M, Marcos-Gragera R, Vernet-Tomas M, Sala M, Castells X. Developing and validating an individualized breast cancer risk prediction model for women attending breast cancer screening. PLoS One 2021; 16:e0248930. [PMID: 33755692 PMCID: PMC7987139 DOI: 10.1371/journal.pone.0248930] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 03/08/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Several studies have proposed personalized strategies based on women's individual breast cancer risk to improve the effectiveness of breast cancer screening. We designed and internally validated an individualized risk prediction model for women eligible for mammography screening. METHODS Retrospective cohort study of 121,969 women aged 50 to 69 years, screened at the long-standing population-based screening program in Spain between 1995 and 2015 and followed up until 2017. We used partly conditional Cox proportional hazards regression to estimate the adjusted hazard ratios (aHR) and individual risks for age, family history of breast cancer, previous benign breast disease, and previous mammographic features. We internally validated our model with the expected-to-observed ratio and the area under the receiver operating characteristic curve. RESULTS During a mean follow-up of 7.5 years, 2,058 women were diagnosed with breast cancer. All three risk factors were strongly associated with breast cancer risk, with the highest risk being found among women with family history of breast cancer (aHR: 1.67), a proliferative benign breast disease (aHR: 3.02) and previous calcifications (aHR: 2.52). The model was well calibrated overall (expected-to-observed ratio ranging from 0.99 at 2 years to 1.02 at 20 years) but slightly overestimated the risk in women with proliferative benign breast disease. The area under the receiver operating characteristic curve ranged from 58.7% to 64.7%, depending of the time horizon selected. CONCLUSIONS We developed a risk prediction model to estimate the short- and long-term risk of breast cancer in women eligible for mammography screening using information routinely reported at screening participation. The model could help to guiding individualized screening strategies aimed at improving the risk-benefit balance of mammography screening programs.
Collapse
Affiliation(s)
- Javier Louro
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
- European Higher Education Area (EHEA) Doctoral Programme in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Marta Román
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
- * E-mail:
| | - Margarita Posso
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | | | - Francina Saladié
- Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, Institut d’Investigació Sanitària Pere Virgili, Universitat Rovira i Virgili, Reus, Spain
| | | | - M. Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de la Santa Creu i Sant Pau, IIB Sant Pau, Barcelona, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Laia Domingo
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Marisa Baré
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Clinical Epidemiology and Cancer Screening, Parc Taulí University Hospital, Sabadell, Spain
| | - Rafael Marcos-Gragera
- CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Department of Health, Epidemiology Unit and Girona Cancer Registry, Oncology Coordination Plan, Autonomous Government of Catalonia, Catalan Institute of Oncology, Girona, Spain
| | | | - Maria Sala
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | - Xavier Castells
- IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain
- Servei d’Epidemiologia i Avaluació, Hospital del Mar, Barcelona, Spain
| | | |
Collapse
|
39
|
van Ravesteyn NT, Schechter CB, Hampton JM, Alagoz O, van den Broek JJ, Kerlikowske K, Mandelblatt JS, Miglioretti DL, Sprague BL, Stout NK, de Koning HJ, Trentham-Dietz A, Tosteson ANA. Trade-Offs Between Harms and Benefits of Different Breast Cancer Screening Intervals Among Low-Risk Women. J Natl Cancer Inst 2021; 113:1017-1026. [PMID: 33515225 PMCID: PMC8502479 DOI: 10.1093/jnci/djaa218] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 10/30/2020] [Accepted: 12/21/2020] [Indexed: 01/25/2023] Open
Abstract
Background A paucity of research addresses breast cancer screening strategies for women at lower-than-average breast cancer risk. The aim of this study was to examine screening harms and benefits among women aged 50-74 years at lower-than-average breast cancer risk by breast density. Methods Three well-established, validated Cancer Intervention and Surveillance Network models were used to estimate the lifetime benefits and harms of different screening scenarios, varying by screening interval (biennial, triennial). Breast cancer deaths averted, life-years and quality-adjusted life-years gained, false-positives, benign biopsies, and overdiagnosis were assessed by relative risk (RR) level (0.6, 0.7, 0.85, 1 [average risk]) and breast density category, for US women born in 1970. Results Screening benefits decreased proportionally with decreasing risk and with lower breast density. False-positives, unnecessary biopsies, and the percentage overdiagnosis also varied substantially by breast density category; false-positives and unnecessary biopsies were highest in the heterogeneously dense category. For women with fatty or scattered fibroglandular breast density and a relative risk of no more than 0.85, the additional deaths averted and life-years gained were small with biennial vs triennial screening. For these groups, undergoing 4 additional screens (screening biennially [13 screens] vs triennially [9 screens]) averted no more than 1 additional breast cancer death and gained no more than 16 life-years and no more than 10 quality-adjusted life-years per 1000 women but resulted in up to 232 more false-positives per 1000 women. Conclusion Triennial screening from age 50 to 74 years may be a reasonable screening strategy for women with lower-than-average breast cancer risk and fatty or scattered fibroglandular breast density.
Collapse
Affiliation(s)
| | - Clyde B Schechter
- Departments of Family and Social Medicine and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John M Hampton
- Carbone Cancer Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA
| | - Oguzhan Alagoz
- Carbone Cancer Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI, USA
| | - Jeroen J van den Broek
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Karla Kerlikowske
- Department of Medicine and Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Jeanne S Mandelblatt
- Department of Oncology, Georgetown University Medical Center and Cancer Prevention and Control Program, Georgetown-Lombardi Comprehensive Cancer Center, WA, USA
| | - Diana L Miglioretti
- Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Brian L Sprague
- Department of Surgery and University of Vermont Cancer Center, College of Medicine, University of Vermont, Burlington, VT, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Harry J de Koning
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Amy Trentham-Dietz
- Carbone Cancer Center, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI, USA.,Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - Anna N A Tosteson
- Norris Cotton Cancer Center and the Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | | |
Collapse
|
40
|
Breast density, benign breast disease, and risk of breast cancer over time. Eur Radiol 2021; 31:4839-4847. [PMID: 33409776 DOI: 10.1007/s00330-020-07490-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 10/06/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Assessing the combined effect of mammographic density and benign breast disease is of utmost importance to design personalized screening strategies. METHODS We analyzed individual-level data from 294,943 women aged 50-69 years with at least one mammographic screening participation in any of four areas of the Spanish Breast Cancer Screening Program from 1995 to 2015, and followed up until 2017. We used partly conditional Cox models to assess the association between benign breast disease, breast density, and the risk of breast cancer. RESULTS During a median follow-up of 8.0 years, 3697 (1.25%) women had a breast cancer diagnosis and 5941 (2.01%) had a benign breast disease. More than half of screened women had scattered fibroglandular density (55.0%). The risk of breast cancer independently increased with the presence of benign breast disease and with the increase in breast density (p for interaction = 0.84). Women with benign breast disease and extremely dense breasts had a threefold elevated risk of breast cancer compared with those with scattered fibroglandular density and without benign breast disease (hazard ratio [HR] = 3.07; 95%CI = 2.01-4.68). Heterogeneous density and benign breast disease was associated with nearly a 2.5 elevated risk (HR = 2.48; 95%CI = 1.66-3.70). Those with extremely dense breast without a benign breast disease had a 2.27 increased risk (95%CI = 2.07-2.49). CONCLUSIONS Women with benign breast disease had an elevated risk for over 15 years independently of their breast density category. Women with benign breast disease and dense breasts are at high risk for future breast cancer. KEY POINTS • Benign breast disease and breast density were independently associated with breast cancer. • Women with benign breast disease had an elevated risk for up to 15 years independently of their mammographic density category.
Collapse
|
41
|
Woof VG, McWilliams L, Donnelly LS, Howell A, Evans DG, Maxwell AJ, French DP. Introducing a low-risk breast screening pathway into the NHS Breast Screening Programme: Views from healthcare professionals who are delivering risk-stratified screening. WOMEN'S HEALTH (LONDON, ENGLAND) 2021; 17:17455065211009746. [PMID: 33877937 PMCID: PMC8060757 DOI: 10.1177/17455065211009746] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 03/01/2021] [Accepted: 03/24/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Proposals to stratify breast screening by breast cancer risk aim to produce a better balance of benefits to harms. Notably, risk estimation calculated from common risk factors and a polygenic risk score would enable high-risk women to benefit from more frequent screening or preventive medication. This service would also identify low-risk women who experience fewer benefits from attending, as lower grade and in situ cancers may be treated unnecessarily. It may therefore be appropriate for low-risk women to attend screening less. This study aimed to elicit views regarding implementing less frequent screening for low-risk women from healthcare professionals who implement risk-stratified screening. METHODS Healthcare professionals involved in the delivery of risk-stratified breast screening were invited to participate in a focus group within the screening setting in which they work or have a telephone interview. Primary care staff were also invited to provide their perspective. Three focus groups and two telephone interviews were conducted with 28 healthcare professionals. To identify patterns across the sample, data were analysed as a single dataset using reflexive thematic analysis. RESULTS Analysis yielded three themes: Reservations concerning the introduction of less frequent screening, highlighting healthcare professionals' unease and concerns towards implementing less frequent screening; Considerations for the management of public knowledge, providing views on media impact on public opinion and the potential for a low-risk pathway to cause confusion and raise suspicion regarding implementation motives; and Deliberating service implications and reconfiguration management, where the practicalities of implementation are discussed. CONCLUSIONS Healthcare professionals broadly supported less frequent screening but had concerns about implementation. It will be essential to address concerns regarding risk estimate accuracy, healthcare professional confidence, service infrastructure and public communication prior to introducing less frequent screening for low-risk women.
Collapse
Affiliation(s)
- Victoria G Woof
- Manchester Centre for Health
Psychology, Division of Psychology & Mental Health, School of Health Sciences,
Faculty of Biology, Medicine and Health, University of Manchester, MAHSC,
Manchester, UK
| | - Lorna McWilliams
- Manchester Centre for Health
Psychology, Division of Psychology & Mental Health, School of Health Sciences,
Faculty of Biology, Medicine and Health, University of Manchester, MAHSC,
Manchester, UK
| | - Louise S Donnelly
- Nightingale and Prevent Breast Cancer
Research Unit, Manchester University NHS Foundation Trust, Manchester, UK
- NIHR Greater Manchester Patient Safety
Translational Research Centre, Centre for Mental Health and Safety, School of Health
Sciences, Faculty of Biology, Medicine and Health, University of Manchester, MAHSC,
Manchester, UK
| | - Anthony Howell
- Nightingale and Prevent Breast Cancer
Research Unit, Manchester University NHS Foundation Trust, Manchester, UK
| | - D Gareth Evans
- Nightingale and Prevent Breast Cancer
Research Unit, Manchester University NHS Foundation Trust, Manchester, UK
- Department of Genomic Medicine,
Division of Evolution and Genomic Science, University of Manchester, MAHSC,
Manchester University NHS Foundation Trust, Manchester, UK
| | - Anthony J Maxwell
- Nightingale and Prevent Breast Cancer
Research Unit, Manchester University NHS Foundation Trust, Manchester, UK
- Division of Informatics, Imaging &
Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health,
University of Manchester, Manchester, UK
| | - David P French
- Manchester Centre for Health
Psychology, Division of Psychology & Mental Health, School of Health Sciences,
Faculty of Biology, Medicine and Health, University of Manchester, MAHSC,
Manchester, UK
| |
Collapse
|
42
|
Pons-Rodriguez A, Forné Izquierdo C, Vilaplana-Mayoral J, Cruz-Esteve I, Sánchez-López I, Reñé-Reñé M, Cazorla C, Hernández-Andreu M, Galindo-Ortego G, Llorens Gabandé M, Laza-Vásquez C, Balaguer-Llaquet P, Martínez-Alonso M, Rué M. Feasibility and acceptability of personalised breast cancer screening (DECIDO study): protocol of a single-arm proof-of-concept trial. BMJ Open 2020; 10:e044597. [PMID: 33361170 PMCID: PMC7759966 DOI: 10.1136/bmjopen-2020-044597] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Personalised cancer screening aims to improve benefits, reduce harms and being more cost-effective than age-based screening. The objective of the DECIDO study is to assess the acceptability and feasibility of offering risk-based personalised breast cancer screening and its integration in regular clinical practice in a National Health System setting. METHODS AND ANALYSIS The study is designed as a single-arm proof-of-concept trial. The study sample will include 385 women aged 40-50 years resident in a primary care health area in Spain. The study intervention consists of (1) a baseline visit; (2) breast cancer risk estimation; (3) a second visit for risk communication and screening recommendations based on breast cancer risk and (4) a follow-up to obtain the study outcomes.A polygenic risk score (PRS) will be constructed as a composite likelihood ratio of 83 single nucleotide polymorphisms. The Breast Cancer Surveillance Consortium risk model, including age, race/ethnicity, family history of breast cancer, benign breast disease and breast density will be used to estimate a preliminary 5-year absolute risk of breast cancer. A Bayesian approach will be used to update this risk with the PRS value.The primary outcome measures will be attitude towards, intention to participate in and satisfaction with personalised breast cancer screening. Secondary outcomes will include the proportions of women who accept to participate and who complete the different phases of the study. The exact binomial and the Student's t-test will be used to obtain 95% CIs. ETHICS AND DISSEMINATION The study protocol was approved by the Drug Research Ethics Committee of the University Hospital Arnau de Vilanova. The trial will be conducted in compliance with this study protocol, the Declaration of Helsinki and Good Clinical Practice.The results will be published in peer-reviewed scientific journals and disseminated in scientific conferences and media. TRIAL REGISTRATION NUMBER NCT03791008.
Collapse
Affiliation(s)
- Anna Pons-Rodriguez
- Eixample Basic Health Area, Catalan Institute of Health, Lleida, Spain
- Health PhD Program, University of Lleida, Lleida, Spain
| | - Carles Forné Izquierdo
- Basic Medical Sciences, University of Lleida, Lleida, Spain
- Research Group on Statistics and Economic Evaluation in Health (GRAEES), University of Lleida, Lleida, Spain
| | | | - Inés Cruz-Esteve
- Primer de Maig Basic Health Area, Catalan Institute of Health, Lleida, Spain
| | | | - Mercè Reñé-Reñé
- Radiology Department, Arnau de Vilanova University Hospital, Lleida, Spain
| | - Cristina Cazorla
- Primer de Maig Basic Health Area, Catalan Institute of Health, Lleida, Spain
| | | | | | | | | | | | - Montserrat Martínez-Alonso
- Basic Medical Sciences, University of Lleida, Lleida, Spain
- Research Group on Statistics and Economic Evaluation in Health (GRAEES), University of Lleida, Lleida, Spain
- IRBLleida, Lleida, Spain
| | - Montserrat Rué
- Basic Medical Sciences, University of Lleida, Lleida, Spain
- Research Group on Statistics and Economic Evaluation in Health (GRAEES), University of Lleida, Lleida, Spain
- IRBLleida, Lleida, Spain
| |
Collapse
|
43
|
Hubbell E, Clarke CA, Aravanis AM, Berg CD. Modeled Reductions in Late-stage Cancer with a Multi-Cancer Early Detection Test. Cancer Epidemiol Biomarkers Prev 2020; 30:460-468. [PMID: 33328254 DOI: 10.1158/1055-9965.epi-20-1134] [Citation(s) in RCA: 57] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/23/2020] [Accepted: 12/10/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer is the second leading cause of death globally, with many cases detected at a late stage when prognosis is poor. New technologies enabling multi-cancer early detection (MCED) may make "universal cancer screening" possible. We extend single-cancer models to understand the potential public health effects of adding a MCED test to usual care. METHODS We obtained data on stage-specific incidence and survival of all invasive cancers diagnosed in persons aged 50-79 between 2006 and 2015 from the US Surveillance, Epidemiology, and End Results (SEER) program, and combined this with published performance of a MCED test in a state transition model (interception model) to predict diagnostic yield, stage shift, and potential mortality reductions. We model long-term (incident) performance, accou.
Collapse
|
44
|
Pashayan N, Antoniou AC, Ivanus U, Esserman LJ, Easton DF, French D, Sroczynski G, Hall P, Cuzick J, Evans DG, Simard J, Garcia-Closas M, Schmutzler R, Wegwarth O, Pharoah P, Moorthie S, De Montgolfier S, Baron C, Herceg Z, Turnbull C, Balleyguier C, Rossi PG, Wesseling J, Ritchie D, Tischkowitz M, Broeders M, Reisel D, Metspalu A, Callender T, de Koning H, Devilee P, Delaloge S, Schmidt MK, Widschwendter M. Personalized early detection and prevention of breast cancer: ENVISION consensus statement. Nat Rev Clin Oncol 2020; 17:687-705. [PMID: 32555420 PMCID: PMC7567644 DOI: 10.1038/s41571-020-0388-9] [Citation(s) in RCA: 160] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2020] [Indexed: 02/07/2023]
Abstract
The European Collaborative on Personalized Early Detection and Prevention of Breast Cancer (ENVISION) brings together several international research consortia working on different aspects of the personalized early detection and prevention of breast cancer. In a consensus conference held in 2019, the members of this network identified research areas requiring development to enable evidence-based personalized interventions that might improve the benefits and reduce the harms of existing breast cancer screening and prevention programmes. The priority areas identified were: 1) breast cancer subtype-specific risk assessment tools applicable to women of all ancestries; 2) intermediate surrogate markers of response to preventive measures; 3) novel non-surgical preventive measures to reduce the incidence of breast cancer of poor prognosis; and 4) hybrid effectiveness-implementation research combined with modelling studies to evaluate the long-term population outcomes of risk-based early detection strategies. The implementation of such programmes would require health-care systems to be open to learning and adapting, the engagement of a diverse range of stakeholders and tailoring to societal norms and values, while also addressing the ethical and legal issues. In this Consensus Statement, we discuss the current state of breast cancer risk prediction, risk-stratified prevention and early detection strategies, and their implementation. Throughout, we highlight priorities for advancing each of these areas.
Collapse
Affiliation(s)
- Nora Pashayan
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Antonis C Antoniou
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Urska Ivanus
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Laura J Esserman
- Carol Franc Buck Breast Care Center, University of California, San Francisco, CA, USA
| | - Douglas F Easton
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - David French
- Division of Psychology & Mental Health, School of Health Sciences, University of Manchester, Manchester, UK
| | - Gaby Sroczynski
- Department of Public Health, Health Services Research and Health Technology Assessment, Institute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT-University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
- Division of Health Technology Assessment, Oncotyrol - Center for Personalized Cancer Medicine, Innsbruck, Austria
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Jack Cuzick
- Wolfson Institute of Preventive Medicine, Barts and The London, Centre for Cancer Prevention, Queen Mary University of London, London, UK
| | - D Gareth Evans
- Division of Evolution and Genomic Sciences, University of Manchester, Manchester, UK
| | - Jacques Simard
- Genomics Center, CHU de Québec - Université Laval Research Center, Québec, Canada
| | | | - Rita Schmutzler
- Center of Family Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - Odette Wegwarth
- Max Planck Institute for Human Development, Center for Adaptive Rationality, Harding Center for Risk Literacy, Berlin, Germany
| | - Paul Pharoah
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | | | - Zdenko Herceg
- Epigenetic Group, International Agency for Research on Cancer (IARC), WHO, Lyon, France
| | - Clare Turnbull
- Division of Genetics and Epidemiology, Institute of Cancer Research, London, UK
| | | | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda USL di Reggio Emilia - IRCCS, Reggio Emilia, Italy
| | - Jelle Wesseling
- Division of Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - David Ritchie
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Marc Tischkowitz
- Department of Medical Genetics, National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge, Cambridge, UK
| | - Mireille Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, Netherlands
| | - Dan Reisel
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK
| | - Andres Metspalu
- The Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - Thomas Callender
- Department of Applied Health Research, Institute of Epidemiology and Healthcare, University College London, London, UK
| | - Harry de Koning
- Department of Public Health, Erasmus MC, Rotterdam, Netherlands
| | - Peter Devilee
- Department of Human Genetics, Department of Pathology, Leiden University Medical Centre, Leiden, Netherlands
| | - Suzette Delaloge
- Breast Cancer Department, Gustave Roussy Institute, Paris, France
| | - Marjanka K Schmidt
- Division of Molecular Pathology, Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands
| | - Martin Widschwendter
- Department of Women's Cancer, Institute for Women's Health, University College London, London, UK.
- Universität Innsbruck, Innsbruck, Austria.
- European Translational Oncology Prevention and Screening (EUTOPS) Institute, Hall in Tirol, Austria.
| |
Collapse
|
45
|
Rainey L, van der Waal D, Broeders MJM. Dutch women's intended participation in a risk-based breast cancer screening and prevention programme: a survey study identifying preferences, facilitators and barriers. BMC Cancer 2020; 20:965. [PMID: 33023516 PMCID: PMC7539478 DOI: 10.1186/s12885-020-07464-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/27/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Risk-based breast cancer screening may improve the benefit-harm ratio of screening by tailoring policy to a woman's personal breast cancer risk. This study aims to explore Dutch women's preferences regarding the organisation and implementation of a risk-based breast cancer screening and prevention programme, identifying potential barriers and facilitators to uptake. METHODS A total of 5110 participants in the Dutch Personalised RISk-based MAmmography screening (PRISMA) study were invited, of whom 942 completed a two-part web-based survey. The first part contained questions about personal characteristics; for the second part, women were randomly assigned to one of four hypothetical breast cancer risk scenarios (i.e. low, average, moderate, or high) with subsequent tailored screening and prevention advice. Descriptive statistics are used to present women's organisational preferences. Univariable and multivariable logistic regression analyses were performed using seven proxy measures for acceptability of risk-based screening (e.g., interest in risk) and risk-based prevention (e.g., willingness to change diet). RESULTS Interest in breast cancer risk was high (80.3%). Higher assigned risk scenario was most consistently associated with acceptance of tailored screening and prevention recommendations. Increased acceptance of lifestyle changes was additionally associated with higher education. Having a first degree family history of breast cancer decreased women's motivation to participate in preventative lifestyle measures. Acceptability of medication was associated with a woman's general beliefs about the (over)use and benefit-harm balance of medication. CONCLUSIONS Dutch women generally appear in favour of receiving their breast cancer risk estimate with subsequent tailored screening and prevention recommendations. However, women's level of acceptance depends on their assigned risk category. Offering tailored screening and prevention recommendations to low-risk women will be most challenging. Educating women on the benefits and harms of all risk-based screening and prevention strategies is key to acceptability and informed decision-making.
Collapse
Affiliation(s)
- Linda Rainey
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - Daniëlle van der Waal
- Radboud Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
| | - Mireille 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, PO Box 6873, 6503 GJ, Nijmegen, The Netherlands
| |
Collapse
|
46
|
Louro J, Román M, Posso M, Comerma L, Vidal C, Saladié F, Alcantara R, Sanchez M, Quintana MJ, Del Riego J, Ferrer J, Peñalva L, Bargalló X, Prieto M, Sala M, Castells X. Differences in breast cancer risk after benign breast disease by type of screening diagnosis. Breast 2020; 54:343-348. [PMID: 33023825 PMCID: PMC7770442 DOI: 10.1016/j.breast.2020.09.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/24/2020] [Accepted: 09/04/2020] [Indexed: 02/01/2023] Open
Abstract
Introduction We aimed to assess differences in breast cancer risk across benign breast disease diagnosed at prevalent or incident screens. Materials and methods We conducted a retrospective cohort study with data from 629,087 women participating in a long-standing population-based breast cancer screening program in Spain. Each benign breast disease was classified as non-proliferative, proliferative without atypia, or proliferative with atypia, and whether it was diagnosed in a prevalent or incident screen. We used partly conditional Cox hazard regression to estimate the adjusted hazard ratios of the risk of breast cancer. Results Compared with women without benign breast disease, the risk of breast cancer was significantly higher (p-value = 0.005) in women with benign breast disease diagnosed in an incident screen (aHR, 2.67; 95%CI: 2.24–3.19) than in those with benign breast disease diagnosed in a prevalent screen (aHR, 1.87; 95%CI: 1.57–2.24). The highest risk was found in women with a proliferative benign breast disease with atypia (aHR, 4.35; 95%CI: 2.09–9.08, and 3.35; 95%CI: 1.51–7.40 for those diagnosed at incident and prevalent screens, respectively), while the lowest was found in women with non-proliferative benign breast disease (aHR, 2.39; 95%CI: 1.95–2.93, and 1.63; 95%CI: 1.32–2.02 for those diagnosed at incident and prevalent screens, respectively). Conclusion Our study showed that the risk of breast cancer conferred by a benign breast disease differed according to type of screen (prevalent or incident). To our knowledge, this is the first study to analyse the impact of the screening type on benign breast disease prognosis. Breast cancer risk after a benign breast disease varied with the screening type. Incident benign breast disease had a higher breast cancer risk than prevalent. The risk remained increased regardless of benign breast disease subtype.
Collapse
Affiliation(s)
- Javier Louro
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain; European Higher Education Area (EHEA) Doctoral Programme in Methodology of Biomedical Research and Public Health in Department of Pediatrics, Obstetrics and Gynecology, Preventive Medicine and Public Health, Universitat Autónoma de Barcelona (UAB), Bellaterra, Barcelona, Spain
| | - Marta Román
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Margarita Posso
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Laura Comerma
- Servei de Patologia, Hospital Del Mar, Barcelona, Spain
| | - Carmen Vidal
- Catalan Institute of Oncology (ICO), Barcelona, Spain
| | - Francina Saladié
- Cancer Epidemiology and Prevention Service, Hospital Universitari Sant Joan de Reus, Institut D'Investigació Sanitària Pere Virgili, Universitat Rovira I Virgili, Reus, Spain
| | - Rodrigo Alcantara
- Servei de Diagnòstic per La Imatge, Hospital Del Mar, Barcelona, Spain
| | - Mar Sanchez
- Direction General of Public Health, Cantabria, Spain
| | - M Jesús Quintana
- Department of Clinical Epidemiology and Public Health, University Hospital de La Santa Creu I Sant Pau, IIB Sant Pau, Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Spain
| | - Javier Del Riego
- Women's Imaging, Department of Radiology, UDIAT Centre Diagnòstic, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain
| | - Joana Ferrer
- Radiology Department, Hospital de Santa Caterina, Salt, Girona, Spain
| | - Lupe Peñalva
- Vallés Oriental Breast Cancer Early Detection Program, Spain
| | | | - Miguel Prieto
- Breast Cancer Screening Program, Principality of Asturias, Spain
| | - María Sala
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain
| | - Xavier Castells
- IMIM (Hospital Del Mar Medical Research Institute), Barcelona, Spain; Research Network on Health Services in Chronic Diseases (REDISSEC), Barcelona, Spain; Servei D'Epidemiologia I Avaluació, Hospital Del Mar, Barcelona, Spain.
| |
Collapse
|
47
|
Sankatsing VDV, Ravesteyn NT, Heijnsdijk EAM, Broeders MJM, Koning HJ. Risk stratification in breast cancer screening: Cost‐effectiveness and harm‐benefit ratios for low‐risk and high‐risk women. Int J Cancer 2020; 147:3059-3067. [DOI: 10.1002/ijc.33126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/31/2020] [Accepted: 04/27/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Valérie D. V. Sankatsing
- Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| | - Nicolien T. Ravesteyn
- 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 Radboud University Medical Center Nijmegen The Netherlands
- Dutch Expert Centre for Screening Nijmegen The Netherlands
| | - Harry J. Koning
- Department of Public Health Erasmus MC, University Medical Center Rotterdam Rotterdam The Netherlands
| |
Collapse
|
48
|
Machine learning-based lifetime breast cancer risk reclassification compared with the BOADICEA model: impact on screening recommendations. Br J Cancer 2020; 123:860-867. [PMID: 32565540 PMCID: PMC7463251 DOI: 10.1038/s41416-020-0937-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 05/13/2020] [Accepted: 05/29/2020] [Indexed: 12/17/2022] Open
Abstract
Background The clinical utility of machine-learning (ML) algorithms for breast cancer risk prediction and screening practices is unknown. We compared classification of lifetime breast cancer risk based on ML and the BOADICEA model. We explored the differences in risk classification and their clinical impact on screening practices. Methods We used three different ML algorithms and the BOADICEA model to estimate lifetime breast cancer risk in a sample of 112,587 individuals from 2481 families from the Oncogenetic Unit, Geneva University Hospitals. Performance of algorithms was evaluated using the area under the receiver operating characteristic (AU-ROC) curve. Risk reclassification was compared for 36,146 breast cancer-free women of ages 20–80. The impact on recommendations for mammography surveillance was based on the Swiss Surveillance Protocol. Results The predictive accuracy of ML-based algorithms (0.843 ≤ AU-ROC ≤ 0.889) was superior to BOADICEA (AU-ROC = 0.639) and reclassified 35.3% of women in different risk categories. The largest reclassification (20.8%) was observed in women characterised as ‘near population’ risk by BOADICEA. Reclassification had the largest impact on screening practices of women younger than 50. Conclusion ML-based reclassification of lifetime breast cancer risk occurred in approximately one in three women. Reclassification is important for younger women because it impacts clinical decision- making for the initiation of screening.
Collapse
|
49
|
Assessing breast cancer risk within the general screening population: developing a breast cancer risk model to identify higher risk women at mammographic screening. Eur Radiol 2020; 30:5417-5426. [PMID: 32358648 DOI: 10.1007/s00330-020-06901-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 04/07/2020] [Accepted: 04/17/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To develop a breast cancer risk model to identify women at mammographic screening who are at higher risk of breast cancer within the general screening population. METHODS This retrospective nested case-control study used data from a population-based breast screening program (2009-2015). All women aged 40-75 diagnosed with screen-detected or interval breast cancer (n = 1882) were frequency-matched 3:1 on age and screen-year with women without screen-detected breast cancer (n = 5888). Image-derived risk factors from the screening mammogram (percent mammographic density [PMD], breast volume, age) were combined with core biopsy history, first-degree family history, and other clinical risk factors in risk models. Model performance was assessed using the area under the receiver operating characteristic curve (AUC). Classifiers assigning women to low- versus high-risk deciles were derived from risk models. Agreement between classifiers was assessed using a weighted kappa. RESULTS The AUC was 0.597 for a risk model including only image-derived risk factors. The successive addition of core biopsy and family history significantly improved performance (AUC = 0.660, p < 0.001 and AUC = 0.664, p = 0.04, respectively). Adding the three remaining risk factors did not further improve performance (AUC = 0.665, p = 0.45). There was almost perfect agreement (kappa = 0.97) between risk assessments based on a classifier derived from image-derived risk factors, core biopsy, and family history compared with those derived from a model including all available risk factors. CONCLUSIONS Women in the general screening population can be risk-stratified at time of screen using a simple model based on age, PMD, breast volume, and biopsy and family history. KEY POINTS • A breast cancer risk model based on three image-derived risk factors as well as core biopsy and first-degree family history can provide current risk estimates at time of screen. • Risk estimates generated from a combination of image-derived risk factors, core biopsy history, and first-degree family history may be more valid than risk estimates that rely on extensive self-reported risk factors. • A simple breast cancer risk model can avoid extensive clinical risk factor data collection.
Collapse
|
50
|
Rainey L, Eriksson M, Trinh T, Czene K, Broeders MJM, van der Waal D, Hall P. The impact of alcohol consumption and physical activity on breast cancer: The role of breast cancer risk. Int J Cancer 2020; 147:931-939. [PMID: 31863475 PMCID: PMC7383781 DOI: 10.1002/ijc.32846] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 11/30/2019] [Accepted: 12/10/2019] [Indexed: 02/01/2023]
Abstract
High alcohol consumption and physical inactivity are known breast cancer risk factors. However, whether the association between these lifestyle factors and breast cancer is modified by a woman's additional breast cancer risk factors has never been studied. Therefore, a population‐based prospective cohort study of 57,654 Swedish women aged 40–74 years, including 957 breast cancer cases, was performed. Alcohol consumption and physical activity were measured with validated web‐based self‐report questionnaires. The Tyrer–Cuzick risk prediction model was used to determine a woman's 10‐year risk of developing breast cancer. Logistic regression models were used to explore whether the effect of alcohol consumption and physical activity on breast cancer was modified by additional breast cancer risk factors. Findings showed that increased alcohol consumption was associated with a higher breast cancer risk (OR = 1.26, 95% CI 1.01, 1.59). However, the association between lifestyle factors (alcohol consumption and physical activity) and breast cancer was generally the same for women at below average, average and above average risk of developing breast cancer. Therefore, additional breast cancer risk factors do not appear to modify the association between lifestyle (alcohol consumption and physical activity) and breast cancer. Considering the general health benefits, preventative lifestyle recommendations can be formulated about alcohol consumption and physical activity for women at all levels of breast cancer risk. What's new? Alcohol consumption and physical inactivity are known breast cancer risk factors but it is currently unclear whether all women would benefit equally from drinking less alcohol and being more physically active. The authors found no difference in association between these lifestyle factors and breast cancer in women with below average, average or above average risk of developing breast cancer. They conclude that general preventative lifestyle recommendations about alcohol intake and physical activity apply to all women regardless of their breast cancer risk.
Collapse
Affiliation(s)
- Linda Rainey
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mikael Eriksson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Thang Trinh
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Kamila Czene
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Mireille J M Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Daniëlle van der Waal
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Per Hall
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Department of Oncology, Södersjukhuset, Stockholm, Sweden
| |
Collapse
|