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Gomi T, Ishihara K, Yamada S, Koibuchi Y. Pre-Reconstruction Processing with the Cycle-Consist Generative Adversarial Network Combined with Attention Gate to Improve Image Quality in Digital Breast Tomosynthesis. Diagnostics (Basel) 2024; 14:1957. [PMID: 39272741 PMCID: PMC11394014 DOI: 10.3390/diagnostics14171957] [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: 06/27/2024] [Revised: 08/30/2024] [Accepted: 08/30/2024] [Indexed: 09/15/2024] Open
Abstract
The current study proposed and evaluated "residual squeeze and excitation attention gate" (rSEAG), a novel network that can improve image quality by reducing distortion attributed to artifacts. This method was established by modifying the Cycle Generative Adversarial Network (cycleGAN)-based generator network using projection data for pre-reconstruction processing in digital breast tomosynthesis. Residual squeeze and excitation were installed in the bridge of the generator network, and the attention gate was installed in the skip connection between the encoder and decoder. Based on the radiation dose index (exposure index and division index) incident on the detector, the cases approved by the ethics committee and used for the study were classified as reference (675 projection images) and object (675 projection images). For the cases, unsupervised data containing a mixture of cases with and without masses were used. The cases were trained using cycleGAN with rSEAG and the conventional networks (ResUNet and U-Net). For testing, predictive processing was performed on cases (60 projection images) that were not used for learning. Images were generated using filtered backprojection reconstruction (kernel: Ramachandran and Lakshminarayanan) from projection data for testing data and without pre-reconstruction processing data (evaluation: in-focus plane). The distortion was evaluated using perception-based image quality evaluation (PIQE) analysis, texture analysis (feature: "Homogeneity" and "Contrast"), and a statistical model with a Gumbel distribution. PIQE has a low rSEAG value. Texture analysis showed that rSEAG and a network without cycleGAN were similar in terms of the "Contrast" feature. In dense breasts, ResUNet had the lowest "Contrast" feature and U-Net had differences between cases. The maximal variations in the Gumbel plot, rSEAG reduced the high-frequency ripple artifacts. In this study, rSEAG could improve distortion and reduce ripple artifacts.
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Affiliation(s)
- Tsutomu Gomi
- School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Kanagawa, Japan
| | - Kotomi Ishihara
- Department of Radiology, NHO Takasaki General Medical Center, Takasaki 370-0829, Gunma, Japan
| | - Satoko Yamada
- School of Allied Health Sciences, Kitasato University, Sagamihara 252-0373, Kanagawa, Japan
| | - Yukio Koibuchi
- Department of Breast and Endocrine Surgery, NHO Takasaki General Medical Center, Takasaki 370-0829, Gunma, Japan
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Hendrick RE, Monticciolo DL. USPSTF Recommendations and Overdiagnosis. JOURNAL OF BREAST IMAGING 2024:wbae028. [PMID: 38865364 DOI: 10.1093/jbi/wbae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Indexed: 06/14/2024]
Abstract
Overdiagnosis is the concept that some cancers detected at screening would never have become clinically apparent during a woman's lifetime in the absence of screening. This could occur if a woman dies of a cause other than breast cancer in the interval between mammographic detection and clinical detection (obligate overdiagnosis) or if a mammographically detected breast cancer fails to progress to clinical presentation. Overdiagnosis cannot be measured directly. Indirect methods of estimating overdiagnosis include use of data from randomized controlled trials (RCTs) designed to evaluate breast cancer mortality, population-based screening studies, or modeling. In each case, estimates of overdiagnosis must consider lead time, breast cancer incidence trends in the absence of screening, and accurate and predictable rates of tumor progression. Failure to do so has led to widely varying estimates of overdiagnosis. The U.S. Preventive Services Task Force (USPSTF) considers overdiagnosis a major harm of mammography screening. Their 2024 report estimated overdiagnosis using summary evaluations of 3 RCTs that did not provide screening to their control groups at the end of the screening period, along with Cancer Intervention and Surveillance Network modeling. However, there are major flaws in their evidence sources and modeling estimates, limiting the USPSTF assessment. The most plausible estimates remain those based on observational studies that suggest overdiagnosis in breast cancer screening is 10% or less and can be attributed primarily to obligate overdiagnosis and nonprogressive ductal carcinoma in situ.
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Affiliation(s)
- R Edward Hendrick
- Department of Radiology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
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Chamberlin MD, Islami DA, Barth RJ, Demaci S. Breast Cancer Disparities and Innovations: A Focus on Kosovo. Hematol Oncol Clin North Am 2024; 38:199-207. [PMID: 37442675 DOI: 10.1016/j.hoc.2023.06.002] [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] [Indexed: 07/15/2023]
Abstract
Due to the current limited capacity to provide digital mammography-based screening to all women, and the lack of modern surgical oncology methods, mastectomy is still the predominant form of surgical treatment in many parts of the world. As such there is little incentive to detect breast cancer earlier and significant fear of treatment and outcomes continues to contribute to late presentations. Neoadjuvant chemotherapy, pre-operative breast MRI and surgical mapping techniques can combine forces to allow for more women to be treated with breast conservation, decrease fear of treatment and improve outcomes.
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Affiliation(s)
- Mary D Chamberlin
- Department of Medicine /Hematology-Oncology, Dartmouth College of Medicine and Dartmouth Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | | | - Richard J Barth
- Department of Surgery, Section of General Surgery, Dartmouth College of Medicine and Dartmouth Cancer Center at Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Shqiptar Demaci
- Department of Thoracic Surgery, University Clinical Center of Kosovo, Prishtina, Kosovo
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Xu Y, Zhao B, Xu Z, Li X, Sun Q. Plasma metabolomic signatures of breast cancer. Front Med (Lausanne) 2023; 10:1148542. [PMID: 37588002 PMCID: PMC10425771 DOI: 10.3389/fmed.2023.1148542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/17/2023] [Indexed: 08/18/2023] Open
Abstract
Background Breast cancer is a common malignant tumor. A large number of medical evidence shows that breast cancer screening can improve the early diagnosis rate and reduce the mortality rate of breast cancer. In the present study, a wide range of targeted metabolomics profiling was conducted to investigate the plasma signatures of breast cancer. Methods A total of 86 patients with benign breast abnormalities (L group) and 143 patients with breast cancer (E group) were recruited. We collected their plasma samples and clinical information. Metabolomic analysis, based on the coverage of a wide range of targeted metabolomics was conducted with ultraperformance liquid chromatography- triple quadrupole-linear ion trap mass spectrometer (UPLC-QTRAP-MS). Results We identified 716 metabolites through widely-targeted metabolomics. Serotonergic synapse was the main different metabolic pathway. The fold change of 14 metabolites was considered significantly different (fold change <0.67 or fold change >2; p < 0.05). By combining all the 14 metabolites, we achieved differentiation of L group vs. E group (AUC = 0.792, 95%Cl: 0.662-0.809). Conclusion This study provided new insights into plasma biomarkers for differential diagnosis of benign abnormalities and breast cancer.
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Affiliation(s)
- Yali Xu
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Bin Zhao
- Department of Breast Surgery, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhu Xu
- Department of Gastrointestinal Surgery II, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaogang Li
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Medical Research Center, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Qiang Sun
- State Key Laboratory of Complex Severe and Rare Diseases, Department of Breast Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
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Funaro K, Niell B. Screening Mammography Utilization in the United States. JOURNAL OF BREAST IMAGING 2023; 5:384-392. [PMID: 38416907 DOI: 10.1093/jbi/wbad042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 03/01/2024]
Abstract
Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
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Affiliation(s)
- Kimberly Funaro
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
| | - Bethany Niell
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
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Bula-Ibula D, Carly B, Rozenberg S. Associated morbidity in screened and diagnosed breast cancer patients: a retrospective study. Arch Gynecol Obstet 2022; 307:1539-1546. [PMID: 35931900 DOI: 10.1007/s00404-022-06630-0] [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: 09/29/2021] [Accepted: 05/14/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Breast cancer (BC) screening has been associated with reduced mortality and morbidity. This study compares tumor characteristics and treatment morbidity in screened versus diagnosed women. MATERIALS AND METHODS This retrospective study, conducted between 2010 and 2013, included 666 BC screened or diagnosed patients. We compared patients and tumors characteristics and received treatments. We also analyzed the results after excluding patients at risk of BC and conducted a multivariate analysis to assess odds ratios (OR). RESULTS Screened women had smaller tumors (16,5 vs 22,6 mm, p < 0.001), of lower grade (p < 0.001) with a lower proliferation index (PI) (p < 0.001) than diagnosed women. Screened women were more frequently treated using conservative surgery (82.8% vs 59.7%, p < 0.001), needed less often axillary dissection (15.1% vs 35.4%, p < 0.001) and less often chemotherapy (20.8% vs 48.3% p < 0.001) than diagnosed women. In the multivariate analysis after adjustment for age and BC history, diagnosed women had increased (OR: 4.79, 95% IC: 3.19-7,18) risk to be administered chemotherapy and to undergo axillary dissection (OR: 4.18, 95% IC: 1.56-11.17) than screened women. CONCLUSION Patients should be informed about the benefits in terms of morbidity that screening confers to them.
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Affiliation(s)
- Diane Bula-Ibula
- ISALA Breast Unit and Prevention Centre, Department of Obstetrics and Gynaecology, University Hospital Saint-Pierre, Université Libre de Bruxelles and Vrije Universiteit Brussel), Rue Haute 290, 1000, Brussels, Belgium. .,Gynecology, Université Libre de Bruxelles, Brussels, Belgium.
| | - Birgit Carly
- ISALA Breast Unit and Prevention Centre, Department of Obstetrics and Gynaecology, University Hospital Saint-Pierre, Université Libre de Bruxelles and Vrije Universiteit Brussel), Rue Haute 290, 1000, Brussels, Belgium
| | - Serge Rozenberg
- ISALA Breast Unit and Prevention Centre, Department of Obstetrics and Gynaecology, University Hospital Saint-Pierre, Université Libre de Bruxelles and Vrije Universiteit Brussel), Rue Haute 290, 1000, Brussels, Belgium
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Lv X, Yang L, Liu T, Yang Z, Jia C, Chen H. Pan-cancer analysis of the prevalence and associated factors of lung metastasis and the construction of the lung metastatic classification system. Front Surg 2022; 9:922167. [PMID: 35959119 PMCID: PMC9360507 DOI: 10.3389/fsurg.2022.922167] [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: 04/17/2022] [Accepted: 07/06/2022] [Indexed: 11/13/2022] Open
Abstract
This study first presents an analysis of the prevalence and associated factors of the lung metastasis (LM) database and then uses this analysis to construct an LM classification system. Using cancer patient data gathered from the surveillance, epidemiology, and end results (SEER) database, this study shows that the prevalence of LM is not consistent among different cancers; that is, the prevalence of LM ranges from 0.0013 [brain; 95% confidence interval (95% CI); 0.0010–0.0018] to 0.234 (“other digestive organs”; 95% CI; 0.221–0.249). This study finds that advanced age, poor grade, higher tumor or node stage, and metastases including bone, brain, and liver are positively related to LM occurrence, while female gender, income, marital status, and insured status are negatively related. Then, this study generates four categories from 58 cancer types based on prevalence and influence factors and satisfactorily validates these. This classification system reflects the LM risk of different cancers. It can guide individualized treatment and the management of these synchronous metastatic cancer patients and help clinicians better distribute medical resources.
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Dale J, Di Tomaso M, Gay V. Marrying Story with Science: The Impact of Outdated and Inconsistent Breast Cancer Screening Practices in Canada. Curr Oncol 2022; 29:3540-3551. [PMID: 35621676 PMCID: PMC9139242 DOI: 10.3390/curroncol29050286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/26/2022] [Accepted: 05/03/2022] [Indexed: 11/17/2022] Open
Abstract
Behind the science of breast cancer in Canada, as well as globally, are the stories of thousands of women, their families, and their communities. These include stories from those who have died or those suffering from the realities of stage III and stage IV breast cancer due to late detection, misinformation, and dismissal. The reality for these women is that, whilst grateful for the latest developments in cancer research, much of this knowledge is not reflected in policy and practice. Canadian guidelines do not reflect the recommended screening by experts within the field and inequities in screening practices and practitioner knowledge exist in different areas within Canada. Told through the stories of women with lived experiences of late-stage breast cancer and supported by scientific evidence, this paper explores the impact of outdated breast cancer screening practices on the lives of women. Recent patient advocacy is driving changes, such as notifying women of their breast density in a few jurisdictions in Canada, but we call for the whole medical community to take responsibility and ensure breast screening is optimised to save more lives.
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Affiliation(s)
| | | | - Victoria Gay
- Independent Researcher, Vancouver, BC, Canada; (M.D.T.); (V.G.)
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Heinig M, Heinze F, Schwarz S, Haug U. Initial and ten-year treatment patterns among 11,000 breast cancer patients undergoing breast surgery-an analysis of German claims data. BMC Cancer 2022; 22:130. [PMID: 35109813 PMCID: PMC8812022 DOI: 10.1186/s12885-022-09240-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/25/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND We aimed to explore the potential of German claims data for describing initial and long-term treatment patterns of breast cancer patients undergoing surgery. METHODS Using the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population) we included patients with invasive breast cancer diagnosed in 2008 undergoing breast surgery and followed them until 2017. We described initial and long-term treatment patterns and deaths. Analyses were stratified by stage (as far as available in claims data), age at diagnosis, and mode of detection (screen-detected vs. interval vs. unscreened cases). RESULTS The cohort comprised 10,802 patients. The proportion with neoadjuvant therapy was highest in patients < 50 years (19% vs. ≤ 8% at older ages). The proportion initiating adjuvant chemotherapy within four months after diagnosis decreased with age (< 50 years: 63%, 50-69: 46%, 70-79: 27%, 80 + : 4%). Among women < 69 years, ~ 30% had two breast surgeries in year one (70-79: 21%, 80 + : 14%). Treatment intensity was lower for screen-detected compared to interval or unscreened cases, both in year one (e.g., proportion with mastectomy ~ 50% lower) and within 2-10 years after surgery (proportions with radiotherapy or chemotherapy about one third lower each). CONCLUSIONS This study illustrates the potential of routine data to describe breast cancer treatment and provided important insights into differences in initial and long-term treatment by mode of detection and age.
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Affiliation(s)
- Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.
| | - Franziska Heinze
- Department of Health, Long-Term Care and Pensions, SOCIUM Research Center On Inequality and Social Policy, University of Bremen, 28359, Bremen, Germany
| | - Sarina Schwarz
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany.,Faculty of Human and Health Sciences, University of Bremen, Grazer Str. 2, 28359, Bremen, Germany
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Kim LS, Lannin DR. Breast Cancer Screening: Is There Room for De-escalation? CURRENT BREAST CANCER REPORTS 2022; 14:153-161. [PMID: 36404936 PMCID: PMC9640864 DOI: 10.1007/s12609-022-00465-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] [Accepted: 10/25/2022] [Indexed: 11/09/2022]
Abstract
Purpose of Review Breast cancer screening is highly controversial and different agencies have widely varying guidelines. Yet it is currently used extensively in the USA and frequently the thought is "the more, the better." The purpose of this review is to objectively assess the risks and benefits of screening mammography and consider whether there may be areas where it could be de-escalated. Recent Findings Over the past few years, there have been several meta-analyses that are concordant, and it is now agreed that the main benefit of screening mammography is about a 20% reduction in breast cancer mortality. This actually benefits about 5% of patients with mammographically detected tumors. We now appreciate that the main harm of screening is overdiagnosis, i.e. detection of a cancer that will not cause the patient any harm and would not have ever been detected without the screening. This currently represents about 20 to 30% of screening detected cancers. Finding extra cancers with more intense screening is not always good, because in this situation, the risk of overdiagnosis increases and the benefit decreases. In some groups, the risk of overdiagnosis approaches 75%. Summary Our goal should be not only to find more cancers, but to avoid finding cancers that would never have caused the patient any harm and lead to unnecessary treatment. The authors suggest some situations where it may be reasonable to de-escalate screening.
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Affiliation(s)
- Leah S. Kim
- Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520 USA
| | - Donald R. Lannin
- Department of Surgery and Yale Comprehensive Cancer Center, Yale University School of Medicine, PO Box 208062, New Haven, CT 06520 USA
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Shepardson LB, Dean L. Current controversies in breast cancer screening. Semin Oncol 2020; 47:177-181. [PMID: 32513421 DOI: 10.1053/j.seminoncol.2020.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 05/01/2020] [Indexed: 02/02/2023]
Abstract
Multiple large-scale, randomized controlled trials throughout the world have demonstrated screening mammography significantly reduces a woman's risk of dying from breast cancer. Despite the known mortality reduction, the perceived harms of mammography are weighed against the known value. Multiple national guidelines have moved away from recommending all women have annual screening mammograms beginning at age 40. Instead, many now encourage women at average risk for developing breast cancer to engage in shared decision-making with their providers, carefully weighing the perceived harms against the known benefits of mammography. These factors should be incorporated into the decision about when to begin and how often to screen. This paradigm shift has been particularly controversial as it relates to women in the 40-49-year age group, considering their incidence of breast cancer and therefore derived benefit of screening is lower, yet the breast cancers that do occur tend to be more aggressive and often require intensive therapy. Thus, debates ensue over the appropriate age at which to begin screening for breast cancer, how often screening should occur, and when to stop.
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Affiliation(s)
| | - Laura Dean
- Department of Breast Imaging, Cleveland Clinic, Cleveland, OH.
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Yaffe MJ. Revamp governance of Canadian Task Force on Preventive Health Care. CMAJ 2020; 192:E145. [PMID: 32041701 PMCID: PMC7012620 DOI: 10.1503/cmaj.71650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Martin J Yaffe
- Senior scientist, Physical Sciences, Tory Family Chair in Cancer Research, Sunnybrook Research Institute; professor, Departments of Medical Biophysics and Medical Imaging, University of Toronto; co-director, Imaging Research Program, Ontario Institute for Cancer Research, Toronto, Ont
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Yaffe MJ. Breast cancer screening policy-good science should trump bad politics. ACTA ACUST UNITED AC 2020; 26:e714-e716. [PMID: 31896941 DOI: 10.3747/co.27.5661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dr. Steven Narod’s comments on breast cancer screening (Countercurrents: Is now the right time to pull the plug on mammography?) [...]
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Affiliation(s)
- M J Yaffe
- Sunnybrook Research Institute, Toronto, ON
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Yaffe MJ, Jong RA, Pritchard KI. Breast Cancer Screening: Beyond Mortality. JOURNAL OF BREAST IMAGING 2019; 1:161-165. [PMID: 38424760 DOI: 10.1093/jbi/wbz038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Indexed: 03/02/2024]
Abstract
Traditionally, the effectiveness of breast cancer screening has been measured in terms of reducing the number of deaths attributable to breast cancer. Other metrics such as the number of life-years or quality-adjusted life-years gained through screening may be more relevant and certainly may better reflect the important burden of the disease on younger women, their families, and society. The effects of earlier detection of breast cancer in reducing morbidities associated with treatment have often also been neglected. In addition, the harms and limitations associated with cancer screening have been poorly quantified and are seldom put into perspective vis-à-vis the benefits. Here, these alternative measures will be discussed and quantified.
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Affiliation(s)
- Martin J Yaffe
- Sunnybrook Health Sciences Centre and The University of Toronto, Departments of Medical Biophysics, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre and The University of Toronto, Medical Imaging, Toronto, ON, Canada
| | - Roberta A Jong
- Sunnybrook Health Sciences Centre and The University of Toronto, Medical Imaging, Toronto, ON, Canada
| | - Kathleen I Pritchard
- Sunnybrook Health Sciences Centre and The University of Toronto, Medical Oncology, Toronto, ON, Canada
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Lane DL, Parikh JR. Finding Inspiration for the Next Generation of Breast Radiologists. JOURNAL OF BREAST IMAGING 2019; 1:239-243. [PMID: 38424750 DOI: 10.1093/jbi/wbz016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Indexed: 03/02/2024]
Abstract
Challenges currently facing breast radiologists, including controversial screening mammography guidelines, radiologist burnout, and the perceived threat posed by artificial intelligence could deter potential candidates from pursuing a career in radiology. However, breast radiologists play a fulfilling role by decreasing the effect of breast cancer through both early detection and direct interaction with patients and interdisciplinary clinical colleagues. While perception is that artificial intelligence will threaten the need for radiologists, it is more likely that it will improve image interpretation and efficiency in workflow, thereby further improving patient care. Trainees can be engaged in breast imaging through interactive teaching methods and by role modeling clinical and image interpretation skills.
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Affiliation(s)
- Deanna L Lane
- University of Texas MD Anderson Cancer Center, Department of Radiology, MD Houston, TX
| | - Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Radiology, MD Houston, TX
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Barth RJ, Krishnaswamy V, Paulsen KD, Rooney TB, Wells WA, Angeles CV, Zuurbier RA, Rosenkranz K, Poplack S, Tosteson TD. A Randomized Prospective Trial of Supine MRI-Guided Versus Wire-Localized Lumpectomy for Breast Cancer. Ann Surg Oncol 2019; 26:3099-3108. [PMID: 31359283 DOI: 10.1245/s10434-019-07531-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Wire-localized excision of non-palpable breast cancer is imprecise, resulting in positive margins 15-35% of the time. METHODS Women with a confirmed diagnosis of non-palpable invasive breast cancer (IBC) or ductal carcinoma in situ (DCIS) were randomized to a new technique using preoperative supine magnetic resonance imaging (MRI) with intraoperative optical scanning and tracking (MRI group) or wire-localized (WL group) partial mastectomy. The main outcome measure was the positive margin rate. RESULTS In this study, 138 patients were randomly assigned. Sixty-six percent had IBC and DCIS, 22% had IBC, and 12% had DCIS. There were no differences in patient or tumor characteristics between the groups. The proportion of patients with positive margins in the MRI-guided surgery group was half that observed in the WL group (12 vs. 23%; p = 0.08). The specimen volumes in the MRI and WL groups did not differ significantly (74 ± 33.9 mL vs. 69.8 ± 25.1 mL; p = 0.45). The pathologic tumor diameters were underestimated by 2 cm or more in 4% of the cases by MRI and in 9% of the cases by mammography. Positive margins were observed in 68% and 58% of the cases underestimated by 2 cm or more using MRI and mammography, respectively, and in 15% and 14% of the cases not underestimated using MRI and mammography, respectively. CONCLUSIONS A novel system using supine MRI images co-registered with intraoperative optical scanning and tracking enabled tumors to be resected with a trend toward a lower positive margin rate compared with wire-localized partial mastectomy. Margin positivity was more likely when imaging underestimated pathologic tumor size.
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Affiliation(s)
- Richard J Barth
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | | | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Timothy B Rooney
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wendy A Wells
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christina V Angeles
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Rebecca A Zuurbier
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Kari Rosenkranz
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Steven Poplack
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Tor D Tosteson
- Department of Biomedical Data Science, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Lefeuvre D, Catajar N, Le Bihan Benjamin C, Ifrah N, De Bels F, Viguier J, Bousquet PJ. Breast cancer screening: Impact on care pathways. Cancer Med 2019; 8:4070-4078. [PMID: 31172693 PMCID: PMC6639186 DOI: 10.1002/cam4.2283] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 04/01/2019] [Accepted: 05/06/2019] [Indexed: 02/03/2023] Open
Abstract
Background Controversy persists concerning screening programs (SPs), related to a potential risk of overdiagnosis or the impact on survival. One of the main questions to be addressed concerns the aggressiveness of the related treatments. Methods Using the "Cancer Cohort,” a national‐based cohort (medico‐administrative database), all women between the ages of 50 and 74 years and treated in 2014 for incident breast cancer were compared, according to whether their diagnosis was made following a mammogram performed within the framework of the SP (SP group) or outside it (NSP group). Results A total of 23 788 women were identified: 13 530 (57%) in the SP group and 10 258 (43%) in the NSP group. The women in the SP group had a higher rate of in situ or localized invasive breast cancer. They had a higher rate of breast‐conserving surgery (82% vs 70%), and a lower rate of chemotherapy (34% vs 53%). These findings were observed irrespective of the stage. They had a higher rate of pathways involving breast‐conserving surgery followed by radiotherapy. Among women with metastatic cancer, those in the SP group had a lower proportion of liver, lung, brain, and bone metastases, and a higher proportion of lymph node metastases (other than axillary), irrespective of the time to onset of the metastases. Conclusion The women in whom cancer was diagnosed following a mammogram performed in the context of the SP had less advanced cancer and less aggressive treatments. This observational study helps illustrate the benefit of the SP in France using a different approach.
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Affiliation(s)
- Delphine Lefeuvre
- Health Data and Assessment Department, Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Nathalie Catajar
- Screening Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Christine Le Bihan Benjamin
- Health Data and Assessment Department, Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Norbert Ifrah
- Presidency, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Frédéric De Bels
- Screening Department, Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Jérôme Viguier
- Public Health and Healthcare Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France
| | - Philippe Jean Bousquet
- Survey, Data Science and Assessment Division, Institut National du Cancer (French National Cancer Institute), Boulogne-Billancourt, France.,Aix Marseille Univ, INSERM, IRD, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France
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Zhang C, Mao M, Guo X, Cui P, Zhang L, Xu Y, Li L, Han X, Peltzer K, Xiong S, Baklaushev VP, Wang X, Wang G. Nomogram based on homogeneous and heterogeneous associated factors for predicting bone metastases in patients with different histological types of lung cancer. BMC Cancer 2019; 19:238. [PMID: 30876473 PMCID: PMC6420732 DOI: 10.1186/s12885-019-5445-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 03/07/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The purpose of the present study was to characterize the prevalence, associated factors, and to construct a nomogram for predicting bone metastasis (BM) with different histological types of lung cancer. PATIENTS AND METHODS This study was a descriptive study that basing on the invasive lung cancer patients diagnosed between 2010 and 2014 in Surveillance, Epidemiology, and End Results program. A total of 125,652 adult patients were retrieved. Logistic regression analysis was conducted to investigate homogeneous and heterogeneous factors for BM occurrence. Nomogram was constructed to predict the risk for developing BM and the performance was evaluated by the receiver operating characteristics curve (ROC) and the calibration curve. The overall survival of the patients with BM was analyzed using the Kaplan-Meier method and the survival differences were tested by the log-rank test. RESULTS A total of 25,645 (20.9%) were reported to have BM, and the prevalence in adenocarcinoma, squamous cell carcinoma, small cell lung cancer (SCLC), large cell lung cancer (LCLC), and non-small cell lung cancer/not otherwise specified lung cancer (NSCLC/NOS) were 24.4, 12.5, 24.7, 19.5 and 19.4%, respectively, with significant difference (P < 0.001). Male gender, more metastatic sites and lymphatic metastasis were positively associated with BM in all lung cancer subtypes. Larger tumor size was positively associated with BM in all the lung cancer subtypes except for NSCLC/NOS. Poorly differentiated histology was positively associated with adenocarcinoma, squamous cell carcinoma and NSCLC/NOS. The calibration curve and ROC curve exhibited good performance for predicting BM. The median survival of the bone metastatic lung cancer patients was 4.00 (95%CI: 3.89-4.11) months. With the increased number of the other metastatic sites (brain, lung and liver metastasis), the survival significantly decreased (p < 0.001). CONCLUSION Different lung cancer histological subtypes exhibited distinct prevalence and homogeneity and heterogeneity associated factors for BM. The nomogram has good calibration and discrimination for predicting BM of lung cancer.
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Affiliation(s)
- Chao Zhang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tiyuan Bei Road, Hexi District, Tianjin, China
| | - Min Mao
- Department of Pathology and Southwest Cancer Center, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Xu Guo
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tiyuan Bei Road, Hexi District, Tianjin, China
- Department of Orthopedics, Cangzhou Central Hospital, Cangzhou, Hebei China
| | - Ping Cui
- Department of Epidemiology and Biostatistics, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Lianmin Zhang
- Department of Lung Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
| | - Yao Xu
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tiyuan Bei Road, Hexi District, Tianjin, China
| | - Lili Li
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tiyuan Bei Road, Hexi District, Tianjin, China
| | - Xiuxin Han
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tiyuan Bei Road, Hexi District, Tianjin, China
| | - Karl Peltzer
- Department of Research and Innovation, University of Limpopo, Turfloop, South Africa
| | - Shunbin Xiong
- Department of Genetics, M.D. Anderson Cancer Center, The University of Texas, Houston, TX USA
| | - Vladimir P. Baklaushev
- Federal Research and Clinical Center of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency of the Russian Federation, Moscow, Russian Federation
| | - Xin Wang
- Department of Epidemiology and Biostatistics, First Affiliated Hospital, Army Medical University, 30 Gaotanyan Street Shapingba District, Chongqing, China
| | - Guowen Wang
- Department of Bone and Soft Tissue Tumors, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tiyuan Bei Road, Hexi District, Tianjin, China
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Lancaster RB, Gulla S, De Los Santos J, Umphrey H. Breast Cancer Screening and Optimizing Recommendations. Semin Roentgenol 2018; 53:280-293. [DOI: 10.1053/j.ro.2018.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Karimi SE, Rafiey H, Sajjadi H, Nosrati Nejad F. Identifying the Social Determinants of Breast Health Behavior: a Qualitative Content Analysis. Asian Pac J Cancer Prev 2018; 19:1867-1877. [PMID: 30049199 PMCID: PMC6165651 DOI: 10.22034/apjcp.2018.19.7.1867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 06/08/2018] [Indexed: 11/27/2022] Open
Abstract
Background: Prevention, early diagnosis and reduction of mortality caused by breast cancer are the priorities of the world health systems. The aim of this study was to identify the social factors that affect the women’s breast health behavior based on the social determinants model of the World Health Organization (WHO). Materials and Method: This qualitative study was conducted and analyzed using content analysis approach. The data were collected from 32 participants by semi-structured interviews and focused group discussion. The participants comprised of breast surgeons, radiologists, health care providers and women over 35 years of age in Tehran who were selected through purposeful sampling. The interviews continued until data saturation was reached. Results: Based on the experiences of the participants, three themes were obtained from the data that shaped the women’s breast health behavior, including 1) the context of health policy, 2) socioeconomic status, and 3) cultural, psychological, and behavioral factors. Conclusion: A better understanding of social determinants related to breast health behavior can be effective in designing and applying of appropriate theories and models of education and intervention, so that, by early diagnosis of breast cancer and timely treatment of patients, the disease complications and mortality would be reduced.
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Affiliation(s)
- Salah Eddin Karimi
- Social welfare management department, University of social Welfare and Rehabilitation Sciences, Tehran, Iran.
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Elder K, Nickson C, Pattanasri M, Cooke S, Machalek D, Rose A, Mou A, Collins JP, Park A, De Boer R, Phillips C, Pridmore V, Farrugia H, Bruce Mann G. Treatment Intensity Differences After Early-Stage Breast Cancer (ESBC) Diagnosis Depending on Participation in a Screening Program. Ann Surg Oncol 2018; 25:2563-2572. [PMID: 29717421 DOI: 10.1245/s10434-018-6469-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Indexed: 12/28/2022]
Abstract
BACKGROUND While population mammographic screening identifies early-stage breast cancers (ESBCs; ductal carcinoma in situ [DCIS] and invasive disease stages 1-3A), commentaries suggest that harms from overdiagnosis and overtreatment may outweigh the benefits. Apparent benefits to patients with screen-detected cancers may be due to selection bias from exclusion of interval cancers (ICs). Treatment intensity is rarely discussed, with an assumption that all ESBCs are treated similarly. We hypothesized that women diagnosed while in a screening program would receive less-intense treatment than those never or not recently screened (NRS). METHODS This was a retrospective analysis of all women aged 50-69 years managed for ESBC (invasive or DCIS) during the period 2007-2013 within a single service, comparing treatment according to screening status. Data on demographics, detection, pathology, and treatment were derived from hospital, cancer registry, and screening service records. RESULTS Overall, 622 patients were active screeners (AS) at diagnosis (569 screen-detected and 53 ICs) and 169 patients were NRS. AS cancers were smaller (17 mm vs. 26 mm, p < 0.0001), less likely to involve nodes (26% vs. 48%, p < 0.0001), and lower grade. For invasive cancer, NRS patients were more likely to be recommended for mastectomies [35% vs. 16%; risk ratio(RR) 2.2, p < 0.0001], axillary dissection (43% vs. 19%; RR 2.3, p < 0.0001), adjuvant chemotherapy (65% vs. 37%; RR 1.7, p < 0.0001), and postmastectomy radiotherapy (58% vs. 39%; RR 1.5, p = 0.04). CONCLUSION Participants in population screening diagnosed with ESBC receive substantially less-intense treatment than non-participants. Differences persist when potential overdiagnosis is taken into account; these differences should be factored into debates around mammographic screening.
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Affiliation(s)
- Kenneth Elder
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Carolyn Nickson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia.,Cancer Council New South Wales, Woolloomooloo, NSW, Australia
| | - Melinda Pattanasri
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Samuel Cooke
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Dorothy Machalek
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Allison Rose
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Arlene Mou
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - John Paxton Collins
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia.,Department of Surgery, The University of Melbourne, Parkville, VIC, Australia
| | - Allan Park
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Richard De Boer
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | - Claire Phillips
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia
| | | | | | - G Bruce Mann
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Parkville, VIC, Australia. .,Department of Surgery, The University of Melbourne, Parkville, VIC, Australia.
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22
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Current Issues in the Overdiagnosis and Overtreatment of Breast Cancer. AJR Am J Roentgenol 2018; 210:285-291. [DOI: 10.2214/ajr.17.18629] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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23
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Marmarà D, Marmarà V, Hubbard G. Lifetime utilization of mammography among Maltese women: a cross-sectional survey. BMC Public Health 2018; 18:182. [PMID: 29370835 PMCID: PMC5785821 DOI: 10.1186/s12889-018-5093-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 01/17/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The knowledge of Maltese women not attending the Maltese Breast Screening Programme (MBSP) for mammography screening is scarce. Previous research has identified two distinct groups of non-attendees: those who do not attend because a mammogram was taken elsewhere and those who never attended for mammography anywhere. It is however unknown which determinants are predictive of lifetime attendance 'anywhere' and 'real' non-attendance. The present study examines the relationship between ever-using (Lifetime attendees) or never using mammography (Lifetime non-attendees) and psychosocial - as well as sociodemographic factors, with the aim to identify predictors that can inform practice. METHODS Women's characteristics, knowledge, health beliefs and illness perceptions were compared, based on prior data of 404 women, aged 50-60 years at the time of their first MBSP invitation. The main variable of interest described women's attendance to mammography (LIFETIME ATTENDEES) and no mammography (LIFETIME NON-ATTENDEES). Data were analyzed using descriptive statistics, chi-square tests, Mann Whitney test, Independent Samples t-test, Shapiro Wilk test and logistic regression. RESULTS During their lifetime, 86.1% of Maltese women (n = 348) were attendees, while 13.9% (n = 56) were non-attendees. Non-attendees were more likely to be women with a lower family income (χ2 = 13.1, p = 0.011), widowers (χ2 = 9.0, p = 0.030), non-drivers (χ2 = 7.7, p = 0.006), without a breast condition (χ2 = 14.2, p < 0.001), who had no relatives or close friends with cancer (χ2 = 8.3, p = 0.016), and who were less encouraged by a physician (χ2 = 4.9, p = 0.027), unsure of the screening frequency (χ2 = 28.5, p < 0.001), more anxious (p = 0.040) and fearful (p = 0.039). Perceived benefits, barriers, cues to action, self-efficacy and emotional representations were the most significant variables to describe the differences between lifetime attendees and non-attendees. Perceived barriers and cues to action were the strongest predictors for lifetime non-attendance (p < 0.05 respectively). CONCLUSIONS The health beliefs of women who have never attended for mammography during their lifetime should be targeted, particularly perceived barriers and cues to action. Further research should focus on understanding knowledge gaps, attitudinal barriers and emotional factors among 'real' non-attendees who require a more targeted approach.
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Affiliation(s)
- Danika Marmarà
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland.
- Ministry for Health, Cancer Care Pathways Directorate, Sir Anthony Mamo Oncology Centre, Level -1, Dun Karm Psaila Street, Msida, MSD 2090, Malta.
| | | | - Gill Hubbard
- Faculty of Health Sciences, University of Stirling, Room E9, Pathfoot, Stirling, FK9 4LA, Scotland
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Niell BL, Freer PE, Weinfurtner RJ, Arleo EK, Drukteinis JS. Screening for Breast Cancer. Radiol Clin North Am 2017; 55:1145-1162. [DOI: 10.1016/j.rcl.2017.06.004] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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25
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Barth RJ, Krishnaswamy V, Paulsen KD, Rooney TB, Wells WA, Rizzo E, Angeles CV, Marotti JD, Zuurbier RA, Black CC. A Patient-Specific 3D-Printed Form Accurately Transfers Supine MRI-Derived Tumor Localization Information to Guide Breast-Conserving Surgery. Ann Surg Oncol 2017; 24:2950-2956. [PMID: 28766199 PMCID: PMC6015768 DOI: 10.1245/s10434-017-5979-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Wire-localized excision of nonpalpable breast cancer is imprecise, resulting in positive margins 25-30% of the time. METHODS Patients underwent preoperative supine magnetic resonance imaging (MRI). A radiologist outlined the tumor edges on consecutive images, creating a three-dimensional (3D) view of its location. Using 3D printing, a bra-like plastic form (the Breast Cancer Locator [BCL]) was fabricated, with features that allowed a surgeon to (1) mark the edges of the tumor on the breast surface; (2) inject blue dye into the breast 1 cm from the tumor edges; and (3) place a wire in the tumor at the time of surgery. RESULTS Nineteen patients with palpable cancers underwent partial mastectomy after placement of surgical cues using patient-specific BCLs. The cues were in place in <5 min and no adverse events occurred. The BCL accurately localized 18/19 cancers. In the 18 accurately localized cases, all 68 blue-dye injections were outside of the tumor edges. Median distance from the blue-dye center to the pathologic tumor edge was 1.4 cm, while distance from the blue dye to the tumor edge was <5 mm in 4% of injections, 0.5-2.0 cm in 72% of injections, and >2 cm in 24% of injections. Median distance from the tumor center to the BCL-localized wire and to the clip placed at the time of diagnosis was similar (0.49 vs. 0.73 cm) on specimen mammograms. CONCLUSIONS Information on breast cancer location and shape derived from a supine MRI can be transferred safely and accurately to patients in the operating room using a 3D-printed form.
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MESH Headings
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Female
- Follow-Up Studies
- Humans
- Imaging, Three-Dimensional/methods
- Magnetic Resonance Imaging/methods
- Mastectomy, Segmental
- Middle Aged
- Neoplasm Invasiveness
- Neoplasm Staging
- Supine Position
- Surgery, Computer-Assisted/methods
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Affiliation(s)
- Richard J Barth
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
| | | | - Keith D Paulsen
- Thayer School of Engineering, Dartmouth College, Hanover, NH, USA
| | - Timothy B Rooney
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Wendy A Wells
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Elizabeth Rizzo
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Christina V Angeles
- Section of General Surgery, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Jonathan D Marotti
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Rebecca A Zuurbier
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
| | - Candice C Black
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
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Keen JD, Jørgensen KJ. Given Overdiagnosis, Recall Reduction Should Trump DCIS Detection. Radiology 2017; 284:608-610. [DOI: 10.1148/radiol.2017170702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- John D. Keen
- Department of Radiology, John H. Stroger Jr Hospital of Cook County, 1901 W Harrison St, Chicago, IL 60612
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Shah TA, Guraya SS. Breast cancer screening programs: Review of merits, demerits, and recent recommendations practiced across the world. J Microsc Ultrastruct 2017; 5:59-69. [PMID: 30023238 PMCID: PMC6025760 DOI: 10.1016/j.jmau.2016.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 10/12/2016] [Accepted: 10/26/2016] [Indexed: 12/29/2022] Open
Abstract
Breast cancer screening is defined as the evaluation of symptom free, otherwise healthy looking females of child bearing age or postmenopausal women for early detection of breast cancer. Screening mammography is the most common and widely practiced breast cancer screening modality across the world. The other modes of breast cancer screening being practiced across the world are: breast self-examination (BSE), clinical breast examination (CBE), digital breast tomosynthesis (DBT), ultrasonography (USG), magnetic resonance imaging (MRI), and identification of certain genetic oncogenes. The major merits of breast cancer screening programs are: early diagnosis, sorting out and prevention of risk factors, and timely treatment to lessen the morbidity (5 years localized stage survival rate is 99%, regional disease 84% while metastatic breast cancer 5 year survival rate is 23%); it also reduces overall 20% mortality rate. The major demerits of breast cancer screening are: overdiagnosis (19% from the perspective of a woman invited to screening), high cost, ionizing radiation (lifetime attributable risk to develop breast cancer is 3/10,000), false positive biopsy recommendation (about 8/1000), false negative results 11/10,000), and their consequences. Worldwide, most of the countries recommend biennial screening for breast cancer at 50-74 years of age. However, some countries recommend screening mammography earlier, starting at the age of 40 years until 70-74 years based on higher breast cancer incidence rate in those countries. This article provides a detailed review of merits, demerits, and recent recommendations for screening programs being practiced across the world.
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Affiliation(s)
- Tajammal Abbas Shah
- Faculty of Medicine, Taibah University, Al-Madina Al Munawara, Kingdom of Saudi Arabia
| | - Shaista Salman Guraya
- Faculty of Medicine, Taibah University, Al-Madina Al Munawara, Kingdom of Saudi Arabia
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Peppercorn J, Horick N, Houck K, Rabin J, Villagra V, Lyman GH, Wheeler SB. Impact of the elimination of cost sharing for mammographic breast cancer screening among rural US women: A natural experiment. Cancer 2017; 123:2506-2515. [PMID: 28195644 DOI: 10.1002/cncr.30629] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 01/13/2017] [Accepted: 01/21/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Rural US women experience disparities in breast cancer screening and outcomes. In 2006, a national rural health insurance provider, the National Rural Electric Cooperative Association (NRECA), eliminated out-of-pocket costs for screening mammography. METHODS This study evaluated the elimination of cost sharing as a natural experiment: it compared trends in screening before and after the policy change. NRECA insurance claims data were used to identify all women aged 40 to 64 years who were eligible for breast cancer screening, and mammography utilization from 1998 through 2011 was evaluated. Repeated measures regression models were used to evaluate changes in utilization over time and the association between screening and sociodemographic factors. RESULTS The analysis was based on 45,738 women enrolled in the NRECA membership database for an average of 6.1 years and included 279,940 person-years of enrollment. Between 1998 and 2011, the annual screening rate increased from 35% to a peak of 50% among women aged 40 to 49 years and from 49% to 58% among women aged 50 to 64 years. The biennial screening rate increased from 56% to 66% for women aged 40 to 49 years and from 68% to 73% for women aged 50 to 64 years. Screening rates increased significantly (P < .0001) after the elimination of cost sharing and then declined slightly after changes to government screening guidelines in 2009. Younger women experienced greater increases in both annual screening (6.2%) and biennial screening (5.6%) after the elimination of cost sharing in comparison with older women (3.0% and 2.6%, respectively). In a multivariate analysis, rural residence, lower population income, and lower population education were associated with modestly lower screening. CONCLUSIONS In a national sample of predominantly rural working-age women, the elimination of cost sharing correlated with increased breast cancer screening. Cancer 2017;123:2506-15. © 2017 American Cancer Society.
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Affiliation(s)
| | - Nora Horick
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Kevin Houck
- Duke University Medical Center, Durham, North Carolina
| | - Julia Rabin
- Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Victor Villagra
- University of Connecticut Health Center, Farmington, Connecticut
| | - Gary H Lyman
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie B Wheeler
- University of North Carolina School of Global Public Health, Chapel Hill, North Carolina
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Patterns and determinants of mammography screening in Lebanese women. Prev Med Rep 2016; 5:187-193. [PMID: 28070475 PMCID: PMC5219635 DOI: 10.1016/j.pmedr.2016.12.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/22/2016] [Accepted: 12/17/2016] [Indexed: 11/21/2022] Open
Abstract
The associations of ever using and/or repeating a mammography test with psychosocial and socio-demographic factors were surveyed in 2014 among Lebanese women ≥ 40. A sample of 2400 women was selected across Lebanon. Variables with significant bivariate associations with various types of behaviors were entered in multivariate analysis. Of the total, 105 women (4·4%) had never heard of mammography as a tool for early breast cancer detection. Among the remaining 2295, 45% had ever used it, of whom 10% had obtained it for the first time within the 12 months preceding the survey. Repeaters were 67% of 926 women who had the time opportunity to do so (median lifetime frequency: 2). Older age, higher socio-economic status (SES) and living within the Greater Beirut (GB) area were significantly associated with ever-use. Within GB, psychosocial factors such as perceived susceptibility and benefits were most strongly associated with ever-use. Outside GB, socio-economic advantage seemed to mostly affect ever-use. Only 4% reported opposition from husbands to their mammography, and husband's support was significant for adherence to mammography guidelines mostly outside GB. Higher education emerged also as a significant socio-demographic determinant for ever-repeating in all regions. Perceived comfort of the previous test strongly affected the likelihood of repeating it. Providing mammography free-of-charge may alleviate some obstacles among women with socio-economic disadvantage. Stressing that good results one year do not make the cancer less likely or repeating the test less important, as well as improving the comfort of mammography testing could ensure test repeating.
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Lee JY, Malak SF, Klimberg VS, Henry-Tillman R, Kadlubar S. Change in Mammography Use Following the Revised Guidelines from the U.S. Preventive Services Task Force. Breast J 2016; 23:164-168. [PMID: 27797121 DOI: 10.1111/tbj.12703] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The U.S. Preventive Services Task Force (USPSTF) recommended screening mammography every 1-2 years for women 40 years and older in 2002, and changed its recommendations in 2009 to no routine screening for women between 40 and 49 years of age; and biennial screening for women between 50 and 74 years of age. This study evaluates the change in mammographic use after the issuance of the revised recommendations. Women who participated in a cross-sectional study of breast cancer risk factors from 2007 to 2013 were asked if they had received a mammogram in the preceding 2 years. All 3442 study participants who enrolled in the study after January 1, 2011 were matched by race, age, and educational level with women enrolled between 2007 and 2010. The proportions of women who stated they had received a mammogram in the past 2 years were compared between the two groups. One fourth of the participants were African American and 39% were 40-49 years of age. Among white women, significant decreases in recent mammogram use from 2007-2010 to 2011-2013 were detected for women 40-49 years of age (-10.3%, p < 0.001) and 50-74 years of age (-8.8%, p < 0.001). Among African-American women, the change in recent mammogram use was not statistically significant for women 40-49 years of age (-2.7%, p = 0.440) or 50-74 years of age (-2.2%, p = 0.398). Following the change in the USPSTF guidelines, mammography use among white women declined; however, no change was observed among African-American women.
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Affiliation(s)
- Jeannette Y Lee
- Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Sharp F Malak
- Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Vicki Suzanne Klimberg
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Ronda Henry-Tillman
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Susan Kadlubar
- Division of Medical Genetics, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Mayo RC, Parikh JR. Breast Imaging: The Face of Imaging 3.0. J Am Coll Radiol 2016; 13:1003-7. [DOI: 10.1016/j.jacr.2016.03.010] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/09/2016] [Indexed: 01/17/2023]
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Armaroli P, Villain P, Suonio E, Almonte M, Anttila A, Atkin WS, Dean PB, de Koning HJ, Dillner L, Herrero R, Kuipers EJ, Lansdorp-Vogelaar I, Minozzi S, Paci E, Regula J, Törnberg S, Segnan N. European Code against Cancer, 4th Edition: Cancer screening. Cancer Epidemiol 2015; 39 Suppl 1:S139-52. [PMID: 26596722 DOI: 10.1016/j.canep.2015.10.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 12/23/2022]
Abstract
In order to update the previous version of the European Code against Cancer and formulate evidence-based recommendations, a systematic search of the literature was performed according to the methodology agreed by the Code Working Groups. Based on the review, the 4th edition of the European Code against Cancer recommends: "Take part in organized cancer screening programmes for: Bowel cancer (men and women); Breast cancer (women); Cervical cancer (women)." Organized screening programs are preferable because they provide better conditions to ensure that the Guidelines for Quality Assurance in Screening are followed in order to achieve the greatest benefit with the least harm. Screening is recommended only for those cancers where a demonstrated life-saving effect substantially outweighs the potential harm of examining very large numbers of people who may otherwise never have, or suffer from, these cancers, and when an adequate quality of the screening is achieved. EU citizens are recommended to participate in cancer screening each time an invitation from the national or regional screening program is received and after having read the information materials provided and carefully considered the potential benefits and harms of screening. Screening programs in the European Union vary with respect to the age groups invited and to the interval between invitations, depending on each country's cancer burden, local resources, and the type of screening test used For colorectal cancer, most programs in the EU invite men and women starting at the age of 50-60 years, and from then on every 2 years if the screening test is the guaiac-based fecal occult blood test or fecal immunochemical test, or every 10 years or more if the screening test is flexible sigmoidoscopy or total colonoscopy. Most programs continue sending invitations to screening up to the age of 70-75 years. For breast cancer, most programs in the EU invite women starting at the age of 50 years, and not before the age of 40 years, and from then on every 2 years until the age of 70-75 years. For cervical cancer, if cytology (Pap) testing is used for screening, most programs in the EU invite women starting at the age of 25-30 years and from then on every 3 or 5 years. If human papillomavirus testing is used for screening, most women are invited starting at the age of 35 years (usually not before age 30 years) and from then on every 5 years or more. Irrespective of the test used, women continue participating in screening until the age of 60 or 65 years, and continue beyond this age unless the most recent test results are normal.
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Affiliation(s)
- Paola Armaroli
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Patricia Villain
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Eero Suonio
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1NY, United Kingdom
| | - Peter B Dean
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Harry J de Koning
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Lena Dillner
- Department of Infectious Disease, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Eugenio Paci
- ISPO-Cancer Prevention and Research Institute, Occupational and Environmental Epidemiology Unit, Ponte Nuovo - Padiglione Mario Fiori, Via delle Oblate 2, 50141 Florence, Italy
| | - Jaroslaw Regula
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Gastroenterology, 02-781 Warsaw, Poland
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm Regional Cancer Centre, PO Box 6909, S-102 39 Stockholm, Sweden
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy.
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Allen B. Fighting Breast Cancer: Better Detection and Better Therapy Make for a Strong One-Two Punch in the Fight Against Breast Cancer. J Am Coll Radiol 2015; 12:1003-4. [PMID: 26435108 DOI: 10.1016/j.jacr.2015.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2015] [Accepted: 09/03/2015] [Indexed: 10/22/2022]
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Breast cancer screening utilization and understanding of current guidelines among rural U.S. women with private insurance. Breast Cancer Res Treat 2015; 153:659-67. [PMID: 26386956 DOI: 10.1007/s10549-015-3566-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 09/07/2015] [Indexed: 01/23/2023]
Abstract
Women living in rural areas of the U.S. face disparities in screening mammography and breast cancer outcomes. We sought to evaluate utilization of mammography, awareness of screening guidelines, and attitudes towards screening among rural insured U.S. women. We conducted a cross-sectional self-administered anonymous survey among 2000 women aged 40-64 insured by the National Rural Electric Cooperative Association, a non-profit insurer for electrical utility workers in predominantly rural areas across the U.S. Outcomes included mammographic screening in the past year, screening interval, awareness of guidelines, and perceived barriers to screening. 1588 women responded to the survey (response rate 79.4 %). 74 % of respondents lived in a rural area. Among women aged 40-49, 66.5 % reported mammographic screening in the past year. 46 % received annual screening, 32 % biennial screening, and 22 % rare/no screening. Among women aged 50-64, 77.1 % reported screening in the past year. 63 % received annual screening, 25 % biennial screening, and 12 % rare/no screening. The majority of women (98 %) believed that the mammography can find breast cancer early and save lives. Less than 1 % of younger women, and only 14 % of women over age 50 identified the recommendations of the U.S. Preventative Services Screening Task Force as the current expert recommendations for screening. Screening practices tended to follow perceived guideline recommendations. When rural U.S. women over age 40 have insurance, most receive breast cancer screening. The screening guidelines of cancer advocacy groups and specialty societies appear more influential and widely recognized than those of the U.S. preventative services taskforce.
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Abstract
Routine screening mammography is recommended by most groups issuing breast cancer screening guidelines, especially for women 50 years of age and older. However, both the potential benefits and risks of screening should be discussed with individual patients to allow for shared decision making regarding their participation in screening, age of commencement and conclusion, and interval of mammography screening.
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Affiliation(s)
- Mackenzie S Fuller
- Department of Medicine, University of Washington, 325 Ninth Avenue, Mailbox 359780, Seattle, WA 98104, USA
| | - Christoph I Lee
- Department of Health Services, University of Washington School of Public Health, Box 357660, Seattle, WA 98195, USA; Department of Radiology, University of Washington, 825 Eastlake Avenue East, G3-200, Seattle, WA 98109, USA
| | - Joann G Elmore
- Department of Medicine, University of Washington, 325 Ninth Avenue, Mailbox 359780, Seattle, WA 98104, USA.
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Lightner AL, Shurell E, Dawson N, Omidvar Y, Foster N. A Single-center Experience and Review of the Literature: 64 Cases of Phyllodes Tumors to Better Understand Risk Factors and Disease Management. Am Surg 2015. [DOI: 10.1177/000313481508100336] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phyllodes tumors of the breast are rare fibroepithelial tumors that are characterized as benign, borderline, or malignant based on cellular characteristics such as stromal overgrowth and number of mitoses. Currently, there is a lack of consensus on risk factors and management of patients with phyllodes tumors, which has led to variation in treatment patterns as well as patient outcomes across many institutions. This study seeks to understand the clinicopathologic features, risk factors for local and metastatic recurrence, and clinical outcomes of patients with phyllodes tumors to better define optimal treatment patterns.
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Affiliation(s)
- Amy L. Lightner
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Elizabeth Shurell
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Nicole Dawson
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Yasaman Omidvar
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
| | - Nova Foster
- Department of Surgery, University of California at Los Angeles, Los Angeles, California
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Abstract
OBJECTIVE The goals of this article are to provide an overview of controversial aspects of imaging-based screening and to elucidate potential risks that may offset anticipated benefits. CONCLUSION Current controversial topics associated with imaging-based screening include false-positive results, incidental findings, overdiagnosis, radiation risks, and costs. Alongside the benefits of screening, radiologists should be prepared to discuss these additional diagnostic consequences with providers and patients to better guide shared decision making regarding imaging-based screening.
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JOURNAL CLUB: Neglecting to Screen Women Between 40 and 49 Years Old With Mammography: What Is the Impact on Treatment Morbidity and Potential Risk Reduction? AJR Am J Roentgenol 2014; 202:282-8. [DOI: 10.2214/ajr.13.11382] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Bhanegaonkar A, Madhavan SS, Khanna R, Remick SC. Declining mammography screening in a state Medicaid Fee-for-Service program: 1999-2008. J Womens Health (Larchmt) 2012; 21:821-9. [PMID: 22568434 PMCID: PMC3411332 DOI: 10.1089/jwh.2011.2748] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE To evaluate and compare annual and biennial mammography screening rates across age, race, and geographic location (rural-urban) and to determine mammography screening persistence over 10 years among women enrolled in the West Virginia (WV) Medicaid Fee-for-Service (FFS) program. METHODS The WV Medicaid FFS administrative claims data for women recipients aged 40-64 from 1999 to 2008 were used for study purposes. Annual and biennial screening rates and persistence with screening were determined for women who were continuously enrolled in the WV Medicaid FFS program for respective calendar years. RESULTS A steady decline in the annual and biennial screening rates over a 10-year period (1999-2008) was observed among women recipients aged 40-64 years in the WV Medicaid FFS program, and screening persistence was also lower. Both annual and biennial screening rates and persistence varied by different demographic characteristics. CONCLUSIONS Although mammography screening services are covered under Medicaid programs, underuse persists as a major concern. The results of this study emphasize the need to identify and address barriers to mammography screening in low-income rural populations.
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Affiliation(s)
- Abhijeet Bhanegaonkar
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, West Virginia University, Morgantown, West Virginia 26506, USA.
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Rosenkranz K. Multiple Ipsilateral Breast Cancers: Current Strategies for Surgical Management. CURRENT BREAST CANCER REPORTS 2012. [DOI: 10.1007/s12609-012-0075-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Malmgren JA, Parikh J, Atwood MK, Kaplan HG. Impact of mammography detection on the course of breast cancer in women aged 40-49 years. Radiology 2012; 262:797-806. [PMID: 22357883 PMCID: PMC6940006 DOI: 10.1148/radiol.11111734] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To analyze trends in detection method related to breast cancer stage at diagnosis, treatments, and outcomes over time among 40-49-year-old women. MATERIALS AND METHODS i This study was institutional review board approved, with a waiver of informed consent, and HIPAA compliant. A longitudinal prospective cohort study was conducted of women aged 40-49 years who had primary breast cancer, during 1990-2008, and were identified and tracked by a dedicated registry database (n = 1977). Method of detection--patient detected (PtD), physician detected (PhysD), or mammography detected (MamD)--was chart abstracted. Disease-specific survival and relapse-free survival statistics were calculated by using the Kaplan-Meier method for stage I-IV breast cancer. RESULTS A significant increase in the percentage of MamD breast cancer over time (28%-58%) and a concurrent decline in patient and physician detected (Pt/PhysD) breast cancer (73%-42%) (Pearson x(2) = 72.72, P < .001) were observed over time from 1990 to 2008, with an overall increase in lower-stage disease detection and a decrease in higher-stage disease. MamD breast cancer patients were more likely to undergo lumpectomy (67% vs 48% of Pt/PhysD breast cancer patients) and less likely to undergo modified radical mastectomy (25% vs 47% of the Pt/PhysD breast cancer patients) (P < .001). Uncorrected for stage, 13% of MamD breast cancer patients underwent surgery and chemotherapy versus 22% of Pt/PhysD breast cancer patients (P < .001), and 31% of MamD breast cancer patients underwent surgery, radiation therapy, and chemotherapy versus 59% of Pt/PhysD breast cancer patients (x(2) = 305.13, P < .001). Analyzing invasive cancers only, 5-year relapse-free survival for MamD breast cancer patients was 92% versus 88% for Pt/PhysD patients (log-rank test, 12.47; P < .001). CONCLUSION Increased mammography-detected breast cancer over time coincided with lower-stage disease detection resulting in reduced treatment and lower rates of recurrence, adding factors to consider when evaluating the benefits of mammography screening of women aged 40-49 years.
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Smith ML, Hochhalter AK, Ahn S, Wernicke MM, Ory MG. Utilization of screening mammography among middle-aged and older women. J Womens Health (Larchmt) 2011; 20:1619-26. [PMID: 21780914 DOI: 10.1089/jwh.2010.2168] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This study examines patterns of screening mammogram use, investigating the relationship of screening with demographic, health status, and healthcare factors. METHODS Data from 1242 women aged ?41 were obtained from a random sample of mailed surveys to community households in an eight-county region in Central Texas in 2010. The dependent variable was the timing of the participants' most recent screening mammography (in the past 12 months, between 1 and 2 years, or >2 years). Predictor variables included demographic, health status, and healthcare access factors. Multinomial logistic regression identified variables associated with screening mammography practices. RESULTS The majority of women reported having at least one mammogram during their lifetime (93.0%) and having a mammography within the past 2 years (76.2%). Participants who reported not having a routine checkup in the past 12 months (odds ratio [OR] 0.12, p<0.001), having a lapse of insurance in the past 3 years (OR 2.95, p<0.05), and living in a health provider shortage area (OR 1.42, p<0.05) were less likely to be screened within the past 2 years. CONCLUSIONS Routine healthcare plays a major role in preventive screening, which indicates screening mammography practices can be enhanced by improving participation in routine checkups with medical providers, continuity of insurance coverage, and women's access to healthcare. Interventions to encourage screening mammography may be particularly needed for women who have experienced a lapse in insurance or have not had a checkup in the past year.
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Affiliation(s)
- Matthew Lee Smith
- College of Public Health, University of Georgia, 330 River Road, Athens, GA 30602-6522, USA.
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Bauman L, Barth RJ, Rosenkranz KM. Breast conservation in women with multifocal-multicentric breast cancer: is it feasible? Ann Surg Oncol 2010; 17 Suppl 3:325-9. [PMID: 20853054 DOI: 10.1245/s10434-010-1247-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Indexed: 12/18/2022]
Abstract
BACKGROUND The incidence of preoperatively identified multifocal and multicentric breast cancer is rising with improved sensitivity of imaging modalities. Based on retrospective, historic data, breast conservation in women with multiple tumors has been discouraged because of high rates of local regional recurrence (LRR). These studies, however, do not extrapolate to contemporary practice as they do not incorporate the use of modern therapies and surgical techniques. This study is designed to evaluate the feasibility of breast conservation in women with multiple breast primaries. MATERIALS AND METHODS We retrospectively reviewed the charts of 22 women who underwent breast conservation surgery for 2 or more synchronous, ipsilateral cancers between 1998 and 2008. We extracted data including tumor size, nodal staging, receptor status, adjuvant therapies administered, and local-regional recurrence. RESULTS A total of 22 patients were identified. Average follow up is 3.5 years. One patient (4.5%) experienced an in-breast recurrence. Both initial tumors in this patient were invasive ductal carcinoma, ER/PR, negative and HER2 positive. Time to LRR was 2.5 years. CONCLUSIONS Our data are consistent with those of recent studies in which multifocal/multicentric local regional recurrence in multicentric/multifocal breast is equivalent to that seen in women with unifocal cancer. The single local recurrence in this study occurred in a premenopausal women with ER/PR- disease who were HER2+. Prior retrospective studies have identified ER/PR- and HER2 overexpression as independent risk factors for recurrence following breast conservation. Additional prospective trials are warranted to better assess the oncologic safety of breast conservation in this population.
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Affiliation(s)
- Laura Bauman
- Department of Surgery, Dartmouth Medical School, Hanover, NH, USA
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Abstract
INTRODUCTION Breast cancer screening increased the ratio of small tumours. These tumours have a low lymph node metastatic potential. Sentinel node detection allows detecting axillary lymph node invasion without the morbidity of complete axillary lymph node dissection. OBJECTIVES In this study we report the results of the learning curve of sentinel node detection in the Institut Salah-Azaïz of Tunis. MATERIALS AND METHODS It is a prospective study between January 2004 and December 2005 in which 115 patients were included with breast cancer less than 3 cm without antecedents of breast surgery. All these women had sentinel node dissection by a colorimetric method and 30% had a combined method (colorimetric and isotopic). RESULTS The rate of detection was 97.3% (n = 112). An extemporaneous examination was performed in 91 patients. The rate of negative forgery of the extemporaneous examination was 4.3% and the sensitivity of 95.7%. There are no false positive with the extemporaneous exam. The sentinel lymph node was the only node invaded in 15 patients (44%). In 3 patients, the sentinel node was healthy whereas the axillary dissection was positive, so the false negative rate is about 2.6%. CONCLUSION Sentinel node dissection is a reliable and feasible technique. It however requires a training of the surgeon, the pathologist and the nuclear doctor. It allows to reduce the morbidity of the treatment of the breast cancer by avoiding "useless" axillary dissection out in patients without node invasion. The increase in the number of the small cancers discovered during screening makes it possible to increase the number of patients who can profit from this technique.
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Rapid noninvasive optical imaging of tissue composition in breast tumor margins. Am J Surg 2009; 198:566-74. [PMID: 19800470 DOI: 10.1016/j.amjsurg.2009.06.018] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 06/30/2009] [Accepted: 06/30/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND In women undergoing breast conserving surgery (BCS), up to 60% can require re-excision. Our objective is to develop an optically based technology which can differentiate benign from malignant breast tissues intraoperatively through differences in tissue composition factors. METHODS A prospective study of optical imaging of BCS margins is being performed. Optical images are transformed into tissue composition maps with parameters of total hemoglobin concentration, b-carotene concentration and scattering. The predicted outcome is then compared to the margin-level pathology. RESULTS Fifty-five margins from 48 patients have undergone assessment. Within 34 specimens with pathologically confirmed positive margins, the ratio map of b-carotene/scattering showed the most significant difference reflecting a decrease in adipose and an increase in cell density within malignant margins (p=.002). These differences were notable in both in-situ and invasive disease. CONCLUSIONS We present a novel optical spectral imaging device that provides a rapid, non-destructive assay of the tissue composition of breast tumor margins.
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Rodríguez-Cuevas S, Guisa-Hohenstein F, Labastida-Almendaro S. First breast cancer mammography screening program in Mexico: initial results 2005-2006. Breast J 2009; 15:623-31. [PMID: 19686232 DOI: 10.1111/j.1524-4741.2009.00811.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Breast cancer is the most frequent malignant neoplasia worldwide. In emergent countries as Mexico, an increase has been shown in frequency and mortality, unfortunately, most cases in advanced loco-regional stages developed in young women. The success of breast screening in mortality reduction has been observed since 1995 in Western Europe and the United States, where as many as 40% mortality reduction has been achieved. Most countries guidelines recommends an annual or biannual mammography for all women >40 years of age. In 2005, FUCAM, a nonlucrative civil foundation in Mexico join with Mexico City government, initiated the first voluntary mammography screening program for women >40 years of age residing in Mexico City's Federal District. Mammographies were carried out with analogical mammographs in specially designed mobile units and were performed in the area of women's domiciles. This report includes data from the first 96,828 mammographies performed between March 2005 and December 2006. There were 1% of mammographies in Breast Imaging Reporting and Data System 0, 4, or 5 and 208 out of 949 women with abnormal mammographies (27.7%) had breast cancer, a rate of 2.1 per thousand, most of them in situ or stage I (29.4%) or stage II (42.2%) nevertheless 21% of those women with abnormal mammography did not present for further clinical and radiologic evaluation despite being personally notified at their home addresses. The breast cancer rate of Mexican women submitted to screening mammography is lower than in European or North American women. Family history of breast cancer, nulliparity, absence of breast feeding, and increasing age are factors that increase the risk of breast cancer. Most cancers were diagnosed in women's age below 60 years (68.5%) with a mean age of 53.55 corroborating previous data published. It is mandatory to sensitize and educate our population with regard to accepting to visit the Specialized Breast Centers.
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The recent decline in mammography rates is limited to low- to average-risk women. Am J Surg 2009; 196:821-6; discussion 826. [PMID: 19095095 DOI: 10.1016/j.amjsurg.2008.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/08/2008] [Accepted: 07/08/2008] [Indexed: 11/23/2022]
Abstract
INTRODUCTION There has recently been a decline in mammography rates noted in the general population. We sought to determine whether similar trends hold in high-risk populations. METHODS Mammography rates from the National Health Interview Survey for 2000 and 2005 were analyzed for differences among risk-stratified populations of women over the age of 40. RESULTS Although high-risk women (those with a personal of family history of breast cancer) were more likely to report having had a mammogram than lower risk women, they, too, showed a small decline in mammography rates. This, however, did not reach statistical significance. The decline in mammography rates in lower risk women, however, was significant and correlated with that of the general population. CONCLUSIONS The decline in breast cancer-screening rates noted over the past 5 years has been predominantly in lower-risk women.
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Ayad E, Francis I, Peston D, Shousha S. Triple negative, basal cell type and EGFR positive invasive breast carcinoma in Kuwaiti and British patients. Breast J 2008; 15:109-11. [PMID: 19077133 DOI: 10.1111/j.1524-4741.2008.00682.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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