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Pisano ED, Gatsonis C, Sparano J, Troester MA, Yaffe M, Cole E, Schnall MD. RE: Advanced Breast Cancer Definitions by Staging System Examined in the Breast Cancer Surveillance Consortium. J Natl Cancer Inst 2021; 113:938-939. [PMID: 33783531 DOI: 10.1093/jnci/djab055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Etta D Pisano
- Beth Israel Lahey Health System, Harvard Medical School, Boston, MA, USA.,The American College of Radiology, Philadelphia, PA, USA
| | | | - Joseph Sparano
- Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Martin Yaffe
- Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.,The University of Toronto, Toronto, Ontario, Canada
| | - Elodia Cole
- The American College of Radiology, Philadelphia, PA, USA
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Rodrigues DCN, Freitas-Junior R, Rahal RMS, da Silveira Corrêa R, Gouveia PA, Peixoto JE, Martins E, Soares LR. Temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service between 2008 and 2017. BMC Public Health 2019; 19:959. [PMID: 31319826 PMCID: PMC6637648 DOI: 10.1186/s12889-019-7278-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 07/03/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In Brazil, 70% of the population depends on the public healthcare system. Since early detection is considered crucial, this study aimed to evaluate temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service (SUS) according to the different regions of the country between 2008 and 2017. METHODS This ecological study analyzed data on breast cancer screening within the SUS for women aged 50-69 years. Coverage was calculated from the ratio between the number of screening tests conducted and the expected number for the target population. Joinpoint regression analysis was used to calculate annual percent changes (APC) in coverage. RESULTS Around 19 million mammograms were performed in 50-69-year old women within the SUS between 2008 and 2016. The estimated APC indicates that breast cancer screening coverage increased by 14.5% annually in Brazil between 2008 and 2012 (p < 0.01), with figures stabilizing between 2012 and 2017 as shown by an APC of - 0.4% (p = 0.3). In the five geographic regions of the country, the APC initially increased, then stabilized in the north, northeast and southeast and decreased in the south and Midwest. Of the 26 states, coverage increased in seven and remained stable in six. In the other 13, there was an initial increase followed by stabilization in 11, and a reduction in coverage in two. In the Federal District, coverage remained stable throughout the study period. CONCLUSION Evaluation of the temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service revealed an initial increase, confirming that public policies were effective, although insufficient to ensure organized screening. There appears to be a lack of uniformity between the different regions and states and this situation is highlighted in the final 5-year period, with the APC reflecting stabilization of breast cancer screening coverage.
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Affiliation(s)
- Danielle Cristina Netto Rodrigues
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil.
| | - Ruffo Freitas-Junior
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Rosemar Macedo Sousa Rahal
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Rosangela da Silveira Corrêa
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Pollyana Alves Gouveia
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - João Emílio Peixoto
- Brazilian Breast Cancer Research Network, Division of Quality Control in Ionizing Radiation, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Edésio Martins
- Brazilian Breast Cancer Research Network, Faculdade Unida de Campinas, Goiânia, Goiás, Brazil
| | - Leonardo Ribeiro Soares
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
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Reduction in advanced breast cancer after introduction of a mammography screening program in Tyrol/Austria. Breast 2017; 33:178-182. [DOI: 10.1016/j.breast.2017.04.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/01/2017] [Accepted: 04/04/2017] [Indexed: 11/21/2022] Open
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Warren LM, Dance DR, Young KC. Radiation risk of breast screening in England with digital mammography. Br J Radiol 2016; 89:20150897. [PMID: 27585843 PMCID: PMC5124825 DOI: 10.1259/bjr.20150897] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 08/25/2016] [Accepted: 09/01/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To estimate the risks and benefits of breast screening in terms of number of deaths due to radiation-induced cancers and the number of lives saved owing to modern screening in the National Health Service Breast Screening Programme (NHSBSP) in England. METHODS Radiation risk model, patient dose data and data from national screening statistics were used to estimate the number of deaths due to radiation-induced breast cancers in the NHSBSP in England. Dose and dose effectiveness factors (DDREFs) equal to one and two were assumed. The breast cancer mortality reduction in the invited population due to screening and the percentage of females diagnosed with symptomatic breast cancer, who die from breast cancer, were collated from the literature. The number of lives saved owing to screening was calculated. RESULTS Assuming, a total of 1,770,436 females between the ages of 50-70 years were screened each year, and a breast cancer mortality reduction of 20% due to screening in the invited population, the number of screen-detected cancers were 14,872 annually, resulting in 1071 lives saved. Conversely, for the same mortality reduction, the number of radiation-induced cancers was 36 and 18 for DDREFs of 1 and 2, respectively. This resulted in seven and three deaths due to radiation-induced cancers annually for DDREFs of 1 and 2, respectively. The ratios of lives saved owing to screening to radiation-induced cancers were 30 : 1 and 60 : 1 for DDREFs of 1 and 2. The ratios of lives saved owing to screening to deaths due to radiation-induced cancers were 156 : 1 and 312 : 1 for DDREFs of 1 and 2. For the 1.8% of the screening population with very thick breasts, the latter ratios decrease to 94 : 1 and 187 : 1 for DDREFs of 1 and 2. CONCLUSION The breast cancer mortality reduction due to screening greatly outweighs the risk of death due to radiation-induced cancers. Advances in knowledge: Estimation of the radiation risk for modern breast screening in England using digital mammography.
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Affiliation(s)
- Lucy M Warren
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - David R Dance
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Physics, University of Surrey, Guildford, UK
| | - Kenneth C Young
- National Coordinating Centre for the Physics of Mammography, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Department of Physics, University of Surrey, Guildford, UK
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Jacklyn G, Glasziou P, Macaskill P, Barratt A. Meta-analysis of breast cancer mortality benefit and overdiagnosis adjusted for adherence: improving information on the effects of attending screening mammography. Br J Cancer 2016; 114:1269-76. [PMID: 27124337 PMCID: PMC4891513 DOI: 10.1038/bjc.2016.90] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/24/2016] [Accepted: 03/12/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Women require information about the impact of regularly attending screening mammography on breast cancer mortality and overdiagnosis to make informed decisions. To provide this information we aimed to meta-analyse randomised controlled trials adjusted for adherence to the trial protocol. METHODS Nine screening mammography trials used in the Independent UK Breast Screening Report were selected. Extending an existing approach to adjust intention-to-treat (ITT) estimates for less than 100% adherence rates, we conducted a random-effects meta-analysis. This produced a combined deattenuated prevented fraction and a combined deattenuated percentage risk of overdiagnosis. RESULTS In women aged 39-75 years invited to screen, the prevented fraction of breast cancer mortality at 13-year follow-up was 0.22 (95% CI 0.15-0.28) and it increased to 0.30 (95% CI 0.18-0.42) with deattenuation. In women aged 40-69 years invited to screen, the ITT percentage risk of overdiagnosis during the screening period was 19.0% (95% CI 15.2-22.7%), deattenuation increased this to 29.7% (95% CI 17.8-41.5%). CONCLUSIONS Adjustment for nonadherence increased the size of the mortality benefit and risk of overdiagnosis by up to 50%. These estimates are more appropriate when developing quantitative information to support individual decisions about attending screening mammography.
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Affiliation(s)
- Gemma Jacklyn
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Paul Glasziou
- Centre for Research in Evidence Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, QLD 4229, Australia
- Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Petra Macaskill
- Screening & Test Evaluation Program (STEP), Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006, Australia
| | - Alexandra Barratt
- Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), Sydney, NSW 2006, Australia
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Allgood PC, Maxwell AJ, Hudson S, Offman J, Hutchison G, Beattie C, Tuano-Donnelly R, Threlfall A, Summersgill T, Bellis L, Robinson C, Heaton S, Patnick J, Duffy SW. A randomised trial of the effect of postal reminders on attendance for breast screening. Br J Cancer 2016; 114:171-6. [PMID: 26784123 PMCID: PMC5154292 DOI: 10.1038/bjc.2015.451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Some women make an informed choice not to attend breast screening, whereas others may have forgotten about the appointment. We report on a randomised trial that investigates whether a reminder letter affects attendance. METHODS Women scheduled for a breast screening appointment were randomised to either receive a reminder letter a few days before their breast screening appointment in addition to the standard invitation letter (intervention) or not (control). The primary outcome was attendance within 30 days of the first offered appointment. Secondary outcomes were attendance within 90 and 180 days. RESULTS In all, 11,383 (49.9%) women were randomised to the intervention and 11,445 (50.1%) to the control. In the intervention arm, 7759 (68.2%) attended within 30 days of the first offered appointment compared with 7349 (64.2%) in the control arm. This difference was significant (P<0.001). The odds ratio (OR) (95% confidence interval) for the primary end point was 1.19 (1.13-1.26). This was not significantly affected by age, socioeconomic status or type of screen (prevalent or incident). Secondary endpoint analyses supported these results. Results did differ, however, between the different centres studied. CONCLUSIONS This study found that postal reminders increase breast screening uptake, and could be practicable to implement in the NHS Breast Screening Programme.
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Affiliation(s)
- Prue C Allgood
- Centre for Cancer Prevention, Wolfson Institute for Cancer Prevention, Charterhouse Square, London EC1M 6BQ, UK
| | - Anthony J Maxwell
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9QZ, UK
| | - Sue Hudson
- Peel and Shriek Consulting, 182 Highbury Hill, London, N5 1AU, UK
| | - Judith Offman
- Centre for Cancer Prevention, Wolfson Institute for Cancer Prevention, Charterhouse Square, London EC1M 6BQ, UK
| | - Gillian Hutchison
- Bolton Hospital NHS Foundation Trust, Minerva Road, Farnworth, Greater Manchester, BL4 0JR, UK
| | - Cathryn Beattie
- Royal Liverpool University Hospital, Prescot Street, Liverpool, Merseyside, L7 8XP, UK
| | - Raquel Tuano-Donnelly
- Wrightington, Wigan and Leigh NHS Foundation Trust, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK
| | | | - Tina Summersgill
- Wrightington, Wigan and Leigh NHS Foundation Trust, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK
| | - Lesley Bellis
- Royal Liverpool University Hospital, Prescot Street, Liverpool, Merseyside, L7 8XP, UK
| | - Collette Robinson
- Bolton Hospital NHS Foundation Trust, Minerva Road, Farnworth, Greater Manchester, BL4 0JR, UK
| | - Samantha Heaton
- Bolton Hospital NHS Foundation Trust, Minerva Road, Farnworth, Greater Manchester, BL4 0JR, UK
| | - Julietta Patnick
- Visiting Professor in Cancer Screening, University of Oxford, Cancer Epidemiology Unit, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute for Cancer Prevention, Charterhouse Square, London EC1M 6BQ, UK
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El Saghir NS, Farhat RA, Charara RN, Khoury KE. Enhancing cancer care in areas of limited resources: our next steps. Future Oncol 2015; 10:1953-65. [PMID: 25386812 DOI: 10.2217/fon.14.124] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
In-depth knowledge of local conditions is necessary in order to enhance care in low- and middle-income countries. In this review we discuss: improving cancer diagnosis, optimizing patient management, increasing health awareness, prevention, early detection, eradication of causative infectious diseases and agents, tobacco control, healthy diets and lifestyles, availability of diagnostic methods, easy access to care, affordable costs, improving infrastructures, quality care measures, implementing and adapting guidelines, multidisciplinary management, supportive and survivorship care, research and optimization of medical school curriculum and training in oncology. Establishment of national cancer control plans by policy makers, physician societies, medical schools, and patient advocates is recommended. We will review evidence and controversies, and outline the next steps needed to prevent cancer and enhance care of cancer patients in LMICs.
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Affiliation(s)
- Nagi S El Saghir
- Breast Center of Excellence, Naef K. Basile Cancer Institute, Division of Hematology Oncology, Department of Internal Medicine, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh 1107 2020, Beirut, Lebanon
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Conclusions for mammography screening after 25-year follow-up of the Canadian National Breast Cancer Screening Study (CNBSS). Eur Radiol 2015; 26:342-50. [PMID: 26017741 PMCID: PMC4712234 DOI: 10.1007/s00330-015-3849-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 04/08/2015] [Accepted: 05/13/2015] [Indexed: 12/29/2022]
Abstract
Twenty-five-year follow-up data of the Canadian National Breast Cancer Screening Study (CNBSS) indicated no mortality reduction. What conclusions should be drawn? After conducting a systematic literature search and narrative analysis, we wish to recapitulate important details of this study, which may have been neglected: Sixty-eight percent of all included cancers were palpable, a situation that does not allow testing the value of early detection. Randomisation was performed at the sites after palpation, while blinding was not guaranteed. In the first round, this “randomisation" assigned 19/24 late stage cancers to the mammography group and only five to the control group, supporting the suspicion of severe errors in the randomisation process. The responsible physicist rated mammography quality as “far below state of the art of that time". Radiological advisors resigned during the study due to unacceptable image quality, training, and medical quality assurance. Each described problem may strongly influence the results between study and control groups. Twenty-five years of follow-up cannot heal these fundamental problems. This study is inappropriate for evidence-based conclusions. The technology and quality assurance of the diagnostic chain is shown to be contrary to today's screening programmes, and the results of the CNBSS are not applicable to them. Key Points • The evidence base of the Canadian study (CNBSS) has to be questioned. • Severe flaws in the randomization process and test methods occurred. • Problems were criticized during and after conclusion of the trial by experts. • The results are not applicable to quality-assured screening programs. • The evidence base of this study must be re-analyzed.
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9
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Duffy SW, Smith RA. A note on the design of cancer screening trials. J Med Screen 2015; 22:65-8. [PMID: 25767104 DOI: 10.1177/0969141315577847] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 02/25/2015] [Indexed: 01/22/2023]
Abstract
OBJECTIVES To investigate the consequences of different cancer screening trial designs and follow-up options for accuracy of the estimate of the effect of screening on disease-specific mortality. METHODS We consider a randomized trial of breast cancer screening with a screening phase in which the intervention group is offered screening and the control group is not, and optional further follow-up after this screening phase. Postulating a lead time effect similar to that observed in breast cancer screening trials, we calculate the observed relative risk of disease-specific mortality and compare this with the true relative risk, for four design options: (1) no follow-up beyond the screening phase, ie. the screening phase and the observation period are identical; (2) follow-up continuing beyond the screening phase, all cancer-specific deaths counted, including those diagnosed after the screening phase; (3) follow-up continuing beyond the screening phase, but with only deaths from cancers diagnosed during the screening phase included; and (4) follow-up continuing beyond the screening phase, a single screen of the control group conducted at the end of the screening phase, and only deaths from cancers diagnosed during the screening phase in both arms up to completion of the single control screen included. RESULTS All designs in which follow-up for mortality continues beyond the screening phase incurred a bias against screening. The design in which the control group undergoes a single screen at the end of the screening phase was least biased in the example used. CONCLUSIONS The expedient of a single screen of the control group at the end of the screening phase has acceptable accuracy, but is still slightly conservatively biased.
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Affiliation(s)
- Stephen W Duffy
- Professor of Cancer Screening, Wolfson Institute of Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Robert A Smith
- Senior Director, Cancer Screening, American Cancer Society Inc, 250 Williams St, Atlanta GA 30303, USA
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O’Connor MK. Molecular breast imaging: an emerging modality for breast cancer screening. BREAST CANCER MANAGEMENT 2015; 4:33-40. [PMID: 25621015 PMCID: PMC4303579 DOI: 10.2217/bmt.14.49] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Screening mammography is recognized as an imperfect imaging tool that performs poorly in women with dense breast tissue - a limitation which has driven demand for supplemental screening techniques. One potential supplemental technique is molecular breast imaging (MBI). Significant improvements in gamma camera technology allow MBI to be performed at low radiation doses, comparable with those of tomosynthesis and mammography. A recent screening trial in women with dense breast tissue yielded a cancer detection rate of 3.2 per 1000 for mammography alone and 12.0 per 1000 for the combination of mammography and MBI. MBI also demonstrated a lower recall rate than that of mammography. MBI is a promising supplemental screening technique in women with dense breast tissue.
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Affiliation(s)
- Michael K O’Connor
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA; Tel.: +1 507 284 7083; Fax: +1 507 266 4461
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Affiliation(s)
- Martin J Yaffe
- Sunnybrook Research Institute and Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Department of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, Ontario, Canada; Smarter Imaging Program, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Assi V, Massat NJ, Thomas S, MacKay J, Warwick J, Kataoka M, Warsi I, Brentnall A, Warren R, Duffy SW. A case-control study to assess the impact of mammographic density on breast cancer risk in women aged 40-49 at intermediate familial risk. Int J Cancer 2014; 136:2378-87. [PMID: 25333209 DOI: 10.1002/ijc.29275] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/12/2014] [Indexed: 11/08/2022]
Abstract
Mammographic density is a strong risk factor for breast cancer, but its potential application in risk management is not clear, partly due to uncertainties about its interaction with other breast cancer risk factors. We aimed to quantify the impact of mammographic density on breast cancer risk in women aged 40-49 at intermediate familial risk of breast cancer (average lifetime risk of 23%), in particular in premenopausal women, and to investigate its relationship with other breast cancer risk factors in this population. We present the results from a case-control study nested with the FH01 cohort study of 6,710 women mostly aged 40-49 at intermediate familial risk of breast cancer. One hundred and three cases of breast cancer were age-matched to one or two controls. Density was measured by semiautomated interactive thresholding. Absolute density, but not percent density, was a significant risk factor for breast cancer in this population after adjusting for area of nondense tissue (OR per 10 cm(2) = 1.07, 95% CI 1.00-1.15, p = 0.04). The effect was stronger in premenopausal women, who made up the majority of the study population. Absolute density remained a significant predictor of breast cancer risk after adjusting for age at menarche, age at first live birth, parity, past or present hormone replacement therapy, and the Tyrer-Cuzick 10-year relative risk estimate of breast cancer. Absolute density can improve breast cancer risk stratification and delineation of high-risk groups alongside the Tyrer-Cuzick 10-year relative risk estimate.
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Affiliation(s)
- Valentina Assi
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
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Tabár L, Yen AMF, Wu WYY, Chen SLS, Chiu SYH, Fann JCY, Ku MMS, Smith RA, Duffy SW, Chen THH. Insights from the Breast Cancer Screening Trials: How Screening Affects the Natural History of Breast Cancer and Implications for Evaluating Service Screening Programs. Breast J 2014; 21:13-20. [DOI: 10.1111/tbj.12354] [Citation(s) in RCA: 104] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- László Tabár
- Department of Mammography; Central Hospital; Falun Sweden
| | | | - Wendy Yi-Ying Wu
- Graduate Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | | | - Sherry Yueh-Hsia Chiu
- Department and Graduate Institute of Health Care Management; Chang Gung University; Taoyuan Taiwan
| | - Jean Ching-Yuan Fann
- Department of Health Industry Management; College of Healthcare Management; Kainan University; Taoyuan Taiwan
| | - May Mei-Sheng Ku
- Graduate Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
| | | | - Stephen W Duffy
- Centre for Cancer Prevention; Wolfson Institute of Preventive Medicine; Queen Mary University of London; London UK
| | - Tony Hsiu-Hsi Chen
- Graduate Institute of Epidemiology and Preventive Medicine; College of Public Health; National Taiwan University; Taipei Taiwan
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14
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Costanza ME. Over- and under-estimating the value of screening mammography. BREAST CANCER MANAGEMENT 2014. [DOI: 10.2217/bmt.14.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Affiliation(s)
- Stephen W Duffy
- Wolfson Institute of Preventive MedicineBarts and the London School of Medicine and Dentistry, London
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Irvin VL, Kaplan RM. Screening mammography & breast cancer mortality: meta-analysis of quasi-experimental studies. PLoS One 2014; 9:e98105. [PMID: 24887150 PMCID: PMC4041743 DOI: 10.1371/journal.pone.0098105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Accepted: 04/28/2014] [Indexed: 02/02/2023] Open
Abstract
Background The magnitude of the benefit associated with screening has been debated. We present a meta-analysis of quasi-experimental studies on the effects of mammography screening. Methods We searched MEDLINE/PubMed and Embase for articles published through January 31, 2013. Studies were included if they reported: 1) a population-wide breast cancer screening program using mammography with 5+ years of data post-implementation; 2) a comparison group with equal access to therapies; and 3) breast cancer mortality. Studies excluded were: RCTs, case-control, or simulation studies. We defined quasi-experimental as studies that compared either geographical, historical or birth cohorts with a screening program to an equivalent cohort without a screening program. Meta-analyses were conducted in Stata using the metan command, random effects. Meta-analyses were conducted separately for ages screened: under 50, 50 to 69 and over 70 and weighted by population and person-years. Results Among 4,903 published papers that were retrieved, 19 studies matched eligibility criteria. Birth cohort studies reported a significant benefit for women screened <age 50, but not for women screened ages 50–69. Significant reductions in breast cancer mortality were observed in historical comparisons. For geographical comparisons, there was a significant 20% reduction in mortality for women <age 50 and a significant 21–22% reduction for women ages 50–69. Studies that tested the interaction of geographical and historical comparisons produced a pooled, significant 13–17% reduction in incident breast cancer mortality for women ages 50–69, but the effects in most individual studies were non-significant. All studies of women ages 70+ were non-significant. Conclusions Mammography screening may have modest effects on cancer mortality between the ages of 50 and 69 and non-significant effects for women older than age 70. Results are consistent with meta-analyses of RCTs. Effects on total mortality could not be assessed because of the limited number of studies.
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Affiliation(s)
- Veronica L. Irvin
- Department of Rehabilitation Medicine, Clinical Research Center, National Institutes of Health, Bethesda, Maryland, United States of America
- * E-mail:
| | - Robert M. Kaplan
- Department of Rehabilitation Medicine, Clinical Research Center, National Institutes of Health, Bethesda, Maryland, United States of America
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Hill C. Dépistage du cancer du sein. Presse Med 2014; 43:501-9. [DOI: 10.1016/j.lpm.2014.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Revised: 12/17/2013] [Accepted: 01/06/2014] [Indexed: 12/29/2022] Open
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The Impact of Mammography Screening on the Diagnosis and Management of Early-Phase Breast Cancer. Breast Cancer 2014. [DOI: 10.1007/978-1-4614-8063-1_2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Duffy SW, Chen THH, Smith RA, Yen AMF, Tabar L. Real and artificial controversies in breast cancer screening. BREAST CANCER MANAGEMENT 2013. [DOI: 10.2217/bmt.13.53] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY We review the apparent disparities between different reviews of the effects of mammographic screening on mortality from breast cancer and overdiagnosis. When results of each review are expressed with respect to a common population and a common baseline, all find a substantial mortality benefit and variation among estimates is minor. There are genuine disagreements about overdiagnosis, but methods that take account of lead time and underlying incidence trends yield estimates of overdiagnosis that are modest and are outweighed by the mortality benefit. There is potential for individualized screening regimens, particularly with respect to breast density.
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Affiliation(s)
- Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Tony Hsiu-Hsi Chen
- Graduate Institute of Epidemiology & Preventive Medicine, National Taiwan University, Taipei, Taiwan
| | - Robert A Smith
- Cancer Control Science Department, American Cancer Society, Atlanta, GA, USA
| | | | - Laszlo Tabar
- Department of Mammography, Falun Central Hospital, Sweden
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Marmot MG, Altman DG, Cameron DA, Dewar JA, Thompson SG, Wilcox M. The benefits and harms of breast cancer screening: an independent review. Br J Cancer 2013; 108:2205-40. [PMID: 23744281 PMCID: PMC3693450 DOI: 10.1038/bjc.2013.177] [Citation(s) in RCA: 622] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- M G Marmot
- UCL Department of Epidemiology and Public Health, UCL Institute of Health Equity, 1-19 Torrington Place, London WC1E 7HB,
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Reply. AJR Am J Roentgenol 2013; 200:W98-9. [DOI: 10.2214/ajr.12.9922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Whether breast cancer screening does more harm than good has been debated extensively. The main questions are how large the benefit of screening is in terms of reduced breast cancer mortality and how substantial the harm is in terms of overdiagnosis, which is defined as cancers detected at screening that would not have otherwise become clinically apparent in the woman's lifetime. An independent Panel was convened to reach conclusions about the benefits and harms of breast screening on the basis of a review of published work and oral and written evidence presented by experts in the subject. To provide estimates of the level of benefits and harms, the Panel relied mainly on findings from randomised trials of breast cancer screening that compared women invited to screening with controls not invited, but also reviewed evidence from observational studies. The Panel focused on the UK setting, where women aged 50-70 years are invited to screening every 3 years. In this Review, we provide a summary of the full report on the Panel's findings and conclusions. In a meta-analysis of 11 randomised trials, the relative risk of breast cancer mortality for women invited to screening compared with controls was 0·80 (95% CI 0·73-0·89), which is a relative risk reduction of 20%. The Panel considered the internal biases in the trials and whether these trials, which were done a long time ago, were still relevant; they concluded that 20% was still a reasonable estimate of the relative risk reduction. The more reliable and recent observational studies generally produced larger estimates of benefit, but these studies might be biased. The best estimates of overdiagnosis are from three trials in which women in the control group were not invited to be screened at the end of the active trial period. In a meta-analysis, estimates of the excess incidence were 11% (95% CI 9-12) when expressed as a proportion of cancers diagnosed in the invited group in the long term, and 19% (15-23) when expressed as a proportion of the cancers diagnosed during the active screening period. Results from observational studies support the occurrence of overdiagnosis, but estimates of its magnitude are unreliable. The Panel concludes that screening reduces breast cancer mortality but that some overdiagnosis occurs. Since the estimates provided are from studies with many limitations and whose relevance to present-day screening programmes can be questioned, they have substantial uncertainty and should be regarded only as an approximate guide. If these figures are used directly, for every 10,000 UK women aged 50 years invited to screening for the next 20 years, 43 deaths from breast cancer would be prevented and 129 cases of breast cancer, invasive and non-invasive, would be overdiagnosed; that is one breast cancer death prevented for about every three overdiagnosed cases identified and treated. Of the roughly 307,000 women aged 50-52 years who are invited to begin screening every year, just over 1% would have an overdiagnosed cancer in the next 20 years. Evidence from a focus group organised by Cancer Research UK and attended by some members of the Panel showed that many women feel that accepting the offer of breast screening is worthwhile, which agrees with the results of previous similar studies. Information should be made available in a transparent and objective way to women invited to screening so that they can make informed decisions.
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